Sunday, 27 April 2014 00:00

Louisiana residents understand need for Medicaid expansion, why don't elected leaders?: Editorial

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The Jeremiah Group, a coalition of religious organizations in New Orleans, with city and community leaders spoke to the press before boarding the bus to deliver the letters to the Governor asking the state to accept federal money to expand Medicaid The Jeremiah Group, a coalition of religious organizations in New Orleans, with city and community leaders spoke to the press before boarding the bus to deliver the letters to the Governor asking the state to accept federal money to expand Medicaid

Gov. Bobby Jindal and the legislators backing his rejection of the Medicaid expansion provided under the Affordable Care Act are out of step with the people of Louisiana. Pollsters this month found that while 62 percent of Louisianians disapprove of President Barack Obama's handling of health care, that doesn't mean they want his health care act nullified.

Instead, 52 percent of people polled in Louisiana want their congressional representatives to work to improve the Affordable Care Act, according to The New York Times Upshot/Kaiser Family Foundation poll. And 52 percent believe our state should expand Medicaid with the federal money that is being offered by the Obama administration.

Yet the six Republican members of the Senate Health and Welfare Committee blocked Democratic Sen. Ben Nevers' bill last week to allow Louisiana residents to decide the fate of the Medicaid expansion.

Do they not trust voters? Or are they afraid of being labeled by ultraconservative political activists as supporters of President Obama's reforms? Or both?

Whatever their motivation, they are doing a disservice to the people of Louisiana. And not only to the more than 242,000 uninsured state residents estimated to benefit from the Medicaid expansion.

Every Louisiana resident will suffer the repercussions of Gov. Jindal's stubborn refusal to accept the $16 billion in new Medicaid money. Our federal tax dollars will go to fund something somewhere else, instead of being sent back to Louisiana. Hospitals and doctors will wind up treating the uninsured in emergency rooms and swallowing the cost. An estimated 15,600 new health care-related jobs that could strengthen Louisiana's economy won't materialize.

The Jindal administration's arguments against the Medicaid expansion are weak and getting weaker.

The federal government will pay 100 percent of the expansion costs for the first three years and phase in a 10 percent share for the state after that. Yet Department of Health and Hospitals Secretary Kathy Kliebert testified in the Health and Welfare meeting Wednesday that the Medicaid expansion would be too expensive for Louisiana.

Her argument doesn't add up.

She told committee members that the state would have to pay $1.7 billion over a decade for the expansion. But the nonpartisan Legislative Fiscal Office's 10-year estimate is $886 million. In the first three years, the expansion would reduce state spending, the fiscal office found.

"You're talking about a worst case scenario," Sen. David Heitmeier, the committee chairman, told Ms. Kliebert.

A new Congressional Budget Office report further undermines her argument. The Center on Budget and Policy Priorities said this week that the April CBO update shows the cost of the expansion for states will be less than originally estimated.

States will spend only 1.6 percent more on Medicaid and the Children's Health Insurance Program than they would have spent without health reform -- and roughly one-third less than the CBO predicted in February.

That doesn't include the savings from no longer having to pay for uncompensated care for the people newly covered by Medicaid.

Ms. Kliebert also argued, as Gov. Jindal has been, that the Medicaid expansion "prioritizes coverage with able-bodied adults to those with disabilities." Not so, according to an advocate for Louisianians with mental and physical disabilities.

Many uninsured residents who would be covered by the Medicaid expansion are "living with chronic illnesses and disabilities," Lois Simpson, executive director of the Advocacy Center in Louisiana, wrote in a March 30 opinion piece in The Shreveport Times. Moreover, she said, providing access to health care coverage to poor state residents could prevent disabilities.

The governor is "presenting a false choice," she wrote.

Ms. Kliebert owes her job to the governor and was echoing his views to the Senate committee. But she should be ashamed as health secretary to argue against health coverage for tens of thousands of uninsured Louisiana residents.

In contrast, former DHH secretary David Hood is fighting to try to get lawmakers to do the right thing and take the Medicaid money.

Mr. Hood, who ran DHH for Republican Gov. Mike Foster, supports Sen. Nevers' legislation to allow Louisianians to decide whether to accept the Medicaid money.

Sen. Nevers' Senate Bill 96, which stalled in the Health and Welfare Committee, would put a constitutional amendment on the Nov. 4 ballot asking voters that question. The amendment would direct the Department of Health and Hospitals to file everything necessary by Jan. 1, 2015, to take the federal funding to provide Medicaid to residents who are at or below 138 percent of the federal poverty rate.

The Kaiser Family Foundation estimates that would provide coverage for roughly 242,000 Louisianians who have no health insurance now and can't get coverage elsewhere.

Sen. Nevers said he isn't giving up and may offer a substitute bill. His dedication is admirable.

"This (bill) is not for me, nor for my family, but for those that are less fortunate ...," he told Health and Welfare committee members. If Gov. Jindal and the senators who voted against his bill cared as much as Sen. Nevers does, they would put people over politics and take the Medicaid money.

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