Medicaid, the federal-state health care program for the poor, has become the second major topic to confront legislators during their current session. It’s a complex issue. Gov. Bobby Jindal’s desire to repeal the state income tax consumed the first couple of weeks, but the issue died for lack of support and money to replace lost revenues. Now, the governor is a major player again.
The Affordable Care Act, often referred to as Obamacare, set up a mechanism for adding millions of uninsured Americans to the Medicaid rolls. The federal government will pick up all of the costs for the first three years and 90 percent a year after that.
Democratic governors have been quick to sign on to the expansion of Medicaid, but Republican chief executives have been slower to respond. Some eventually gave in; others seek compromises and a few have flat-out said they aren’t going to join.
Jindal is a member of that last category, and he isn’t budging an inch. The governor picked up some strong allies this week when the House Republican Delegation said it’s in his camp.
The delegation represents 58 GOP members, five more than the 53 House majority. Not all of those may vote with the governor, but it definitely strengthens his hand when he needs a boost. Jindal did get all of the Republican votes when the House Health and Welfare Committee voted 10-8 Wednesday to reject Medicaid expansion.
Democrats in the Legislature are going all out to try and force the state to expand its program. They lost their first skirmish Wednesday, but they have other legislation in the pipeline.
The Democrats did get a shot in the arm this week when the Legislative Fiscal Office released an analysis saying the expansion would result in up to $500 million in savings over the first 10 years.
Jindal quickly shot down the report, calling it “too conservative.” He has said since the beginning the expansion would cost the state $1.7 billion over those same 10 years, and he is sticking to his guns.
The big problem in this Medicaid expansion effort is the uncertainty of Obamacare. It doesn’t take effect until 2014, and even supporters aren’t sure what effect it is going to have down the line.
Rep. Julie Stokes, R-Jefferson Parish, said Louisiana should see how the expanded program works in other states before participating.
“Once we offer benefits, they are irretractable,” she said. “I’m leary of jumping in the first year.”
Louisiana’s numbers add to the confusion. One report said 290,000 uninsured adults between 19 and 64 would be eligible to participate in the expansion. Earlier reports put that number at 400,000. Another one counted over 650,000.
The House Republican Delegation said the expansion would move 171,000 state residents out of private insurance plans and into Medicaid, and 77,000 more wouldn’t go into private health care plans.
Jindal put it another way: “By expanding President Obama’s health care law, 41 percent of Louisiana’s population would be dumped into Medicaid,” he said in an op-ed piece. “Soon there will be more people riding in the cart than people pulling the cart.”
The question is, does anyone really know the correct number? We may never find out until Obamacare is up and running two or three years down the road.
Kathy Kliebert, interim secretary of the state Department of Health and Hospitals, talked about numbers at the committee hearing.
“We have good estimates on our programs, but not on this one,” she said.
Rep. Kenny Havard, R-Jackson, talked about the current confusion at Wednesday’s committee hearing.
“No one in this room or in this country can tell me what’s in ACA,” Havard said.
Rep. Taylor Barras, R-New Iberia, and policy chairman for the House GOP delegation, said even prominent Democrats are worried about the effects of Obamacare.
Barras said U.S. Sen. Max Baucus, D-Mont., a lead author of the Affordable Care Act, and others are expressing their fear the program will be a train wreck for the nation.
U.S. Sen. Mary Landrieu, D-La., has a different view. She has written Louisiana legislative committees urging them to support Medicaid expansion.
A leader at a pro-expansion rally Tuesday called on the governor to negotiate a good deal for the state. He said Arizona is taking the Medicaid money, but would drop out if the federal subsidy ever dropped below the 90 percent mark.
The odds are Jindal is going to prevail and keep the state from expanding its Medicaid program. If the next governor who takes office in 2016 decides otherwise, Louisiana will have lost the “free ride” of the first two years of Obamacare.
Expansion could be just as risky. What if it ends up as Jindal predicted or worse? This state already has more money problems than it can handle.
Size this Medicaid situation up any way you want, but it’s still a risky and uncertain venture because there are few clear answers. It’s a gamble either way the state goes.