Jul 18, 2013 23:45 Our Views: Rocky road to Obamacare Our Views: Rocky road to Obamacare Advocate story July 18, 2013 Comments In Louisiana’s long list of behind-the-curve situations, add the problems of adaptation to a new health-care system. Not only has the state failed to apply for expanded Medicaid coverage for the poor. That decision, made mostly along party lines by Gov. Bobby Jindal and the Republican majority in the Legislature, leaves probably 300,000 people who could have been insured without any coverage at all — even though the U.S. government was willing to pay 100 percent of the cost of enrolling the currently uninsured this year. That is only one element of the new Affordable Care Act — aka Obamacare — that requires adjustment by the state. The governor also refused to set up a state health insurance exchange, so the U.S. government will set up one for Louisiana. If, that is, the feds can manage the complicated process. The complexities of implementation of Obamacare have been emphasized by the U.S. government’s decision to delay some requirements on employers, a national issue that is of limited importance in Louisiana. Still, it’s another sign that things are complicated, and there are specific problems in Louisiana that are pressing. If the Jindal administration does not want to do the heavy lifting on the insurance exchanges, it is more than happy to bank any savings from it. The state anticipates in this year’s budget a savings of $66 million from people moving off the Medicaid rolls and into coverage through the health insurance exchange, which will be subsidized by the U.S. taxpayer. The medical community is scrambling to adjust, even as the state changes its rules so that in the new year some people, including women in maternity programs and some disabled persons, will need to go into the exchanges. Unfortunately, the exchanges will not help many of the desperately poor, and that is why the Medicaid expansion is so important to the overall scheme of the Affordable Care Act. “Not taking that (Medicaid expansion) was inexcusable,” says Rep. Walt Leger, D-New Orleans. He is right, not only because of the need for care for working people in low-wage jobs, but because people who don’t get care at a doctor’s office all too often and end up sick in emergency rooms. That is paid for indirectly: Cost-shifting is alive and well at your local hospital, even if there is no line-item in the hospital bill to show it. “By not taking that money, all of our private insurance rates will be higher,” Leger told the Press Club of Baton Rouge. One can only hope that the exchanges work as planned, for Louisiana is a poverty-ridden state in which too many people go without insurance. All too often, that results in problems that could be dealt with by doctors and nurses being treated in a higher-cost setting. From the new privatization projects for the former charity hospitals to the clinics in New Orleans that filled the post-Katrina health care gaps, the lack of expanded Medicaid coverage will likely be a financial problem, as well as a health care issue for the working poor.