Stephanie Grace: Seeking Medicaid detour around Jindal

If there’s one constant in Louisiana politics these days, it’s Gov. Bobby Jindal’s stubborn refusal to accept the Medicaid expansion authorized by President Barack Obama’s Affordable Care Act.

Never mind that the cost of the new coverage would be fully covered by the feds for three years and 90 percent financed thereafter. And never mind that it would enable nearly a quarter-million of Jindal’s constituents — people who earn less than 100 percent of the poverty limit — to get insurance, according to the Kaiser Commission. And certainly never mind that covering this group was part of the clear legislative intent of the law, even though the U.S. Supreme Court later gave states permission to opt out.

Whether it’s because he really thinks expansion is bad policy or because he’s all about shoring up his GOP credentials for the 2016 presidential season, Jindal will have none of it.

So, here’s an idea. What if, instead of trying to move Jindal when he’s bent on standing firm, proponents just tried to go around him?

That’s a key component to state Sen. Ben Nevers’ plan to introduce several constitutional amendments aimed at accepting the Medicaid money, whether Jindal signs on or not.

Not that Jindal is the only daunting obstacle, of course. Before taking effect, any constitutional amendment would have to attract support of two-thirds of lawmakers, a tall order given the Legislature’s conservative leanings, and also be approved by voters. But it would not require a gubernatorial signature or be subject to a veto.

On a conference call organized by the Louisiana Democratic Party, Nevers said Obama’s recent approval of the so-called Arkansas model, which calls for expansion through private insurance exchanges, could help the cause. Nevers supports a similar approach, which plays to conservative goals of state-level autonomy and private sector involvement.

There are other reasons to think the public at large might be open to the idea.

An LSU Public Policy Research Lab poll taken last spring found 70 percent of those interviewed backed Medicaid expansion. Another poll by Voter Consumer Research pegged support at a much lower 51 percent, but that’s still not a bad starting point. Reading between the lines, polls also have suggested a certain level of fatigue over Jindal’s relentless national positioning, so casting his obstinacy as more about his outside standing than the state’s needs could work.

And while it’s easy to overinterpret the outcome of last fall’s 5th District congressional race, there’s no question that winner Vance McAllister’s support for Medicaid expansion didn’t drive voters away, even though the district is largely Republican and opponent Neil Riser tried to capitalize on McAllister’s detour from GOP orthodoxy.

A campaign in favor of a Medicaid amendment could feature not just ideological Democrats but also people such as David Hood, who once served as Jindal’s deputy at the Department of Health and Hospitals and later his replacement as secretary under Republican Gov. Mike Foster. Hood told the Press Club of Baton Rouge this week that he plans to participate in the lobbying effort during the upcoming session.

“We do seem to be stuck here in Louisiana. But we’re not giving up. We’re going to keep this issue right in front of everybody’s face, so that they can see that we’re passing up an opportunity here to do something that would be very good for our people,” he said.

The Jindal administration says it’s pursuing an alternative approach, which basically amounts to doubling down on the old Charity Hospital model — albeit at privatized facilities — and providing care to uninsured residents through a safety net program.

But this amounts to Louisiana zigging while much of the country zags toward a universal coverage model. And it relies heavily on federal funding for uncompensated care that will likely decline in coming years, according to a recent analysis of the state’s new hospital partnerships by the Public Affairs Research Council.

Given that prospect, it’s not out of the question that Republicans hoping to succeed Jindal might be inclined to stay neutral or only pay lip service to opposition. After all, taking the money would solve a big problem for them. The same goes for health care industry leaders who now face political pressure to remain silent.

Still, getting a Medicaid constitutional amendment through the Legislature and selling the voters remains a long shot. Nevers himself acknowledged continued, widespread suspicion of anything associated with the Affordable Care Act.

But considering the potential to help people, shore up the state’s financial health and even keep Louisiana’s federal taxes from simply being shipped to other states, there are plenty of good reasons to ponder the possibility.

Editor’s note: This story was changed on Jan. 17, 2014 to correctly characterize the income level of the people who’d benefit from Medicaid expansion.

Stephanie Grace can be contacted at sgrace@theadvocate.com.