Hearing on Medicaid expansion

Advocate staff photo by BILL FEIG --  Petula Workman, foreground, vice president of Gallagher Benefit Services Inc., discussed Wednesday the impacts of the Affordable Care Act during a Louisiana House and Senate Insurance Committee meeting. Workman talked about provisions that apply to employee, employer and state governments, including health insurance exchanges and Medicaid expansion. Show caption
Advocate staff photo by BILL FEIG -- Petula Workman, foreground, vice president of Gallagher Benefit Services Inc., discussed Wednesday the impacts of the Affordable Care Act during a Louisiana House and Senate Insurance Committee meeting. Workman talked about provisions that apply to employee, employer and state governments, including health insurance exchanges and Medicaid expansion.

Although Gov. Bobby Jindal has rejected the idea, legislators said Wednesday they want more information about Medicaid expansion and what its impact would be on Louisiana.

“What is really the best thing for Louisiana to do, politics aside,” Senate Insurance Committee Chairman Dan “Blade” Morrish, R-Jennings, said. “The people of the state need to know we are making the right decision.”

The new federal health care law would expand Medicaid, the state-federal insurance program for the poor and some elderly, to include people who make too much money to qualify for government insurance but too little to buy private policies. Jindal opposes expanding Medicaid.

State Rep. Barbara Norton, D-Shreveport, has pre-filed legislation that would require Louisiana’s Medicaid eligibility standards to conform with those established in the Affordable Care Act, also known as Obamacare.

The joint Louisiana Senate and House Insurance Committees started gathering information during a five-hour hearing that drew a standing-room-only crowd in one of the Legislature’s largest committee rooms.

Morrish promised more hearings. He said he wants to know more about an Arkansas model in which the Medicaid population is funneled into the private insurance market. He said that sounds a lot like Jindal’s revamp of the state’s Medicaid program known as Bayou Health.

Testimony came from independent national experts, Jindal’s health secretary and proponents of expanding Medicaid coverage.

The federal law includes an expansion of Medicaid to include adults with income up to 133 percent of the federal poverty level.

Jindal has said the current Medicaid system is “broken” and states need to be given more flexibility to develop programs that meet needs. He favors a private sector-based plan. Jindal also has argued that the expansion is too costly for the state.

The federal government pays 100 percent of costs for the first three years, beginning in 2014, after which states pick up a fraction of the costs, no more than 10 percent under the Affordable Care Act.

State health Secretary Bruce Greenstein underscored Jindal’s opposition to the change, calling it “a massive entitlement expansion” that “weakens the private insurance market.”

Greenstein said there would be 467,000 new Medicaid enrollees, of which 187,000 people are on the private insurance rolls today.

Morrish asked Greenstein about potential penalties that employers would be exposed to if there’s no Medicaid expansion mentioned in an Affordable Care Act overview by Petula Workman, area vice president of Gallagher Benefit Services Inc.

“We have not forecast what likely penalties would be,” Greenstein said. He said it depends on a lot of factors.

“I have a concern for our employers this may be something they may be quite unaware of without the Medicaid expansion,” Morrish said.

“It could be a hidden cost to employers,” said state Sen. Gary Smith, D-Norco.

Jan Moller, director of the Louisiana Budget Project, said the Medicaid expansion could reduce the number of uninsured in Louisiana by 60 percent, most of them working age adults. One in four working age adults in Louisiana do not have insurance, he said.

No Medicaid expansion would leave a “significant coverage gap” for adults with income below 100 percent of the poverty level, Moller said. “A coverage gap means a care gap,” he said.

While there would be an estimated $1.2 billion added state costs over time associated with the expansion, it would be offset by $1.1 billion in reduced uncompensated care spending, he said

Supporting expansion were representatives of AARP Louisiana, the Louisiana Campaign for Health Care for Everyone, the Public Affairs Research Council, Louisiana chapters of the National Multiple Sclerosis Society, the Mental Health of America, the Louisiana AIDS Advocacy Network, the American Cancer Society and other health care advocates who waited for hours to talk.

“As many 400,000 Louisianians could gain better access to health care with Medicaid expansion,” said Alma Stewart, president of the Louisiana Center for Health Equity. “Many of the people are working and don’t have access to affordable coverage today.”

“We encourage you to consider it ... for the financial advantage, increased access to health care and health care insurance. This will save lives,” said Andrew Muhl, director of Louisiana’s division of the Cancer Society.