In less than thirty days, Louisiana Governor Bobby Jindal will make a final decision on whether he wants to accept, according to a report published by his own Department of Health and Hospitals, as much as $25 billion from the federal government in order to guarantee and expand health care coverage for as many as 653,000 poor and working class Louisiana families and individuals. By all indications, it appears that Jindal will continue to dig in his heels, arguing that accepting the money would stick Louisiana taxpayers with a worst-case-scenario bill for $1.7 billion over the next ten years. If he does, in fact, decide to pass on receiving billions and billions of dollars in aid to which Louisiana is already entitled, Bobby Jindal will solidify, permanently, his legacy as the worst Governor in the history of the Great State of Louisiana. And he will prove, once and for all, that he never cared about Louisiana, that he always considered his office on the fourth floor of the Capitol Building and his mansion across the street as nothing more than temporary rental property.

To be sure, there may be some folks who still support Jindal and believe his opposition to Medicaid expansion is a prudent and fiscally responsible action. But these people are wrong. It has nothing to do with the budget or with state finances; it’s about politics, plain and simple. It’s about Bobby Jindal’s desire to earn media attention by pretending like he’s an intellectual political leader opposed to anything and everything that bears the imprimatur of President Barack Obama, regardless of how it impacts the people he was elected to serve.

Five years ago, when George W. Bush was still President, Bobby Jindal asked the federal government to expand Louisiana Medicaid. He wanted the federal government to provide enough money to ensure that everyone in “District 5” would be able to access Medicaid financing. He pitched it as a “pilot program,” and he hoped it would go statewide. But there was a catch: Bobby Jindal wasn’t asking the federal government to improve Medicaid; he was asking the federal government to spend billions subsidizing his friends in the private insurance industry. In typical Jindal fashion, he wanted the government to underwrite private industry, which is the definition of crony socialism. At the same time, though, he promoted his idea as fostering free-market “choice” and denounced any plans to strengthen public services and institutions as “government-run” or “government giveaways.”

The fiscally, socially, ethically, and morally responsible thing to do would be to accept the Medicaid expansion dollars to which we are already entitled. The fiscally, socially, ethically, and morally responsible thing to do would be to champion and embrace the promise of lifting hundreds of thousands of our neighbors and fellow citizens out of despair and hopelessness, to provide them with the very basic opportunity to access affordable and quality health care. It is profoundly decent, but even more than that, it is also represents the single most important and transformative investment in Louisiana’s workforce in modern history.

According to the Kaiser Foundation, even if Louisiana declines Medicaid expansion funding, we will still spend at least $500 million over the next ten years, simply to preserve the status quo. Jindal’s own DHH suggests that Medicaid expansion, at worst, could cost Louisiana $1.7 billion over 10 years, an expenditure that is easily recompensed as a result of the (at minimum) economic impact of the $16 billion simultaneously invested by the federal government. Again, remember, Jindal’s DHH also suggested that, at most, Louisiana stands to gain $25 billion from Medicaid expansion. This means jobs, tens of thousands of them; it means a more sustainable and modern charity and university hospital system; but, above all, it means a healthier and more productive workforce.

Louisianians need to know what, exactly, Bobby Jindal is talking about whenever he says Medicaid expansion could cost the state $1.7 billion over the next ten years. First, he’s cherry-picking from an analysis done by Mercer Consulting on behalf of his administration, and not surprisingly, he’s being incredibly disingenuous about what the report actually said.

More than likely, Medicaid expansion will actually save the State of Louisiana hundreds of millions of dollars; the Mercer report makes that abundantly clear.

Governor Jindal has built his entire argument against Medicaid expansion on this assumption: The Affordable Care Act gradually reduces the federal government’s “Disproportionate Share” payments, which is, essentially, the money the government provides to cover uncompensated care. The idea, of course, is that the more people who are insured, the less the government needs to pay for uncompensated care. However, if people don’t sign up for insurance in Louisiana, the state may be on the hook, at least for 10%. In other words, Jindal is suggesting that Medicaid expansion will cost the state $1.7 billion over ten years because he’s banking on people remaining uninsured, which would drive up Louisiana’s exposure. Either way, though, it’s all ridiculous, because Medicaid expansion is funded fully by the federal government for the first three years and then gradually drops to a 90/10 split by Year Ten. It’s a sweetheart deal, a win/win.

