BEAM: Should Jindal Play Ball On The Medicaid Expansion?

Some Republican governors in this country have decided participating in Obamacare’s Medicaid program might not be such a bad idea after all. However, Gov. Bobby Jindal says it isn’t going to happen in Louisiana, and he made that clear once again last week.

“Medicaid relies on an outdated model that costs taxpayers billions of dollars and produces poor outcomes,” Jindal said. He was responding to a letter from 44 non-profit organizations pleading with him to reconsider joining the program that begins in 2014.

Bruce Greenstein, the governor’s secretary of the state Department of Health and Hospitals, was even more emphatic.

“I want to make it absolutely crystal clear: We are not expanding, this (letter) does not change our mind, this is not a good deal for the state,” Greenstein said.

Just what is Medicaid anyway?

The state and federal government teamed up to operate the Medicaid program that provides health care coverage for lower-income people, families and children, the elderly and people with disabilities. Each state operates the program differently.

The Affordable Care Act, better known as Obamacare, will expand the number of people who qualify for Medicaid. The 400,000 people in Louisiana who would benefit will be in what The Washington Post calls “a sort of no-man’s land.” They live below the poverty line ($11,170) and won’t qualify for federal subsidies to buy health insurance. They won’t be on Medicaid either if the state doesn’t participate in the program.

LaPolitics Weekly reported last week that 51 percent of 600 state voters who were polled want Louisiana to participate in expanded Medicaid, and 43 percent are opposed. The survey was commissioned by the Louisiana State Medical Society.

Hospitals have a big stake in the outcome because the federal government plans to reduce payments hospitals receive for giving health care to the poor. The payments are being reduced because the theory was those folks would be joining the Medicaid program.

“States that don’t expand coverage will sentence their hospitals to treating big pools of uninsured people even as payments for doing so fall…,” said National Journal, a political news magazine in Washington, D.C.

A state senator in South Carolina, which is opting out like Louisiana, said, “There’s no question we will see massive closings of hospitals.”

Republican governors in five states — Arizona, Nevada, New Mexico, North Dakota and Ohio — have changed their tunes and decided joining the expanding Medicaid program might be a good idea. However, legislatures in some of those states may have the final word.

Congress, under Obamacare, will pay all of the Medicaid expansion costs for the first three years and 90 percent after that. That is far more than the federal government contributes under the existing federal-state split.

Jindal said the program will cost Louisiana more than $1 billion over 10 years. He explained his concerns in an e-mailed statement.

“New federal guidelines might be a step in the right direction, but they are not yet final, do not go far enough and fail to address key issues,” he said. “Medicaid still operates under a 1960s model of medicine with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility.”

Jindal got some support last week from the conservative Heritage Foundation that talked about the five governors who are now thinking about joining the program. It said the country’s mounting federal debt may eventually force cutbacks in federal programs like Medicaid, and their states could be left “holding the bag.”

“… These governors may be looking at a short-term bump in new federal dollars, but the longer view shows that over time this new revenue disappears and the cost of expansion continues to rise…,” the foundation said.

Some argue that states not participating in Medicaid expansion will be leaving billions of federal dollars on the table. In the case of Arizona changing its mind, National Journal said the state will spend $3.1 billion on the expansion over the next 10 years and receive $17.3 billion in federal funds. Arizona Gov. Jan Brewer said that money will protect hospitals from excessive costs, create thousands of jobs and provide health care to large numbers of uninsured people.

The letter sent to Jindal by those non-profit groups repeated the same arguments, adding that Louisiana would receive $15.7 billion over the next decade. It didn’t move him one bit.

Anyone who knows Jindal realizes that once he makes up his mind on almost any issue, he doesn’t waver — unless he benefits politically in the process. The governor refused two years ago, for example, to support renewal of a 4-cents-per-pack tax on cigarettes. However, he now wants to add a $1-dollar-per-pack increase to the existing 36-cent tax in order to replace some of the revenues lost by eliminating the state’s income taxes, which is politically popular.

Although some refuse to accept the fact there are people in this state who are truly poor and unable to take care of all of their needs, they do exist. Medicaid has helped hundreds of thousands of them get the health care assistance they need for their very survival. Maybe opting out of this new Medicaid program is the right answer, but maybe it isn’t. That is why the Legislature needs to be a full partner in the final decision.

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 [email protected].



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