Mar 31, 2013 19:54 Our Views: Expansion provides better care for poor Our Views: Expansion provides better care for poor Advocate story March 31, 2013 Comments Expanding health services to Louisiana’s working poor is not a gift, as the state eventually would have to put up some money to match federal Medicaid grants. But it’s a deal worth taking, and we urge Gov. Bobby Jindal and the Legislature to take up the offer. Ultimately, the state has no other solution in view for the problems of the uninsured who are working in low-wage jobs. Leave politics aside: In the first flush of opposition to the Affordable Care Act, largely known as Obamacare, Jindal said Louisiana would not expand Medicaid rolls to take in adults with annual incomes up to 138 percent of the poverty level. That was arguably good politics at the time for a Republican governor. We believe that there were good reasons for the governor’s caution, not just because of politics. At the time, the opposition to Obamacare was intense, and it was not clear if a new president would follow through on the act’s commitments to the states. However, the November election appears to have settled that concern. As Jindal has noted, the full costs of expanding Medicaid are met for only three years in the Affordable Care Act. The best estimate going is that over 10 years, the addition of some 400,000 people to the Medicaid rolls will cost $1.2 billion to the state, in exchange for $15.8 billion in federal funding. In a business proposition, that would be a no-brainer for “yes.” Many health-care providers want this to happen. Those without insurance who are today treated in emergency rooms cost people with private insurance, as costs are shifted to the insured who see their insurance premiums go up. An infusion of money for those services is good for today’s private-sector insured. Utilization of health-care services is obviously likely to bump up, as people with coverage go to physicians to see to conditions they’ve been suffering from, but unable to attend to. But it is vastly more efficient for those people to see a physician than wait for a bad event that results in an emergency room visit. The governor’s caution about expanding liabilities for the state was reasonable to a point, but many of his fellow Republican governors have crunched the numbers and have now agreed to the Obamacare expansion. Among them are conservative leaders such as Jan Brewer of Arizona and John Kasich of Ohio. Jindal’s other objections to the expansion are not as strong: Yes, the U.S. government might renege on such a generous plan in future. However, not soon, given the results of the November election, and that speculation can apply to any program. Given how stressed America’s health-care system is, who can predict what will be the post-Obamacare plan costs that might come along a decade from now? And yes, a few people — we suspect not many — will be in a position to give up existing but probably very modest private insurance coverage in favor of expanded Medicaid. But people making so little money cannot, on their own, afford good health coverage. That leads to the moral case: Louisiana is a poor state, and those working in low-wage jobs will never get ahead if they are prey to illness. Costs in this population will only grow if people don’t have a Medicaid card and thus put off the minor treatments or prescriptions that could avert more-serious conditions in the future. Preventive medicine, perhaps through the Bayou Health managed care pushed by Jindal, is not free, but with the new Medicaid expansion plan would be more likely to help avoid future costs. We urge the governor to rethink his position, but if he does not, the Legislature should act to make the best of this proposition for health care.