Medicaid, the federal-state health care program that serves the poor, elderly and disabled, is under attack on two fronts in Louisiana. The state has to cut $859 million from the program, which is 11 percent of its $7.7 billion Medicaid budget. And Gov. Bobby Jindal said he isn’t going to add a possible half-million more recipients in 2014 as required by the nation’s new health care law.

Why should citizens who don’t need Medicaid help be concerned? It’s because they will end up paying more for health care services when the poor and uninsured have to seek medical treatment in non-public hospitals and other private facilities.

Let’s talk about the Medicaid cuts first. They have to be made because of a flaw in the federal formula that gave Louisiana too much Medicaid money. Congress is taking that money back this year in order to get additional funding for its transportation bill. The highway measure also includes a provision that will give five states, including Louisiana, future BP Gulf oil spill fines for coastal restoration.

So the state lost on one hand and gained on the other. All the Jindal administration can do now is make the Medicaid cuts. The reductions will affect many medical professionals who provide health care to the poor. Some medical programs not required by the federal government could also be eliminated.

Louisiana has over 823,000 people in the poverty ranks, a rate of 18.3 percent — 49th in the country. Mississippi is in last place at 20.1 percent.

Organizations who speak for the poor are calling for a special legislative session to come up with funds to shore up Medicaid. They say this is a catastrophe that could eventually eliminate the program in Louisiana. Reductions announced Friday will fall primarily on LSU’s health care system that operates the charity hospital network. And Moss Regional Medical Center in Lake Charles is usually among the first to feel the pain.

A special session isn’t going to happen. Jindal considers taxes to be worse than the plague. He and his spokesmen always take the optimistic approach.

“At the end of the day, Louisiana will have a balanced budget that doesn’t raise taxes on families and businesses,” the governor told The Advocate.

Paul Rainwater, Jindal’s commissioner of administration, and Bruce Greenstein, secretary of the state Department of Health and Hospitals, said they are “working closely together on a plan that continues to reform and restructure the way the state delivers health care services.”

You don’t see any panic in those responses, but it’s not unusual. The Jindal administration is famous for “keeping a stiff upper lip.” It’s that “do your duty and show no emotion” reaction.

Then, there is the Medicaid provision in the Affordable Care Act that has come to be known as Obamacare. The U.S. Supreme Court upheld the law, but it said states could opt out of the provision that expands the Medicaid program for more Americans without being penalized. And that is exactly what Jindal plans to do.

“We’re certainly not going to start implementing Obamacare,” the governor said. “We’re going to work very hard to elect Gov. (Mitt) Romney and repeal the law well before the effective dates.”

One in every five citizens in this state doesn’t have health insurance. Those folks would benefit from an expansion of Medicaid and are naturally concerned. They want to know what Jindal has to offer them in return for rejecting the expansion of Medicaid.

The governor hasn’t said what his future plans are, and don’t look for him to even think about alternatives until after the Nov. 6 presidential election.

Two candidates in a Louisiana Supreme Court special election explained the U.S. Supreme Court’s decision on Obamacare in simple terms, according to a report in The Advocate.

“He (Chief Justice John Roberts) did what he thought was right,” said state appeal court Judge Duke Welch of Baker. “If I could explain it to you in a really simple way: Justice Roberts says just because you don’t eat broccoli, the federal government can’t make you eat broccoli. But if the federal government chooses to tax you for not eating broccoli, they can.”

Appeal court Judge Toni Higginbotham of Baton Rouge said the high court justices left the future of Obamacare up to the voters.

“We need to do whatever we need to do to have Congress repeal it,” Higginbotham said.

The final decision will come after the presidential election. If President Obama is re-elected, the health care law will probably stay on the books pretty much as is. If Republican candidate Mitt Romney wins and the GOP gets a majority in the House and Senate, repeal has a chance. However, it won’t be a cinch even then.

In order to improve their election chances, Republicans will have to come up with a health care plan of their own before Nov. 6 that embodies the desirable and workable features of Obamacare. Those who benefit from the new health care law will be looking for GOP solutions to their individual health care needs.

Meanwhile, it would be nice to hear what Jindal is going to do if his Republican party isn’t successful. However, don’t hold your breath while waiting for the governor to give us a Plan B.

Jim Beam, the retired editor of the Lake Charles American Press, has covered people and politics for more than five decades. Contact him at 494-4025 or jbeam@americanpress.com.