During the last few weeks, Republican leaders, including Governor Jindal, have seemed apoplectic about a website, suggesting that it is somehow a harbinger of a greater systemic failure. To me, their outrage seems particularly myopic and petty, because in a few months from now, when millions of Americans are able to access their state’s Medicaid program, failure won’t be defined by a website; it will be measured by the number of decent Americans who died without health insurance in states like Louisiana, places where, had it not been for a single man with a brazen political agenda, they may have had a chance.

37 thoughts

  1. Jindal may be right. Throwing money at problems doesn’t mean you solve problems. US is ranked anywhere from 7th to 19th in healthcare in the world (we were number 1 when I finished) The U.S. spends more than twice as much per person per year on healthcare than the top rated countries (~7850 per person vs less than 3000 per person per year by scandinavian countries) Our % GNP spent on healthcare is around 18% . We should focus on proper utilization of resoures, decrease waste in healthcare, decrease abuse of our tort system, engage people in being resonsible for their healthcare and encourge better healthcare decisions and reward them for those good healthcare choices. Taking money and wasting it by throwing it at the problem when we don’t need it is part of the problem and will increase our taxes (where does this money come from). And remember the ones that want the money are the ones who might benefit from it the most (and I am not talking about patients)

    1. We spend so much money on health care in the United States, largely, because of the subsidization of expensive, specialized care and the fact that so many Americans are uninsured.

      If we eliminated ALL of the “waste, fraud, and abuse,” we’d only reduce our spending by 2%. If we somehow banned ALL medical malpractice litigation (tort reform), we’d only reduce spending by 1%.

      Investing in insurance coverage, particularly through Medicaid, is a no-brainer. It’s easy enough to say that we should “engage people in being responsible for their health care and encourage better healthcare decisions and reward them for those good healthcare choices,” except for one, minor thing: You can only really do that if people are insured.

      Sorry, yes, it does require public spending.

      So does the military and the police department and the fire department. We spend taxes to build roads and infrastructure and to provide basic services like picking up the trash. We also spend tax money to incentivize corporate America; you can easily make the argument that a large percentage of American industry is dependent on the government.

      Somehow, though, when the discussion is about health care, we’re more than willing to blame the poor for being poor or fret about government dependency and how our taxes are being spent to help those less fortunate. We need to get our priorities straight.

      1. “Obama care is socialism pure and simple.”

        Except for the fact that it is a market-based solution making heavy use of Republican ideas first hatched in the 1990’s. There’s that.

  2. Did you know that Louisians Medicaid pays up to $5000 a year to pay for compliancy drug testing per person.
    i.e Pain clinics write large amount of pain meds on weekly or monthly basis which medicad pays for (and we know many, many of these patiens do not need these large volumes )and then spends hundreds of dollars each visit to give urine test to be sure that the patients are taking them and not selling them, yet we know this is still a large source of diversion of drugs to the streets. This adds up to as much $8000 PER PERSON PER YEAR.TO TAKE nARCOTIC THAT THEY DON’T NEED.
    THE US has 4% of the worlds population but uses 98% to 99% of all the hydrocodone and oxycondone produced in the World. Something wrong with this .

