House panel rejects Medicaid expansion

On a party-line vote, a Louisiana House committee Wednesday effectively killed legislation that would require state government to expand its Medicaid program to cover some 400,000 uninsured residents.

The House Health and Welfare Committee voted 11-8 after five hours to involuntarily defer the legislation aimed at implementing a key provision of the federal Affordable Care Act, familiarly known as Obamacare. Involuntary deferral means the legislation cannot be brought up for reconsideration.

Republican Gov. Bobby Jindal has rejected the expansion as not being in the state’s or its residents’ best interest.

Republican committee members voted against the measure, House Bill 110, as legislators tackled the controversial subject for the first time. Other legislation dealing with the same subject matter is pending in committee and is expected to be heard next week.

On the other side of the State Capitol on Wednesday, a state Senate committee voluntarily postponed a vote on a measure that similarly would require state government to expand Medicaid until May 1.

HB110 sponsor state Rep. Barbara Norton, D-Shreveport, warned those who voted against health care access for Louisiana’s uninsured that they would be held accountable when they run for re-election. “When those citizens get sick, all they are going to remember is you voted no,” Norton said.

Medicaid is the insurance program that provides medical services for the poor and is paid for mostly by the federal government, with some matching funds from state government.

The Affordable Care Act would change, beginning in 2014, eligibility for Medicaid giving people with income of up to 138 percent of the federal poverty level to enroll. Today, that would mean individuals earning up to $1,285 a month. For a family of four, the earning level would be up to $2,651 a month.

Supporters say that many of those people currently make too much money to qualify for Medicaid but too little to buy adequate insurance of their own. Expanding Medicaid, as the ACA does, could provide coverage for about 400,000 people in this state, according to the Louisiana Budget project.

The Jindal administration puts the number of uninsured that would be covered at about 200,000, with others abandoning private insurance for the free program.

Democratic lawmakers argued that the state should take advantage of the federal dollars which would pay for 100 percent of the expansion initially and then no less than 90 percent for the first decade.

If Louisiana does not participate, its taxpayer dollars will be going to fund Medicaid expansion in other states, the Democratic representatives argued. Additionally, the federal government is reducing the pool of money it pays to provide medical care for people without insurance.

“I’m not excited about having to pay and then there’s no benefit for the people we serve,” said state Rep. Regina Barrow, D-Baton Rouge.

But Republican legislators and Jindal administration officials said the proposition is too “financially risky” given the federal government’s track record of changing the rules. They pointed to the sudden reduction in federal funding support for the existing Medicaid program that threw this year’s budget into a tailspin as health care dollars were yanked.

“This has to do with fiscal responsibility for the state of Louisiana,” said state Rep. Lance Harris, R-Alexandria, chairman of the House Republican delegation. “The federal government can change their mind at any time, in midstream.”

“We are just as concerned about the health of our citizens in Louisiana as anyone else. It’s how we get there and how can we sustain it in the long run,” Harris said. “This is not a political issue to us. It’s strictly a fiscal matter.”

Interim state Department of Health and Hospitals Secretary Kathy Kliebert called Affordable Care “a flawed law,” because it has too many uncertainties and unknowns.

Kliebert said the latest DHH analysis puts a worst-case scenario of $1.64 billion in new state costs over the next 10 years. But state Rep. Katrina Jackson, D-Monroe, noted the same report projects a $386 million savings in a best-case scenario.

Legislative Fiscal Office analyst Shawn Hotstream testified that according to his review there would be a cumulative decrease in state costs of between $185 million and $510 million over the decade.

During public testimony, Robert Tasman, associate director of Louisiana Conference of Catholic Bishops, urged committee members to consider those people “who need this type of coverage.”

“It’s about the people. It’s about human lives,” Tasman said. He said if they could not support the legislation before them, they should consider other models.

Kevin Kane, president for Pelican Institute for Public Policy, a New Orleans research and educational organization “for free markets in Louisiana,” compared the 100 percent federal Medicaid funding for expansion to “a drug dealer offering a free taste” so the state can get “hooked” on the federal dollars.

“We need a policy to introduce market principles into health care,” Kane said.

Voting FOR shelving legislation that would require Medicaid expansion (11): Republican Reps. Scott Simon, of Abita Springs; Richard Burford, of Stonewall; Lance Harris, of Alexandria; Kenny Havard, of Jackson; Bob Hensgens, of Abbeville; Frank Hoffman, of West Monroe; John Morris, of Monroe; J. Rogers Pope, of Denham Springs; Julie Stokes, of Kenner; Lenar Whitney, of Houma; and Tom Willmott, of Kenner.

Voting AGAINST shelving HB110 (8): Democratic Reps. Andy Anders, of Vidalia; Regina Barrow, of Baton Rouge; Kenny Cox, of Natchitoches; A.B. Franklin, of Lake Charles; Dorothy Sue Hill, of Dry Creek; Katrina Jackson, of Monroe; Harvey LeBas, of Ville Platte; and Patrick Williams, of Shreveport.