Political Horizons: Bobbycare being considered

Louisiana Democrats have finished with trying to force a Republican governor, who hums “Hail to the Chief,” to accept billions of federal dollars to provide health care for the state’s uninsured working poor.

Largely along party lines, the House Health and Welfare Committee voted 12-4 Wednesday against a Medicaid expansion proposal by state Rep. Herbert Dixon, D-Alexandria. The House rejected five similar bills, and the Senate refused three others.

“Medicaid expansion is dead for this session and probably forever,” said state Rep. Patricia Smith, D-Baton Rouge. The amount of federal money available next year will be less than the $16 billion Louisiana could have received over 10 years had Gov. Bobby Jindal not refused the funding for two years running.

It was just a few months ago that Smith stood among the laxatives and pill trays in the aisle of a Baton Rouge pharmacy with state Rep. Walt Leger III, D-New Orleans, boldly predicting that Democrats had come across a strategy that would allow Jindal and GOP legislators to quietly accept the federal monies without angering the stalwart conservative activists who vote in the early presidential primaries.

Democrats pushed legislation that would put the issue on the ballot and thereby let voters statewide decide whether to allow on Medicaid rolls a quarter-million more people — mostly working people who make too much for government insurance but too little to buy reasonable coverage of their own.

The government insurance covers about one of every four of the state’s 4.6 million residents. Jindal says that even though the federal government already pays most of the expenses, the increase in patients would bump up the state’s portion to an unsustainable amount in the future.

Leger is cautious in his comments. “Apparently, letting the people decide was not the will of the body,” he said.

Not only did that plan not work out, there’s a good chance that Jindal’s Republican alternative to the Democratic Obamacare plan will get passed in Louisiana.

Senate Bill 682 would require the state Department of Health and Hospitals to develop a plan for putting into action the proposal Jindal forwarded to buff up his national cred as an idea man.

“It is a sarcastic bill. But it’s going through the process,” Smith said, then nodded at her colleagues in the House chamber.

“It’s probably going to pass. They’re too afraid of voting against the governor,” she added.

But Jindal’s 23-page “Freedom and Empowerment Plan,” which he rolled out a couple months ago to burnish his idea man reputation, isn’t really ready for prime time.

“The fiscal note is pretty scary,” said state Sen. Jack Donahue, R-Mandeville, who, as chairman of the Finance Committee, carries the responsibility of ensuring the state budget is balanced. There’s too much “Gee, don’t know” in the fiscal office’s projections.

DHH is going to have to figure out, among other issues, how to give individuals a tax deduction and what a newly created state health insurance program would look like.

DHH Secretary Kathy Kliebert says her staff can pull together the details without incurring any additional expenses.

The Legislative Fiscal Office says the impact on the state general fund, which pays the government’s bills, is “indeterminable.”

State income tax revenues might decline. Costs might go up.

According to the 2013 Louisiana Health Insurance Survey, about 622,033 adults are not insured in Louisiana, of whom about 216,042 fall under the federal poverty line.

The cost could lie between $540 and $856 per person per year, depending on the parameters of the plan.

Probably the biggest hurdle will be whether the federal government is willing to directly give Louisiana the money it now pays for health care services. The current level of federal funds associated with the Medicaid program is $5.3 billion, roughly 20 percent of the state’s proposed $25 billion budget for the fiscal year on July 1.

Though he has the reputation of a policy wonk and litters his presentations with white paper references and talking points, Jindal’s ideas tend to be thematic, rather than detailed.

“At least, we get to pay for figuring out the details,” Smith said.

Mark Ballard is editor of The Advocate Capitol news bureau. His email is mballard@theadvocate.com.