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.