  3. Lamar–The topic here is we don’t need to spend more money on healthcare ,but we need to spend our healthcare dollar more wisely. I want to know what you mean by subsidization of expensive specialized care. Is this bypass surgery or treatment of cancer or brain tumors?. Why do we spend more money on uninsured ? I would think the whole basis of covering them by insurance is so we spend more on them, so how is giving them insurance going to reduce “spending so much money” on the uninsured? And why does a person have to have health insurance in order to make better healthcare desicions such as stop smoking , lose weight ,and exercising . Louisiana Medicaid can spend up to $8000 a year per person to take something many of them do not need as discussed in previous comment. I did not say I didn’t think we needed to spend on healthcare as we do teachers and policemen and where the heck did you come up with blaming the poor? I agree with you on this…… GET OUR PRIORITES STRAIGHT. 1)PROPER UTILIZATION OF RESOURSES and we can cover alot more people with proper healthcare.2) DECREASE WASTE IN HEALTHCARE and I do disagree somewhat on potential saving% with you 3) Tort Reform IS NOT BANNING MEDICAL MALPRACTICE but decreasing abuse of our tort system has potential for saving more than 1% if we reduce product liability cases and class action suits which are not paid based on merit but settled based on cost of defense of the suits and this would be a simple fix which is make the loser pay the the bill instead of the winner paying the bill but that is a whole other disscussion. I am passionate about this topicas I have dedicated my entire life to helping other people and helping them have more productive lives with no thought of how it might benefit me and at times at great personal expense to me . Good Lord willing I will have a few more years to do it . Thank you for this opportunnity to dicuss these issues. It is A BRAINER as we need much more thought and analysis to find real answers to our problems . Too often I hear rhetoical answers without true thought and rhetorical answers I find to be selfesh , self-serving , and non-productive. Throwing money at problems does noot necessarily solve problems. Effective, efficient ,Appropriate utilization of resourses is the best ( and hardest) place to start

    3 minutes ago · Like

    1. Dr. Riser-

      Thank you for your comments and your insight. Last year, health care spending across the world was approximately $6.2 trillion, and $2.7 trillion of that spending occurred in the good ol’ US of A. We have 4.5% of the world’s population, and we account for nearly 45% of the entire world’s total health care spending. I think many of us would like to think that the massive spending in American health care can be blamed on things like waste, fraud, and abuse (which is being done due to the ACA’s guidelines on medical loss spending) or medical malpractice litigation, but remember, we’re talking about $2.7 trillion a year. We could clamp down on waste, fraud, and abuse, and we could severely limit damages in tort cases for negligence and medical malpractice. I get that always seems like the most logical target for some, and don’t get me wrong: I’m not suggesting these reforms are completely unnecessary (though I am opposed to creating statutorily-defined caps on damages claims for malpractice). My point was this: Even if we reformed all of these things, it’d only reduce spending by 3%, at the most.

      The problem is much more systemic.

      So, sensibly, you asked what does cause these enormous costs? Specialized care for any number of health-related issues, conditions, and diseases has made the American health care system the envy of the world for certain treatments. Specialized care, of course, is astronomically more expensive than general or family care. In addition to specialized care, American medicine is heavily-reliant on the newest, greatest machinery, technology, and drugs. Many dentists, for example, compete for new patients by financing the newest and most expensive X-ray machines, for example, and paying down their note by requiring X-rays as much as possible.

      But the real reason the United States is so burdened by out-of-control health care spending is because nearly 50 million Americans cannot afford or cannot qualify for health care. If you’re on a private insurance plan, the chances are: You’re paying more than you otherwise would be because your care providers rely on higher premiums from privately-insured patients in order to offset the losses they encounter due to uncompensated care. The federal and state governments offer care providers funds through the Disproportionate Share Program in order to offset the differences between Medicaid or Medicare reimbursement and uncompensated care. Expanding the market means decreasing the risks- and therefore, the costs- for everyone else.

      Look, we actually have the money to fix this thing, and to get our priorities straight. Our reliance on specialized care is a result, in part, of our lack of emphasis on primary and preventative care. Too many Americans are only treated when it’s already “too late.” That’s another reason why investing in expansion makes sense: We become a system much more reliant on lower-cost preventative care and much less dependent on specialized and catastrophic care. I agree with you: We need to be thinking long-term, and we need to be thinking holistically.

      Governor Jindal is dead wrong on this issue. Yes, it’s a ton of money, but it is money that will save hundreds of thousands, if not millions of jobs and opportunities; it is decent and just, and the time is now.

