"With Louisiana near the top of many of the country's 'worst of' health lists -- asthma, diabetes, heart disease, obesity -- it could be tempting to credit this distinction to our state's particularly unhealthy population. But the study, which was commissioned under the terms of the [ACA], found that differences in traditional, fee-for-service health care spending exist in spite of age, sex and health status. 'Geographic variation in spending and utilization is real, and not an artifact reflecting random noise,' the report says."