Inside Report: Jindal Medicaid decision still under fire

Gov. Bobby Jindal continues to reject Louisiana participation in the federally funded Medicaid expansion.

His refusal comes as other governors — several of them Republican and with high national visibility — have opted to expand the government’s health insurance program for the poor in their states.

In Louisiana up to 400,000 uninsured, largely working, adults would be eligible for health care coverage. Some 1.3 million Louisiana residents, mainly children and pregnant women, are covered by Medicaid, the government insurance program for the poor.

Jindal argues that the current Medicaid program is broken, states are not given sufficient flexibility in designing programs, and it will become too costly over time.

Jindal appears to have drawn a line in the sand, but there’s activity on a number of fronts to get the governor to alter his stance as the April 8 legislative session start approaches.

Democrat and Republican legislators are pushing Jindal to come up with a fleshed-out plan of his own if he doesn’t like the current plan and seek federal approval of it. Legislation has been filed to require the state to embrace the expansion.

Among the developments in recent weeks were:

Two state legislative committees, chaired by Republicans, started meeting to look at the Affordable Care Act and its Medicaid expansion. Panel members learned there could be a significant financial impact on employers as a result of state rejection of Medicaid expansion.

A national Jackson Hewitt report issued at the same time said collective tax penalties for Louisiana employers could potentially range from $51.7 million to $77.5 million annually. Employers don’t have to pay the penalty if their employees qualify for Medicaid expansion coverage.

State Sen. Dan “Blade” Morrish, R-Jennings, chairman of one of the insurance panels, said potential employer costs might be enough reason to go with the Medicaid expansion.

Along the way, groups as diverse as the Public Affairs Research Council and the Louisiana Budget Project weighed in. PAR basically suggested Jindal provide an option if he doesn’t like the current plan. The Budget Project released a report that detailed the merits of expanding Medicaid.

The state health agency, without fanfare, posted on its website an updated financial analysis of Medicaid expansion that concluded in a best-case scenario there would be a $386 million benefit to the state because of offsets. Previously, the administration has been using only a worst-case $1.7 billion cost over 10 years.

Arkansas’ governor announced that the federal government approved a private insurance-based alternative to Medicaid, which would give the state the flexibility it sought.

The Arkansas model caught the attention of legislators who continue to ask state health officials whether Louisiana can do likewise. Most recently, it was the subject of debate at a House Appropriations Committee budget hearing.

House Speaker pro tem Walt Leger III, D-New Orleans, said the Arkansas model “seems to have more flexibility. ... Has our state developed any such proposal or plan to seek the flexibility we want to have?”

Department of Health and Hospitals Undersecretary Jerry Phillips said the administration is “actively monitoring” the developments in Arkansas. “Arkansas currently has the most interest of the ones we have seen out there,” he said.

Jindal’s still not budging but the effort continues to push the governor over that line he’s drawn in the sand.

Marsha Shuler covers health-care policy for The Advocate’s Capitol news bureau. Her email address is mshuler@theadvocate.com.