The poor and low-income residents of Louisiana who can’t afford to purchase health care insurance have to be wondering whether they will have a place to go when they need medical care. President Obama’s Affordable Care Act offers them a couple of alternatives, but Gov. Bobby Jindal has decided the state isn’t going to participate in those key provisions.

Obamacare is designed to expand Medicaid, the federal-state health care program for the poor. However, Jindal considers it will be too costly three years down the road when federal funding drops from 100 to 90 percent. The second major feature of the health care reform law sets up state exchanges where low-income residents can buy insurance with the help of government subsidies. The governor wants no part of that either.

OK, so if you can’t get on Medicaid, where do you go when you get sick? You do like the poor in Louisiana have been doing for generations — you go to a charity hospital. Or maybe you don’t. Jindal is in the process of redesigning the charity hospital system by turning those operations over to private hospitals, and their emergency rooms may be your only alternative.

Can those private hospitals take on the additional patient load? There is no definite answer to that question, but there are plenty of opinions on both sides of the issue.

Dr. Fred Cerise, former director of the LSU system that manages charity hospitals, said this week the Medicaid expansion that Jindal doesn’t like would help many uninsured Louisiana residents at a time when the state is cutting back on services at charity hospitals.

Louisiana has some serious health care challenges, Cerise said in a piece appearing on The Atlantic’s website. He said the state has the fourth highest number of uninsured in the country, is among states with the highest cost and lowest quality outcomes for patients with Medicare and is among states with the highest rates of tobacco use, obesity, poverty and infant mortality.

If there was ever a state that desperately needs some help with its health care programs, Louisiana certainly seems to fit the bill perfectly.

However, Jindal administration officials think they have the health care situation well in hand. And you can be sure they aren’t going to give Cerise any credibility. They relieved Cerise of his duties, claiming he refused to modernize the way the state’s public hospitals are operated. State officials also insist private hospitals will improve care at the former charity hospitals.

We can only hope they are correct, because lives hang in the balance.

Let’s talk for a minute about those insurance exchanges for low-income residents. Half of the 50 states have turned them down, so the federal government will operate exchanges in those states. Louisiana is unique because of its high poverty rate and the question is whether the feds can set up a health insurance exchange tailored to the state’s needs.

U.S. Sen. Mary Landrieu, D-La., asked Jindal to participate in those exchanges rather than let the federal government do the job. And she made a good point.

“As a strong states’ rights advocate, it seems you would surely want to retain this flexibility for Louisiana,” Landrieu said.

Others argue that consumers won’t notice much difference in the state-run vs. federally operated insurance exchanges. An Associated Press poll done in November found that 63 percent of Americans want states to run the exchanges, while 32 percent favor federal control.

James Varney, a conservative columnist for The Times-Picayune and NOLA.com, defends Jindal’s decision to let the feds run the insurance exchange in Louisiana. The governor is with the “overwhelming majority,” he said, and added, “It’s (the exchange) probably not practical; I can see why a lot of states decided to punt.”

Obama’s re-election ensures his health care reform act is here to stay. Whether it is a lifeline for the nation’s poor and low-income residents or is destined to fail remains to be seen. The best the reluctant states can do is try to make the best of what they think is a bad situation. Some think Obamacare is a good deal for Louisiana; others don’t.

Ron Pollack, executive director of Families USA, called Louisiana “one of the biggest winners of the Affordable Care Act.” He said the state has one of the highest percentages of low-income workers who would qualify for Medicaid under the act and those costs would be picked up by the federal government during the first three years of the program.

U.S. Rep. Bill Cassidy, R-Baton Rouge, and a practicing physician, said the money isn’t there, whatever the cost.

“Our state is cannibalizing every other part of the budget to pay for Medicaid,” Cassidy told The Times-Picayune. “This is before the additional $1.8 billion over 10 years required for the state portion of this expansion. How much higher does tuition have to go? How much lower does funding for K through 12 have to go? How many more prisons have to be shuttered, how many roads and bridges will not be built or updated in order to do this?”

Trying to determine which side is right on these critical health care issues is virtually impossible at this point. It’s simply too early to tell. Meanwhile, pity the poor and low-income citizens of Louisiana who are wondering whether they are going to be denied health care advantages soon to be enjoyed by their counterparts in other states.

Jim Beam, the retired editor of the Lake Charles American Press, has covered people and politics for more than five decades. Contact him at 337-494-4025 or jbeam@americanpress.com.