Inside Report: Senate panel vote on Medicaid expansion likely not end of debate

“It should also reduce the cost-shifting to the private pay.” PAUL SALLES, Louisiana Hospital Association president

Elizabeth “Beth” Ackerman traveled from her Shreveport home to the State Capitol as legislators took up the issue of Medicaid expansion once again.

Ackerman is a woman in the “Medicaid gap,” called the “Jindal gap” by those placing the blame on Gov. Bobby Jindal’s rejection of the coverage for some 240,000 Louisiana residents.

The working mother lost her job several years ago because of health issues. She suffers from hypothyroidism, which causes her to be overweight, diabetes, sleep apnea and depression.

Ackerman said she began search for new employment to no avail.

“I had to employ myself,” said Ackerman. “I grow my own vegetables. I make laundry detergent, dish detergent, even hand cream. But I’m still not able to purchase health insurance.”

Her income is too high for Medicaid and too low to qualify for subsidies to purchase insurance under the federal Affordable Care Act. “If I had adequate health care, I would no longer be underemployed. I could be a more productive citizen paying taxes rather than being on this end of it,” Ackerman said.

She was one of a parade of witnesses trying to get the Legislature to put the issue of Medicaid expansion to Louisiana voters.

Each came at it from a different perspective with a little different pitch.

Small-business owner Bruce Blaney’s company provides in-home support for the disabled and elderly and employs about 160. He also represents the Supportive Living Network with 40 agency members and some 30,000 employees.

“The ACA provides a unique and remarkable benefit for my business through the Medicaid expansion,” Blaney said, referring to the federal Affordable Care Act.

“It allows employees to have health care coverage,” he said. Ninety percent of his staff would receive coverage for the first time and it would help with employee recruitment and retention.

The Medicaid expansion would help companies like his avoid having to pay a penalty for not offering health insurance coverage, another part of the Affordable Care Act, Blaney said. His firm would be faced with paying $150,000 a year penalty for each employee without insurance.

“We would be bankrupt; 350 of the agencies we serve would be bankrupt,” he said.

Louisiana Hospital Association President Paul Salles said health care coverage is a great investment.

He said hospital Medicaid payments have been cut 26 percent since 2009 creating “a great deal of uncertainty for hospitals.”

Salles noted that the federal health revamp calls for significant cuts in federal dollars available for uninsured care.

The federal government allots about $11 billion a year for Medicaid uncompensated care nationally. Beginning in federal fiscal year 2016, reductions will equal $600 million. By fiscal year 2019, the reductions will rise to $5.6 billion, about a 50 percent cut.

Louisiana has traditionally been one of the top users of the dollars — up there with New York and California.

The Jindal administration’s LSU public-private hospital partnerships rely heavily on the private interests’ access to those dollars. Some Medicaid expansion proponents say it would put the deals between LSU and the community hospitals in jeopardy and put at risk the “safety net” providers.

Salles said Medicaid expansion would offset those uninsured care reductions. Medicaid expansion is estimated to bring $16 billion to the state over 10 years, with $8 billion going to hospitals for care delivered.

“It should also reduce the cost-shifting to the private pay,” he said, which happens to offset some hospital costs of the uninsured.

Legislators listened for hours but the pleas didn’t alter the outcome.

Senate committee members aligned themselves with Jindal, voting along party lines against legislation that would let voters decide Medicaid expansion.

It’s not surprising nor unexpected but don’t think the proponents are going to stop pushing anytime soon to eliminate the “Jindal gap.”

Marsha Shuler covers healthcare policy for The Advocate Capitol news bureau. Her email address is mshuler@theadvocate.com.