With a call for a “pragmatic” approach to the expansion of Medicaid health care for the poor, the leaders of the Together Louisiana alliance of congregations has challenged Gov. Bobby Jindal and lawmakers to work with the federal government on expanding health coverage for the poor.

“We don’t need an ideological discussion about Obamacare,” the Rev. Melvin Rushing of Baton Rouge told a State Capitol rally. “We need our state’s technocrats to sit down with the national Medicaid technocrats, and work through this issue as the practical, pragmatic matter it is.”

Pragmatism goes only so far in politics.

Some Republican governors work with the Medicaid expansion, part of the national health-care law pushed by President Barack Obama. Part of it allows a family earning up to 138 percent of the poverty level — about $2,600 a month for a family of four — to get Medicaid coverage.

That’s an increase over Louisiana’s lower income levels for Medicaid, but it’s still not a huge income for families.

Legislators are so far not listening to those pushing for broader coverage for the poor. Yet the testimony of the advocates reveals a problem in the lives of lawmakers’ constituents.

A physician, Julie Assercq of Baton Rouge, told the Together Baton Rouge rally of a patient who broke her hip, lost her low-paying job, and faces a $45,000 medical bill.

Medicaid is not perfect, she said — agreeing with Jindal on one of his talking points — but it’s a great help with catastrophic medical events that overwhelm the finances of the working poor.

Louisiana is behind only Texas in the numbers of uninsured adults.

“Louisiana ranks last in the nation or close to it in cancer mortality, diabetes, low birth (weight babies), infant mortality, preventable hospitalizations,” Rushing said. “Overall, we rank 49th in health outcomes.”

It is those statistics that are going to be an issue in Louisiana, no matter whether Jindal shows any signs of conversion to pragmatism. Health care for those working in low-wage jobs is an important economic issue as well as one with social — if not moral — challenges for society.