Gov. John Bel Edwards issues executive order to expand Medicaid

On his second day in office, Gov. John Bel Edwards signed, as promised, an executive order that begins the process of expanding Medicaid.

Tuesday’s move will allow another 300,000 or so people — by July — to join the state-federal government program that already pays the health care costs for about 1.4 million Louisiana residents.

“This will not only afford them peace of mind, but also help them from slipping further into poverty and give them a fighting chance for a better life,” Edwards told a cheering crowd crammed into a meeting room adjacent to the governor’s office in the State Capitol.

“I don’t look at this as some revolutionary thing — this is just the right thing to do,” Edwards added. Thirty states have adopted Medicaid expansion, but Louisiana will be the first in the Deep South to do so.

It will take several months to work out the details of changing the Medicaid definitions to include people who make too much money to qualify but too little to buy adequate insurance on the private market. Additional rules need to be written, processes need to be set up and people need to be hired.

“It is an aggressive timeline, and if we don’t get them all signed up by July 1, it’ll happen soon thereafter,” Edwards said.

Edwards said he would ask President Barack Obama for help when they meet Wednesday after the president arrives for his first visit to Baton Rouge.

“I will be asking for as much cooperation as possible out of the (U.S. Department of) Health and Human Services in Washington,” Edwards said, adding that he already has visited with federal authorities in hopes of fast-tracking Louisiana’s efforts.

Medicaid expansion is an integral part of the federal Affordable Care Act — Obama’s signature legislation — and has been the target of pointed opposition from Republicans. The GOP-dominated Louisiana Legislature under former Gov. Bobby Jindal had defeated multiple attempts to expand the Medicaid rolls.

Jindal and his GOP legislative majority argued that Medicaid provided inadequate care and expanding the government program eventually would saddle Louisiana taxpayers with unsustainable costs — even with the lucrative federal incentives.

While some Republican legislators may try to block expansion, Edwards predicted they would not be successful.

The GOP lawmakers also had argued over the past few years that the Legislature didn’t have authority to expand Medicaid — only a governor could do that, said Ben Nevers, Edwards’ chief of staff and who, as state senator, sponsored three of the unsuccessful efforts.

“The Legislature held that a governor needs to do it, so we got a governor who did it,” Nevers said.

House Speaker Taylor Barras, R-New Iberia, said he’d have to study the order, which he hadn’t seen on Tuesday afternoon, before he could get a feel for what input the Legislature could have. But there’s time for that.

Barras said, “If there are measures we can consider, on the process, when it begins, safeguards we want to build,” then the regular session of the Legislature, which begins March 14, would be lawmakers’ opportunity to weigh in.

Expansion would open the rolls to people in households making up to 138 percent of the official poverty level, a complicated formula but, generally, $33,465 annual income for a family of four.

Even without expansion, Louisiana has more of its residents — one in every four — in the government health care program than most of the other states, including those who already adopted the federal program.

Medicaid accounts for about a third of the state’s $25.1 billion budget — and that’s only for the part that Louisiana pays. The federal government picks up 62.1 percent of the costs.

The federal government will pay for the entire cost of the new enrollees through September. The federal portion will then gradually step down to no less than 90 percent, which is better than any other health care program.

That’s not good enough warned Dawn Starns, the local representative of a conservative trade association representing small businesses. “Washington might be paying 100 percent of the cost of expansion today, but Louisiana is going to have to come up with at least 10 percent by 2020, and there’s no guarantee Congress won’t shift even more of the burden onto the backs of Louisiana’s small businesses as it struggles with the $19 trillion national debt,” Starns said in a prepared statement.

Edwards said expansion would save the state money even though 248 more employees will be needed to handle the surge in enrollment. The federal government would pay 75 percent of the costs, but the state’s portion will be about $2.8 million.

Dr. Rebekah Gee, Edwards’ secretary at the state Department of Health and Hospitals, said she has worked out a system in which providers of health care services to Medicaid patients will cover those costs.

Gee said she also hopes that rather than setting up separate offices to handle the enrollments, the federal government will allow Louisiana to sign up new Medicaid members at places like hospitals, clinics and, perhaps, pharmacies.

“It’s a better way for patients to access enrollment services, as well as, I think, a really important commitment on the part of the providers to say, ‘We care about this; we want to make this successful.’”

“This is the first step in reforming a broken system,” said Mark Slyter, president and CEO of Baton Rouge General hospitals. “It’s the right thing to do: for the people of Louisiana, for the state budget, and for the sustainability of community health systems delivering top-notch, value-based care.”

Follow Mark Ballard on Twitter, @MarkBallardCNB. For more coverage of government and politics, follow our Politics Blog at http://blogs.the advocate.com/politicsblog/.

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