Beam: Will poor get care they need?

By By Jim Beam / American Press

The poor and low-income residents of

Louisiana who can’t afford to purchase health care insurance have to be

wondering whether

they will have a place to go when they need medical care.

President Obama’s Affordable Care Act offers them a couple of


but Gov. Bobby Jindal has decided the state isn’t going to

participate in those key provisions.

Obamacare is designed to expand

Medicaid, the federal-state health care program for the poor. However,

Jindal considers it

will be too costly three years down the road when federal funding

drops from 100 to 90 percent. The second major feature of

the health care reform law sets up state exchanges where

low-income residents can buy insurance with the help of government

subsidies. The governor wants no part of that either.

OK, so if you can’t get on Medicaid,

where do you go when you get sick? You do like the poor in Louisiana

have been doing

for generations — you go to a charity hospital. Or maybe you

don’t. Jindal is in the process of redesigning the charity hospital

system by turning those operations over to private hospitals, and

their emergency rooms may be your only alternative.

Can those private hospitals take on the additional patient load? There is no definite answer to that question, but there are

plenty of opinions on both sides of the issue.

Dr. Fred Cerise, former director of the LSU system that manages charity hospitals, said this week the Medicaid expansion that

Jindal doesn’t like would help many uninsured Louisiana residents at a time when the state is cutting back on services at

charity hospitals.

Louisiana has some serious health care challenges, Cerise said in a piece appearing on The Atlantic’s web site. He said the

state has the fourth highest number of uninsured in the country, is among states with the highest cost and lowest quality

outcomes for patients with Medicare and is among states with the highest rates of tobacco use, obesity, poverty and infant


If there was ever a state that desperately needs some help with its health care programs, Louisiana certainly seems to fit

the bill perfectly.

However, Jindal administration

officials think they have the health care situation well in hand. And

you can be sure they

aren’t going to give Cerise any credibility. They relieved Cerise

of his duties, claiming he refused to modernize the way

the state’s public hospitals are operated. State officials also

insist private hospitals will improve care at the former charity


We can only hope they are correct, because lives hang in the balance.

Let’s talk for a minute about those insurance exchanges for low-income residents. Half of the 50 states have turned them down,

so the federal government will operate exchanges in those states. Louisiana is unique because of its high poverty rate and

the question is whether the feds can set up a health insurance exchange tailored to the state’s needs.

U.S. Sen. Mary Landrieu, D-La., asked Jindal to participate in those exchanges rather than let the federal government do the

job. And she made a good point.

“As a strong states’ rights advocate, it seems you would surely want to retain this flexibility for Louisiana,” Landrieu said.

Others argue that consumers won’t

notice much difference in the state-run vs. federally operated insurance

exchanges. An Associated

Press poll done in November found that 63 percent of Americans

want states to run the exchanges, while 32 percent favor federal


James Varney, a conservative columnist

for The Times-Picayune and, defends Jindal’s decision to let

the feds run

the insurance exchange in Louisiana. The governor is with the

“overwhelming majority,” he said, and added, “It’s (the exchange)

probably not practical; I can see why a lot of states decided to


Obama’s re-election ensures his health

care reform act is here to stay. Whether it is a lifeline for the

nation’s poor and

low-income residents or is destined to fail remains to be seen.

The best the reluctant states can do is try to make the best

of what they think is a bad situation. Some think Obamacare is a

good deal for Louisiana; others don’t.

Ron Pollack, executive director of

Families USA, called Louisiana “one of the biggest winners of the

Affordable Care Act.”

He said the state has one of the highest percentages of low-income

workers who would qualify for Medicaid under the act and

those costs would be picked up by the federal government during

the first three years of the program.

U.S. Rep. Bill Cassidy, R-Baton Rouge, and a practicing physician, said the money isn’t there, whatever the cost.

“Our state is cannibalizing every other

part of the budget to pay for Medicaid,” Cassidy told The

Times-Picayune. “This is

before the additional $1.8 billion over 10 years required for the

state portion of this expansion. How much higher does tuition

have to go? How much lower does funding for K through 12 have to

go? How many more prisons have to be shuttered, how many

roads and bridges will not be built or updated in order to do


Trying to determine which side is right on these critical health care issues is virtually impossible at this point. It’s simply

too early to tell. Meanwhile, pity the poor and low-income citizens of Louisiana who are wondering whether they are going

to be denied health care advantages soon to be enjoyed by their counterparts in other states.

• • •

Jim Beam, the retired editor of the American Press, has covered people and politics for more than five decades. Contact him at 494-4025 or