Despite adverse election results that signaled no fundamental change was coming to the flawed Patient Protection and Affordable Care Act (“Obamacare”), the Gov. Bobby Jindal Administration correctly continues to opt out of both expansion of Medicaid eligibility and the establishment of health care exchanges optional under the law.
Department of Health and Hospitals Secretary Bruce Greenstein informed the federal government of rejection of the latter, after Jindal immediately after the recent reelection of Pres. Barack Obama didn’t respond to calls from the political left to rethink his position on the former. Overall, state-run health exchanges don’t make medical economic sense, and, among other things such as they would force applying the employer mandate and beggar the private insurance market while driving up costs to individuals, they would cost states additional money to run them.
While those costs then would get paid by the federal government, this means in aggregate there are no savings nationally and some would be passed on to Louisiana taxpayers. But there is no money appropriated for the federal government to do that, and every state that opt outs increases those costs, making it easier for a Republican House of Representatives to ensure that Obamacare is partially or totally defunded, rendering it unable to operate at its 2014 target date except for its more popular and sensible mandates. Therefore, in pursuit of the goal of negating the harmful effects of Obamacare, the more states that opt out of exchanges, the better.
Nor should Jindal reconsider on the expansion issue – the fiscal reasons continue to show expansion spends too much for too little. But in addition to the numbers, the whole philosophy of Medicaid itself contributes to avoidable inefficiency, as Rep. Bill Cassidy pointed out in an opinion column. There’s no reason to expand a program designed as a social welfare safety net to become, as several such programs have already under Obama, one that serves more non-poor than poor.
The wisdom of the Jindal Administration on this matter, and continued stalwart application of that with the assistance of other states and Cassidy and other Republican representatives, will save the state money, not reduce the quality of health care provision to the indigent, help keep down costs for those pay and/or whose employers pay for their health insurance, and will increase the chances of genuine Medicaid reform, which Louisiana already is trying to pursue with its reduction of reliance on a money-goes-to-the-institution charity hospital model and transforming to a money-follows-the-person with its premium-support plan Bayou Health. Louisiana needs to stay the course for the best policy outcome.