Jindal’s Refusal To Expand Medicaid Directly Accountable For Hundreds of Deaths

Since 1982, the State of Texas has executed 514 Americans and at least one citizen of Mexico, with hundreds more waiting on death row. Two years ago, during the Republican primary Presidential debate, news anchor Brian Williams reminded Texas Governor Rick Perry that during his years in Austin, he approved more executions of American citizens, 232, than anyone in contemporary history. The audience actually applauded Perry for his record as Chief Execution Officer, and when Williams followed up with a question about whether Governor Perry sleeps soundly at night, Perry was happy to report that he never stayed up thinking about the lives of the men and women he sent to death.

Regardless of your personal position on the death penalty, it is undeniable that taxpayers spend exponentially more on those sentenced to death than those sentenced to life in prison without the possibility of parole. It’s actually cheaper to keep a criminal behind bars for the rest of his life than it is to kill him. Murder is expensive.


According to a recent study by academics at Harvard and CUNY (one of whom received her doctorate in medicine at LSU), Governor Bobby Jindal’s refusal to expand Medicaid will result in the deaths of 542 Louisianians, more than the total number of people executed by the State of Texas in the last 32 years. I’ll get to the substance of the study soon, but first, I think it’s important we consider a few things.

Texas spends around $2.3 million per death row inmate, which means that Texas, over the last 32 years, has spent at least $1.185 billion on executing 515 people. To be sure, there are hundreds of inmates currently on death row in Texas, and that means a billion more has already been spent and hundreds of millions more will be spent. Yet despite this massive investment, Texas isn’t any less dangerous. The murder rate in Texas is in line with the national average. In fact, the only states significantly safer than Texas all share a couple of things in common: Their public radio stations don’t air weekly shows about death row inmates, and no one aspires to live in the dystopia envisioned in The Hunger Games, a place where people will applaud their leader for his prolific record of state-sanctioned murder.

It’s important to put all of this in context. Bobby Jindal, after all, was the very first major Republican leader to endorse Rick Perry’s disastrous Presidential campaign.


For nearly four years, Bobby Jindal has stood his ground against the implementation of the Affordable Care Act. To him, it didn’t matter that the law is modeled, almost entirely, off of Mitt Romney’s successful plan in Massachusetts or that the law’s framework was actually developed in the back rooms of conservative think tanks. And it didn’t even register that the creation of private health insurance exchanges was an idea that Jindal himself had pitched to the Bush Administration as late as November of 2008, only days after then-Senator Obama became President-elect Obama. Jindal had always considered himself to be his party’s intellectual leader on health care policy, but his hubris on the issue wasn’t entirely unmerited or unfounded.

When he was only 24 years old, he became the head of Louisiana’s Department of Health and Hospitals because the Governor at the time, Mike Foster, was impressed by a whitepaper Jindal wrote. A few years later, he advised President George W. Bush on Medicare reform. Months after he was elected Governor of Louisiana, Jindal proposed a pilot program in Lake Charles that would provide federal subsidies to all citizens in the district in order to allow them the opportunity to purchase health insurance on the private market. If the pilot worked as he anticipated, he would expand the program statewide. There was only one problem: He needed federal money, and President Bush decided against financing Jindal’s wildly ambitious and controversial health insurance pilot program; after all, only two months later, the President and his wife walked down the steps of the Capitol, boarded Marine One for the last time, and were whisked away to Crawford, Texas.

With George W. Bush’s exit, Bobby Jindal was no longer the health care policy innovator; he became the health care policy cynic. Health care reform was, arguably, the single biggest issue in the 2008 elections, and it quickly became President Obama’s top legislative priority. On the same night that Barack Obama debuted in front of a joint session of Congress, Governor Bobby Jindal of Louisiana was selected to give the Republican response. It should have been immediately obvious: Jindal wasn’t selected because of his oratorical skills. He was selected because, at the time, Republican leaders thought he was the best approximation of Obama: Their version of a young, fiercely smart, charismatic politician, a minority and the son of immigrants, and perhaps even more importantly, a guy who seemed to know a lot about health care policy, the Republican Party’s best chance at retaking the narrative.

Jindal botched the speech, and for the last six years, he’s been botching pretty much everything else. There was an opportunity, albeit brief, for Bobby Jindal to assert himself as the transformational leader he promised to be. He had built up a tremendous amount of goodwill, and even among Louisiana Democrats, he had once been respected as an imminently reasonable guy, despite their disagreements with him on policy. When Jindal worked for Governor Foster, he and his wife were close friends with a number of Democratic leaders and policymakers.

At some point, according to those who knew him best in those early years, his personality changed. He became more rabidly partisan, more detached from his friends across the aisle. Most trace the change to his first election to Congress. He became intoxicated with the allure of national politics, so the narrative goes, and he’s been drunk on it ever since.


To some, the mere assertion that Jindal’s refusal to expand Medicaid will result in hundreds of unnecessary deaths may seem egregious, unfair, and hyperbolically partisan. But health care outcomes are quantifiable. This is not, as Jindal would have people believe, simply an economic issue, and even if it were, the numbers do not and have never supported Jindal’s position.

Because of Bobby Jindal and Bobby Jindal alone, 277,000  (according to the study) Louisiana citizens will remain uninsured, despite the fact that federal law would provide them with the opportunity and the resources to guarantee their coverage.

277,000 may not seem like an enormous number to people who live in America’s big cities, but in Louisiana, a city of 277,000 would be the second-largest in the entire state.

Governor Jindal defends his decision to refuse Medicaid expansion on the basis that it could, at the very worst, cost Louisiana $1.7 billion over the next ten years. That projection is now definitively dubious, as it was based on a series of worst-case assumptions on enrollment and participation. More than likely, Medicaid expansion would actually make money for Louisiana.

But let’s assume Governor Jindal’s worst case scenario is right: Louisiana has to come up with $1.7 billion over the next 10 years. (It’s not right, but again, let’s just pretend it is).

That would mean Texas has spent just as much money executing 515 people and keeping another few hundred on death row than Louisiana would have to spend ensuring that 277,000 people have health care insurance, which, in and of itself, would save more lives than Texas has ended.

Texas spent over a billion dollars to execute 515 people, and Bobby Jindal thinks its Governor should become the next President of the United States. Meanwhile, because of Jindal’s refusal to accept Medicaid expansion funds, Louisiana is unwilling to accept $16 billion in federal funding to ensure health care for 277,000 people and prevent the deaths of as many as 542 Louisiana citizens.