Expanding Medicaid: Bobby Jindal’s 47 percent moment?

Bobby Jindal (Photo credit: Gage Skidmore)

By Robert Mann

Forcing Gov. Bobby Jindal to abandon his ill-advised, half-baked tax swap must have been liberating for those Louisiana legislators who have long lived in fear of the petulant governor and his vindictive staff.

Of course, their sudden rush of independence may have less to do with courage and more to do with Jindal’s job approval rating – currently wheels up in the ditch at a dismal 38 percent.

Giving thumbs down to Jindal’s regressive and poorly sold tax scheme was really not all that brave. Not only is Jindal’s popularity in the ditch; the tax plan itself was very unpopular with the public.

Not so with another proposal before the Legislature this week. Lawmakers will vote on whether Louisiana should defy Jindal and accept federal funds to expand its Medicaid program for the uninsured working poor.

As explained by the Associated Press,

The potential expansion would cover adults making up to 138 percent of the poverty level — $15,420 a year for an individual or $31,812 for a family of four. The federal government will cover the full costs of the Medicaid expansion from 2014 to 2016 and pick up most of the price tag after that, requiring states to pay up to 10 percent.

Louisiana would get an estimated $15 billion to $16 billion in federal Medicaid funding over a decade to cover the additional low-income residents.

If you’re looking for courage among Louisiana legislators, you’ll need a bloodhound. In this case, however, we don’t actually need courage. We should merely check the polls and consult the budget numbers.

Pollsters have asked the question in various ways. Each has revealed a majority or plurality of Louisiana citizens in favor of accepting federal money to expand Medicaid. (In its survey, Southern Media & Opinion Research, for example, posed a rambling question that pitted Jindal against Sen. Mary Landrieu, but still revealed a slight plurality for accepting the federal funds.)

The simplest and most straightforward of the questions came from LSU’s Public Policy Research Lab (PPRL) in its annual “Louisiana Survey” (full disclosure: the PPRL is a unit of the Reilly Center for Media & Public Affairs, which I direct).

The PPRL asked the following question of 903 Louisiana residents in February-March: “Do you think the Louisiana state government should accept or reject federal money to expand the Medicaid program for uninsured adults?”

Seventy percent said the state should accept the federal money; only 24 percent wanted the state to reject it.

Jindal, of course, is strongly opposed to the idea, arguing in a newspaper op-ed today that the plan “could cost taxpayers in Louisiana $1.7 billion over the first 10 years of implementation, and the cost will continue to rise.”

Jindal conveniently neglected to inform his readers that his own Department of Health and Hospitals recently published a white paper, which projected that over ten years Louisiana could save between $1.35 billion and $1.57 billion on federal expansion of Medicaid.

Those findings virtually mirror a February report by the Louisiana Budget Project, which concluded that expanding the state’s Medicaid program to cover up to 400,000 low-income adults would cost Louisiana little or nothing.

In a report last year, the Center on Budget and Policy Priorities also examined the proposed Medicaid expansion and noted:

-CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022). The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.

-The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.

-This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured. The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019. The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.

Expanding Medicaid would not only help the insured. As the Louisiana Budget Project notes, “The new federal dollars would help create Louisiana jobs and ensure that doctors, hospitals and other health-care providers are paid for their services.”

These and other arguments have persuaded several Republican governors – formerly opposed to the expansion — to accept the money, including New Jersey’s Chris Christie, Ohio’s John Kasich and Arizona’s Jan Brewer.

“Accepting these federal resources will provide health insurance to tens of thousands of low-income New Jerseyans, help keep our hospitals financially healthy and actually save money for New Jersey taxpayers,” Christie said in February, estimating that his decision would save his state $227 million next fiscal year.

“We are going to extend Medicaid for the working poor and for those who are jobless trying to find work,” Kasich said in February. “It makes great sense for the state of Ohio because it will allow us to provide greater care with our own dollars.”

Just last week, another GOP governor — Republican Gov. Jack Dalrymple of North Dakota — opted to accept the federal funds.

Jindal — tending his presidential ambitions and, therefore, loath to support anything related to Obamacare — remains adamantly opposed.

In fact, Jindal descended to a new low in his Sunday op-ed, attacking these low-income working Americans without health care as freeloaders who would be “dumped into Medicaid. Soon there will be more people riding in the cart than people pulling the cart. The president is gradually turning the world’s greatest health care system into the world’s largest welfare system.”

Just who are these people for whom Jindal has such disdain?

They are Americans with jobs. They earn minimum wage or work part-time. They pay Social Security taxes, property taxes and sales taxes (and would have paid a great deal more in sales taxes if Jindal’s tax swap had passed).

They make about $15,000 for an individual and $30,000 for a family of four.

To Jindal, these people are the 47 percent. He thinks they are deadbeats who want to ride “in the cart” and who refuse to pull their weight. (Has he been hanging out with Mitt Romney again?)

To many, however, they are hard-working citizens who — if they quit their jobs and had no income at all — might easily qualify for Medicaid.

But they don’t. They continue to work at their jobs – harder, in fact, than Jindal does at his.

They value their dignity. They want to work. They support their families the best they can.

And, thanks to Bobby Jindal, they may continue to live without health insurance.

But as our state’s newly independent legislators recently demonstrated, they don’t work for Jindal. They work for us and for the hundreds of thousands of hard-working Louisiana citizens without health insurance.

This week, we’ll not only discover how truly independent they are; we’ll also learn if they have any compassion.

I’m praying for both.

Related articles

• Health-challenged Southern states resist Medicaid expansion (sacbee.com)
• Jindal Not to Follow Arkansas Model on Medicaid (medindia.net)
• Medicaid expansion set for a vote Wednesday (wdsu.com)
• POLL: Jindal 38%. Obama 43%. In Louisiana (dailykingfish.com)
• Former Louisiana Health Secretaries To Bobby Jindal: It’s Time To Expand Medicaid (thinkprogress.org)
• DHH report: La. could save on Medicaid expansion (wwltv.com)