    1. His math is that if he runs for president in 2016 or 2020, he’ll be competing for the Republican party nomination with Senators and Congressmen who can say “I voted against Obamacare, while this guy took the Obamacare money”.

      So in other words, his math is Jindal – Louisiana Citizens = President

  4. If you want to be a slave to the federal government, jump all over that. How about LA keep its money and invest it in its own people. Everyone should have a job, not stand around with their hands held out for a give-a-way.

    1. LA keeping its money isn’t an option here. We’ll be contributing to other states’ medicaid expansion through our federal tax dollars. The best thing that Jindal can do for LOUISIANA is to accept the money.

    2. That’s the problem with Louisiana…. You don’t have enough money to assist people without the governments help. That’s what Medicare/AHA are about.

    3. Jindal has given away Louisiana’s money in the form of tax cuts for the rich and corporations. He also pays his staff too much.

  5. All of this federal money that Louisiana is “entitled” to has to come from other citizens! So you’re taking money from another state that might need it to help their own people. How about we remember what Abraham Lincoln once said? “As each man has one mouth to be fed, and one pair of hands to furnish food, it was probably intended that that particular pair of hands should feed that particular mouth.”

    What we need to make sure everyone has what they need in order to survive is not more government intervention, but much less. The road to hell is paved with good intentions, and most of it is government meddling.

    1. Appealing obamacare isn’t something that Jindal can due. We elected him governor of LOUISIANA to do what’s best for LOUISIANA, not to do what’s best for his own presidential ambitions.

    2. Mark, how about this? Taxpayers in other states can keep their money for themselves, but only if they let Louisiana keep its oil. If the health and well-being of the people of Louisiana aren’t important to the rest of the nation, then our oil shouldn’t be important either, right? I mean, how is anyone else “entitled” to Louisiana’s natural resources?

  6. The dumbest decision in contemporary LA history was trusting the corrupt mayor and council of NOLA. They stole the money that was supposed to secure the levies, then, instead of filling the buses with people to get them the hell outa there, they let them fill with water and many people died.

    The next dumbest move was not stringing them all up.

    The next dumbest move was rebuilding a city that is actually sitting on land that is below sea level.

    Seriously, anything about healthcare couldn’t even be in the same hemisphere as that stampede of stupid.

    1. The next dumbest move was rebuilding a city that is actually sitting on land that is below sea level.

      Where do YOU want to build the fifth busiest SEAPORT in the country by volume? In the mountains??

    2. Dave,

      1) The original city of New Orleans (The French Quarter) was built on land above sea level.
      2) The choice of the City’s location was based on Bayou St. John, which served as a entry way to the Mississippi River from the Gulf of Mexico and vice versa, therefore making the location of New Orleans extremely important to trade of French Colony and eventually the US. The reason why the US gained so much territory in the Louisiana Purchase was because they wanted this important geographic location, the rest of the land gain was pretty much lagniappe .
      3) The City did spread to areas that were once flood prone, but were later supposed to be protected by the USACE built levees.
      4) It was the Federal Government, i.e The US Army Corps of Engineers, who built the failed levees and, they did it knowingly causing the deaths of thousands of people who thought they were protected by the levees. To top it off, the people affected by this gross negligence. or anyone else in this country for that matter, cannot sue the Federal Government for their negligence. Those city officials involved in any illegal such as the corrupt mayor have not gotten away with anything. Nagin’s case will be brought to court soon, unfortunately justice tends to be slow.
      5) I guess you think the East Coast should not have been built after Hurricane Sandy.
      6) I could have simply said that you were an ignoramus but instead have taken time to try and educate you about your logic-less argument. I hope you will learn something from what I have written. I cannot imagine how boring the US and the rest of the world for that matter, would be without New Orleans. Google it.

    3. New Orleans was built on land above sea level. Your comment that the Mayor and the City Council stole the money that was meant for the levees, that is not true. The levees were built by the Corps of Engineers and financing was from the US Congress. Not using buses to get people out of New Orleans was Bush jr’s fault, and Brownie’s, of course.

