For the first time, state legislators opened a crack in the political door that could lead to Louisiana participating in Medicaid expansion — a key component of the Affordable Care Act — but only after a new governor takes office.
A state House panel Monday advanced legislation that would allow Louisiana hospitals to assess fees on themselves to attract more federal dollars for patient care. But it would only take effect if the state agrees to change Medicaid income qualifications to sign up uninsured people who make too much to join the government coverage but too little to buy adequate insurance on the private market.
Gov. Bobby Jindal opposes Medicaid expansion, but the resolution could be passed by both chambers of the Legislature without going to governor for his signature, thereby avoiding his veto.
“This governor has made very clear what his position is. There’s nothing I can do about that,” House Speaker Chuck Kleckley said. But Kleckley said he wanted the next governor who takes office in January to have the funding option.
“All four candidates have said they would look at some kind of expansion,” he said. “These are dollars that could benefit the state.”
Kleckley referred to candidates for governor in the election that takes place later this year: Public Service Commissioner Scott Angelle, Lt. Gov. Jay Dardenne and U.S. Sen. David Vitter, all Republicans, and state Rep. John Bel Edwards, a Democrat.
The House Appropriations Committee, without objection, sent the measure — House Concurrent Resolution 75 — on to the full House for debate.
Representatives of Jindal’s office put in “red” cards in opposition to the measure. No one spoke against it.
Kleckley said the assessment hospitals would levy on themselves could lead to freeing up $100 million to $200 million in state dollars, which could be used to fund higher education and other budget needs.
“These are the hospitals taking their money, reinvesting in the state of Louisiana,” Kleckley, R-Lake Charles, said. “These are real dollars.”
The state’s hospitals, which like other groups that rely on government health care dollars, are continuing to face major cuts because of continuing state fiscal problems.
Health care and higher education are exposed to the deepest budget cuts next fiscal year as the state is $1.6 billion short of funding the state operating budget.
Louisiana Hospital Association President Paul Salles said the extra hospital dollars would be used to draw down federal funds to cover the Medicaid expansion costs. “This legislation is a commitment, a significant commitment by hospitals to be a part of the health care solution in Louisiana,” he said.
House Appropriations Committee chairman Rep. Jim Fannin wanted assurances that hospitals would not charge patients an extra fee to generate the dollars.
Salles said there would be no pass-along charges.
Under the resolution, Medicaid coverage expansion would have to occur prior to April 2016 in order for the assessment to be triggered. If it is not done by that point, Kleckley said, a new resolution would have to be proposed.
Last week, legislative committees on the House and Senate side killed efforts to force Louisiana into Medicaid expansion. Both measures gave state officials options of designing a program that fit Louisiana needs, instead of expanding traditional Medicaid. The sponsor of one measure, Edwards, the Democratic candidate for governor, suggested that Jindal use the private insurance model that he’s implemented for two-thirds of Louisiana’s Medicaid population.
The committee votes came largely on partisan lines with Democrats favoring the expansion and Republicans opposing it. Republicans joined Democrats in advancing Kleckley’s resolution on Monday.
The Affordable Care Act, known as “Obamacare,” allows expansion of Medicaid eligibility to 138 percent of the federal poverty level. Jindal has contended that Medicaid is a broken system and would cost the state too much down the road. The federal government pays 100 percent for the first three years.
After that the federal share declines gradually to 90 percent with the state making up the difference.
During a recent forum on the governor’s race, none of the four major gubernatorial candidates completely ruled out expansion, as Jindal has done.
Edwards, the only major Democrat in the running, said the state is missing out on millions that could improve health care by not considering expansion.
The Republicans have each expressed interest in exploring the state’s options. Angelle called for “a conversation” on expansion. Dardenne expressed interest in developing a waiver to let the state craft its own expansion model. Vitter said he hasn’t taken expansion off the table.