Hospitals endorse Medicaid expansion

Top Jindal administration health officials continued Tuesday to reject the idea of Medicaid expansion while state senators grilled them on the state’s plan to care for its working uninsured without it.

Also Tuesday, the Louisiana Hospital Association endorsed Medicaid expansion.

And the Louisiana State Medical Society said it would support “models which seek to provide private insurance coverage to additional low-income individuals and families not covered by Medicaid.”

John Matessino, president of Louisiana Hospital Association, said it is “critically important for Louisiana to take advantage of the significant federal resources available to expand health care coverage.”

Matessino said any expansion must be done thoughtfully and with Louisiana’s circumstances in mind.

Increasing the number of individuals who have health care coverage will help to offset the cost of uninsured care, help stabilize insurance premiums and ebb cost-shifting to the private insurance market.

Up to 400,000 Louisiana residents would be covered under the expansion.

The federal government, for three years, pays 100 percent of costs for people with income of up to 138 percent of the federal poverty level, mostly low-paid working adults. State participation would not exceed 10 percent of annual costs after that time.

News of the Louisiana Hospital Association’s stance came after Jindal health officials sparred with members of the state Senate Health and Welfare Committee looking at Medicaid options being pursued in other states.

“To do nothing is by far the worst approach of all,” Ray Hanley, president of the Arkansas Foundation for Medical Care, told the panel.

Hanley, a former veteran Medicaid director, encouraged the panel to consider a private sector-based insurance approach that is winding its way to approval in the Republican-controlled Arkansas Legislature.

The Medical Society’s position statement says, “By using federal dollars to offset the costs of purchasing private insurance, patients get more choices and better access to health care providers.”

Gov. Bobby Jindal opposes Louisiana Medicaid expansion, claiming it’s too costly and does not provide the flexibility for the state to design a program that fits its needs.

Interim state Department of Health and Hospitals Secretary Kathy Kliebert told the panel there are too many “uncertainties” involved with the Medicaid expansion and future generations should not be “saddled” with its costs. New estimates show the expansion could cost Louisiana $1.7 billion over 10 years, she said.

“It seems that uncertainties have not stopped this administration before on some things they have done,” state Sen. Dan Claitor, R-Baton Rouge, replied to Kliebert.

“It’s frustrating to me for us not to have what appears to be a plan. ... Arkansas and these other places seem to be saying, ‘We are not going to sit here and get run over.’ What are we doing?” Claitor said. “We are leaving all this money on the table. Arkansas is at least attempting to thread the needle.”

Kliebert said there are things DHH is doing to get ready for the administrative things that must be done as the law kicks in Jan. 1. She said the state has weekly calls with federal health officials and is monitoring guidance issued.

“I would like to have a more visible plan,” Claitor said. And if the administration isn’t going to come up with one, Claitor said, “we will.”

State Sen. Fred Mills, R-St. Martinville, asked Kliebert if the state was considering Arkansas’ private insurance-based proposal, which would be submitted for federal approval as a three-year demonstration project.

“We have looked at it but we are not entertaining it,” Kliebert said.

She said the plan does not address “the high-risk concerns.”

Mills said he and other legislators have heard from representatives of major health care providers “who don’t understand how we cannot do it. ... They are quite worried about not expanding Medicaid.”

State Sen. Yvonne Dorsey-Colomb, D-Baton Rouge, questioned DHH statistics on Medicaid expansion costs, noting that numbers can be used in a variety of ways to bolster points.

“We are using all the data and information we have available to us,” Kliebert said. “We choose not to take risks that are unreasonable.”

“No, we would rather risk our people’s lives and health of our people,” Dorsey-Colomb replied.