  7. Lamar-
    So we agree that throwing money at a problem does not necessarily solve the problem. However, you did not address the issue I brought up, which is the need for proper, effective, and efficient utilization of our current resources. Fraud/abuse and abuse of the tort system are only a small part of the problem.
    It appears we differ on the definition of “waste”.
    I agree that the problem is much more systemic.
    I question whether we are talking about the same problem so let me first address the Goals of any Health Care System and I will paraphrase The World Health Organization.
    The goals of Health Care Systems include
    i) Improvement in the health of the population both in terms of level attained and distribution
    ii) Enhanced responsiveness of the health system to the legitimate expectation of the population
    iii) Fairness in financing and financial risk protection

    Click to access paper30.pdf

    Now let’s define the “the problem”
    1) Decreased Quality – First we must look at outcomes. Are we getting what we are paying for? We pay more per capita in health care than any other country in the world according to the WHO at $7960 and according to OECO $8233. However, the WHO has the U.S. ranked # 38 in healthcare systems in the world and # 37 in health care outcomes which is on par with Cuba.
    2) Overutilization and inappropriate utilization of the health care dollar
    This is where the problem really gets complicated. Where does the health care dollar go?
    How much is actually spent on health care?
    I heard from a fellow named Bob Kocher, who was an advisor for the ACA health care reform bill, that for every healthcare provider in the US there may be as high as a 15:1 ratio of health management and support workers per provider in the US with as many as 9 of the 15 in administrative and management support and only 6 of the 15 involved in clinical support roles. Certainly this is part of the problem of spiraling health care costs and apparently yields no increase in quality.
    If we just spend more money on healthcare without looking at rebuilding the basic healthcare delivery model to service more people at a higher quality and lower cost, I fear we are putting gasoline on a house fire and the smoke just keeps us from seeing the real problems and meaningful solutions.
    We need to focus on improving outcomes, decreasing costs and increasing satisfaction of our citizens with our healthcare dollar.
    The medical creed of “first, do no harm” applies to healthcare reform as importantly as it does to our patients. The inappropriate use of healthcare dollars for compliancy screening in my earlier example in this thread is just one of many examples where the healthcare dollar needs to be re-evaluated.
    Health care is about people, not about jobs and not about profits.
    Just as we have separation of church and state, we need a separation of healthcare and profit motive. Indeed healthcare should be truly nonprofit.
    Just as we have separation of church and state, we need separation of healthcare and politics.
    Learning comes from the free exchange of differing ideas without worrying about political correctness or name calling
    I am grateful for your engaging me in this discussion and I have benefitted from this discussion however I will end my thread on this particular blog
    Good luck in your future endeavors
    God Bless

  8. Dear Lamar,
    Please tell me where the feds get the 25 billion to give to Louisiana. There are two possibilities: we either borrow them or get them from the taxpayers pockets. With 17 trillions of deficit, btw, do you know how many zeroes that is or how much money it really is? I doubt that.

    Just go on and spend, spend, spend, spend … Apparently you have no children or grandchildren. I do, and I do not want to stuck them with the bill.

    1. Peter, I’ll repeat what I said to Mark: If you’re offended by the idea of the federal government funding health insurance for hundreds of thousands of poor and working class Louisianians, if you’re somehow worried this could bankrupt the country, then fine: I again propose a compromise. Let Louisiana take complete control of its own oil and gas resources. Why should Texas and Saudi Arabia and Great Britain make hundreds of billions, if not trillions, from their ownership of Louisiana’s energy resources and infrastructure? Nothing is more fundamental to a state than its natural resources, right?

      I’m purposely walking us down this rabbit hole, because I’m interested to hear how you, as a father and grandfather and a man who therefore, by definition, knows more and cares more about the future than I do, thinks about the capacity of a poor state like Louisiana to become self-sufficient.

  9. Just want to point this out: When Ted Cruz and Tea Party House Republicans shut the government down, they cost the economy more money in 16 (sixteen) days than we’d need to spend to expand Medicaid in Louisiana for the next ten years.

