Accept new Medicaid money, Gov. Jindal: Editorial | NOLA.com

The new head of LSU's battered public hospital system acknowledged the obvious this week: Without the expansion of Medicaid under the Affordable Care Act, Louisianians will suffer. If that happens, the state will be to blame.

In a show of partisan solidarity, Gov. Bobby Jindal has said Louisiana will opt out of the Medicaid provision under President Barack Obama's health care plan. The governor argues that the federal budget can't absorb the cost of greater Medicaid spending. On "Meet the Press" in July, he said: "Look, federal dollars aren't free. Those dollars are coming from us, our children, our grandchildren. We're borrowing money from China to spend on government programs we can't afford. The best thing we can do is help people get good-paying jobs instead of giving them federal programs."

The federal debt is massive, and the White House and Congress need to get a grip on spending. But Gov. Jindal's primary concern should be what is best for his own people -- and thousands of them need a way to pay for medical care. In New Orleans, the Musicians' Clinic is stepping up fundraising and bracing for continued financial difficulties if the state doesn't agree to expand Medicaid. A letter on its website from founders Bethany and Johann Bultman says the clinic is "facing a heavy downpour." The clinic is only one example of the ripples that the lost funding could have on our community.

The governor didn't argue after Hurricane Isaac that the state should forgo aid because the federal government is strapped for cash. Nor should he. Isaac visited misery on thousands of residents in south Louisiana, and storm victims need the full array of disaster aid the federal government can provide.

The number of Louisianians without health care is at a crisis level as well. About 20.8 percent of residents -- 938,000 people -- didn't have health insurance in 2011. Only Texas and Nevada had a higher proportion of uninsured. Gov. Jindal's administration could cut into that number significantly by accepting the reimbursement in the Affordable Care Act -- and should do so.

For the first three years, 2014 through 2016, the federal government will pay 100 percent of the cost of expanding Medicaid to cover people whose income is 133 percent of the poverty level. That income threshold is $29,326 for a family of four.

Even after the first three years, the vast majority of the tab would be paid by the federal government. At the most, in 2020 and beyond, the state would be on the hook for 10 percent of the cost. Dee Mahan, deputy director of health policy at Families USA, a nonprofit consumer health care advocacy group, argues that taking the money is sensible policy.

"Why wouldn't governors take advantage of this program, particularly during the first three years when you get 100 percent reimbursement and have a chance to reduce the cost of uncompensated care and get more health care to your citizens?" she said in September. Why, indeed?

The short answer: politics. With Republican nominee Mitt Romney trying to unseat President Obama, the nine Republican governors rejecting the Medicaid provision surely don't want to give the president's plan any currency. Depending on what happens Nov. 6, perhaps Gov. Jindal will see that the wise course for Louisiana is to take the extra Medicaid money. He ought to see that now.

The administration is already making deep cuts to LSU's public hospital system because Congress in July did away with a provision that had sent extra Medicaid money to Louisiana after Katrina. LSU announced $152 million in reductions earlier this month that will eliminate about 1,500 jobs, force specialty clinics to cut back hours and upend the health safety net for Louisiana's poorest residents.

Dr. Frank Opelka, who took over the LSU hospital system last month, has said that the state is talking to private providers about taking on more uninsured patients to blunt the current round of cuts. But state health officials haven't provided details and couldn't answer lawmakers' pointed questions about what the level of care would be at private hospitals and whether certain treatments would be denied.

The patients who get treatment through the state's public hospitals typically have serious health problems. Are private hospitals willing to take them on? If so, they are certainly going to want decent compensation.

Dr. Opelka and Bruce Greenstein, secretary of the state's Department of Health and Hospitals, say the care at private hospitals will be paid for by federal health care dollars. And yet the state is resisting an infusion of federal health care dollars going forward? That makes no sense.

Dr. Opelka seems to understand the illogic of that position. "I don't know how we can handle the underinsured without strong consideration of the Medicaid expansion. I can't do the math and get it to come out where it works," he said Tuesday. The math doesn't work out. And Gov. Jindal should acknowledge that and take the money being offered.

Source: http://www.nola.com/opinions/index.ssf/2012/10/accept_medicaid_money_gov_jind.html

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