Beam: Give Medicaid plan second look

By By Jim Beam / American Press

Some Republican governors in this

country have decided participating in Obamacare’s Medicaid program might

not be such a bad

idea after all. However, Gov. Bobby Jindal says it isn’t going to

happen in Louisiana, and he made that clear once again last


“Medicaid relies on an outdated model

that costs taxpayers billions of dollars and produces poor outcomes,”

Jindal said. He

was responding to a letter from 44 non-profit organizations

pleading with him to reconsider joining the program that begins

in 2014.

Bruce Greenstein, the governor’s secretary of the state Department of Health and Hospitals, was even more emphatic.

“I want to make it absolutely crystal clear: We are not expanding, this (letter) does not change our mind, this is not a good

deal for the state,” Greenstein said.

Just what is Medicaid anyway?

The state and federal government teamed up to operate the Medicaid program that provides health care coverage for lower-income

people, families and children, the elderly and people with disabilities. Each state operates the program differently.

The Affordable Care Act, better known

as Obamacare, will expand the number of people who qualify for Medicaid.

The 400,000

people in Louisiana who would benefit will be in what The

Washington Post calls “a sort of no-man’s land.” They live below

the poverty line ($11,170) and won’t qualify for federal subsidies

to buy health insurance. They won’t be on Medicaid either

if the state doesn’t participate in the program.

LaPolitics Weekly reported last week that 51 percent of 600 state voters who were polled want Louisiana to participate in

expanded Medicaid, and 43 percent are opposed. The survey was commissioned by the Louisiana State Medical Society.

Hospitals have a big stake in the

outcome because the federal government plans to reduce payments

hospitals receive for giving

health care to the poor. The payments are being reduced because

the theory was those folks would be joining the Medicaid program.

“States that don’t expand coverage will sentence their hospitals to treating big pools of uninsured people even as payments

for doing so fall...,” said National Journal, a political news magazine in Washington, D.C.

A state senator in South Carolina, which is opting out like Louisiana, said, “There’s no question we will see massive closings

of hospitals.”

Republican governors in five states —

Arizona, Nevada, New Mexico, North Dakota and Ohio — have changed their

tunes and decided

joining the expanding Medicaid program might be a good idea.

However, legislatures in some of those states may have the final


Congress, under Obamacare, will pay all of the Medicaid expansion costs for the first three years and 90 percent after that.

That is far more than the federal government contributes under the existing federal-state split.

Jindal said the program will cost

Louisiana more than $1 billion over 10 years. He explained his concerns

in an e-mailed statement.

“New federal guidelines might be a step

in the right direction, but they are not yet final, do not go far

enough and fail

to address key issues,” he said. “Medicaid still operates under a

1960s model of medicine with inflexible, one-size-fits-all

benefits and little consumer engagement and responsibility.”

Jindal got some support last week from

the conservative Heritage Foundation that talked about the five

governors who are now

thinking about joining the program. It said the country’s mounting

federal debt may eventually force cutbacks in federal programs

like Medicaid, and their states could be left “holding the bag.”

“... These governors may be looking at a short-term bump in new federal dollars, but the longer view shows that over time

this new revenue disappears and the cost of expansion continues to rise...,” the foundation said.

Some argue that states not

participating in Medicaid expansion will be leaving billions of federal

dollars on the table. In

the case of Arizona changing its mind, National Journal said the

state will spend $3.1 billion on the expansion over the next

10 years and receive $17.3 billion in federal funds. Arizona Gov.

Jan Brewer said that money will protect hospitals from excessive

costs, create thousands of jobs and provide health care to large

numbers of uninsured people.

The letter sent to Jindal by those non-profit groups repeated the same arguments, adding that Louisiana would receive $15.7

billion over the next decade. It didn’t move him one bit.

Anyone who knows Jindal realizes that once he makes up his mind on almost any issue, he doesn’t waver — unless he benefits

politically in the process. The governor refused two years ago, for example, to support renewal of a 4-cents-per-pack tax

on cigarettes. However, he now wants to add a $1-dollar-per-pack increase to the existing 36-cent tax in order to replace

some of the revenues lost by eliminating the state’s income taxes, which is politically popular.

Although some refuse to accept the fact

there are people in this state who are truly poor and unable to take

care of all of

their needs, they do exist. Medicaid has helped hundreds of

thousands of them get the health care assistance they need for

their very survival. Maybe opting out of this new Medicaid program

is the right answer, but maybe it isn’t. That is why the

Legislature needs to be a full partner in the final decision.

• • •

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