Medicaid, the federal-state health care program for poor and lowincome Americans, has become a major issue in Louisiana’s gubernatorial campaign. Republican lawmakers have never liked the fact that the Affordable Care Act (Obamacare) has allowed states to expand their Medicaid programs, but 36 states have done it.
Democratic Gov. John Bel Edwards promised to expand Medicaid during his successful 2015 campaign, and he did it shortly after taking office. Former Gov. Bobby Jindal had refused to do it, and he had the support of GOP legislators. Eleven of the 14 states, including all of those in the South, except Louisiana, that haven’t expanded Medicaid have Republican governors.
The Advocate newspaper has done an excellent job of explaining the Medicaid expansion program’s complexities and its pros and cons.
The federal government pays 66.4 percent for the regular Medicaid program and the states pay 33.6 percent. In order to get more states to participate in Medicaid expansion, the federal government picked up 100 percent of the cost of Medicaid expansion for three years.
Louisiana missed out on two of those years because of Jindal’s opposition, but the program is now costing the 36 states that expanded Medicaid only 7 percent of the total cost. The states’ share will go to 10 percent on Jan. 1, and it is scheduled to stay there.
State legislators who are strongly opposed to Medicaid expansion wasted no time attacking the program as soon as Edwards expanded it. However, citizens like features of Obamacare like coverage of pre-existing conditions. And an LSU survey found that state support for Medicaid expansion stood at 72 percent.
Unfortunately, a 2018 legislative audit suggested the state Department of Health spent between $61.6 million and $85.5 million over 20 months on people who weren’t eligible for expansion coverage. It was instant fuel for the GOP critics who have complained for years about rampant fraud and abuse in the expansion program.
The Center on Budget and Policy Priorities, a nonpartisan research institute, said earlier this year that some lawmakers and press accounts were mischaracterizing the 2018 audit. “Some have implied that these cases (in the audit) show fraud,” the Center said. “In fact, the vast majority of these people were eligible when they first enrolled in Medicaid — the state verified their eligibility using electronic data sources, including information on citizenship and income — but their income later changed, which is not uncommon among lowincome people…”
The Center said no one should misconstrue or misrepresent findings like these and then use them to re-impose burdensome processes that deny health care coverage to eligible low-income people.
The Associated Press reported in February that the U.S. Centers for Medicare and Medicaid Services (CMS) said a computer system change launched by the Edwards administration now does quarterly checks, rather than earlier annual checks.
Seema Verma, CMS administrator, in a letter to a U.S. senator questioning the audit, said, “As we understand, recent upgrades to Louisiana’s eligibility systems will help to address some of the issues identified.”
Baton Rouge businessman Eddie Rispone, Edwards’ Republican opponent in the Nov. 16 gubernatorial runoff, was asked during a primary debate whether he would roll back Medicaid expansion. After some hesitation, Rispone said no, but added he would freeze enrollment while he rooted out what he calls waste and fraud in the program. As has been his custom throughout the campaign, Rispone hasn’t revealed details about exactly what he plans to do.
The newspaper report said under an enrollment freeze people who lose their coverage because of additional income would lose their access to health care if their income fell back below the $17,244 annual income for an individual and the $35,544 income for a family of four.
There were about 467,000 people covered by Medicaid expansion as of Oct. 1. Nearly 50,000 have been removed from the rolls under a new state eligibility check system. If a freeze were in place, total enrollment would shrink drastically as people drop off the program and can’t go back on if their income goes down.
The Louisiana Budget Project that advocates for the poor said three states have frozen Medicaid enrollment. It said Utah’s plan was blocked by the Trump administration. Ohio’s governor vetoed a plan because 500,000 people would have lost coverage. And Arizona saw a 70 percent drop in enrollment after it instituted a Medicaid cap in 2011.
The state’s taxpayers aren’t funding the state’s 7 percent share of Medicaid expansion costs. The money comes primarily from fees on health care providers and taxes on premiums paid to the private companies that manage care for Medicaid enrollees.
Medicaid is a health care system that serves 1.7 million Louisiana citizens. It is a complex system that many critics of the program don’t really understand. Any serious and haphazard changes like the freeze would affect the thousands of citizens in this state who have been screened and are being treated for serious diseases.
The bottom line is clear: Medicaid expansion is saving lives in Louisiana.