  10. Here is the “problem” with US healthcare in a nutshell …. no one treats healthcare dollars as their own money. If they did, it would not cost as much nor would we use it as often. The “poor” (non-insured) don’t care about costs ….. they have been conditioned to see healthcare as “free” long before Obama came along because by law they can just show up at an ER and get treatment. The “rich” (insured) don’t care about costs …. they have paid for the insurance.

    Example: say you strain your knee or ankle (whatever). You could go to the ER where they will probably order an MRI and/or CT then maybe prescribe some physical therapy. Maybe even some other diagnostic testing or therapy that could easily run up to $4-5K. Or you could take some Tylenol or Advil, take it easy and see if it gets better in a week or so. If you are not paying the bill, you could care less about the $4-5K.

    All the best,


    1. Soop–

      Even if I accepted your example, which I don’t, as the primary reason for the high cost of medical care, what you’re describing is a “provider” (including hospitals and doctors) problem, not an “insured” vs. “non-insured” problem. Second, by this logic, if I were in control of my own healthcare dollars, what would I do when I am having a heart attack? Do I tell the doctor, “nope, let’s not use that expensive anti-coagulant. I’m in charge of my healthcare dollars here. Just give me some pepto bismol instead”?

      The market for medical care simply does not operate the same way as other markets for goods and services. For the sake of argument, let’s assume that the market for healthcare has no such thing as insurance. In other words, as you suggest, people will only pay out-of-pocket for their care. In a traditional market, you and I should be able to compare quality and price among several competitors to make a rational, and, one hopes, inexpensive decision. But medical care is different. It’s my health that I’m worried about. Price and quality, meanwhile, have a strong correlation; that is, the higher the price is, the more likely I’ll presume that quality of care is also higher. So I have a heart attack, and assuming I even have time to decide which doctor will treat me, who am I going to spend my healthcare dollars on? The cheap doctor or the expensive doctor? The expensive doctor will win out every time because no one wants to risk his or her health on a “lesser” quality of care. The same goes for non-emergency situations. Do I risk my health by going to the cheap GP instead of the expensive GP? After all, this is MY health we’re talking about. So long as I correlate price with quality of care, there’s no incentive for the healthcare provider to lower costs to the consumer. Traditional notions of competition don’t apply. Prices increase because higher prices, not lower prices, win the competition for consumers.


  11. I really appreciate all of the commentary here. But I need to make one thing abundantly clear (because I’ve had to delete a few comments): I don’t mind if you’re anonymous, but I will not tolerate personal attacks. This is my website, and I’m under absolutely no obligation to publish commentary from people attempting their best impression of Rush Limbaugh. Stick to the issues. Be thoughtful and considerate. And if you want to challenge me- personally- on my opinions and my experiences, that’s cool; you just need to leave your real name and your real e-mail address so that everyone knows who you are as well.

  12. What do you suggest as the best way for a non-moneyed citizen to try and convince Jindal to correct such an epic mistake before he finalizes it? Can one contact the governor directly or does she have to go through her local rep?

  13. Having read the article and all the commentary, I see that we continue to call others dumb and stupid. Secondly, there is nothing wrong with Jindal wanting to be president. It seems there are many would be presidents who post on this type of article all day long.
    There is no way that accepting money from the federal government will “fix” anything in a state whose politicians and lobbyists have historically misappropriated funds. And secondly, that amount of money has an interest rate to a foriegn country who historically has enslaved their own women and children in factories. Someone is paying the bill. And that someone is the middle class working tax payer. We are slaves to a global system. And this has nothing to do with healthcare. It has to do with insurance company lobbyist who are listed on the HCA site. They are the criminals. So any debate about someone being dumb and stupid is pointless. The kindness in our poorest communities has to start within the community. Not a check from the Feds spent by a state who is sorely lacking in ethics.

  14. You really make it seem so easy with your presentation but I find this matter to be actually something which I
    think I would never understand. It seems too complex and
    extremely broad for me. I am looking forward for
    your next post, I will try to get the hang of it!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s