If Gov. John Bel Edwards sold used cars the way he pitches Medicaid expansion, he would be out of business already.
Last week, Edwards proclaimed to a state Senate panel that expansion would “save” Louisiana $1 billion over the next decade. This builds upon what he asserted last month, when initially he said about $100 million extra would come the state’s way this fiscal year as a result of expansion, later bumping that total higher.
These numbers entirely contradict previous figures calculated by the state Department of Health and Hospitals under former Gov. Bobby Jindal. A report released in 2013, drawing heavily on existing data explained four scenarios that expansion could bring. Two showed relatively small savings over the next decade after implementation that would disappear almost immediately after 10 years, while two others showed huge losses that would continue to compound past 2023.
DHH followed up the next year using data from other states’ expansion experiences that revealed the less-optimistic scenarios seemed more likely. The one most closely reflecting what happened elsewhere predicted a $2.08 billion additional cost to the state from 2014 to 2023, which included a higher federal reimbursement rate than Louisiana will get from 2016 to 2025 but excluded federal legal changes since then that decrease the estimated savings states would realize with expansion.
The Jindal administration used this information to back its refusal to expand Medicaid, and since then, challenges in states that did expand Medicaid have confirmed the validity of those assumptions. Among many others, Ohio saw actual costs twice as high as expected; so did Kentucky, while its health care workforce actually shrank. That’s nothing compared to Illinois, where realized plus projected costs through 2020 nearly have quadrupled to almost $1.5 billion higher than predicted.
Yet with a straight face, Edwards told senators not only had the Jindal administration misinformed them by picking “worst-case scenarios on every variable” but also the sunny projections he embraced came “from the experiences of other states.” So who’s right? Let’s compare each.
Except we can’t. Just as in George Orwell’s dystopian novel “1984,” where the government removed mention of individuals from history books who inconvenienced its current party line, so have the Jindal-era reports become “unpersons” as DHH no longer makes them available on its website. Fortunately, other Internet sites archived them.
But neither does DHH make available a report explaining the sources and derivations of the numbers Edwards bandies about. Only a short statement distributed to the media that explained the initial $100 million “savings” appears to address any of his assertions.
And just as Edwards during his campaign dissembled to audiences by claiming expansion would bring back $1.6 billion annually to Louisiana — that represented additional federal spending apportioned to Louisianians to pay for other states’ expansion costs and had nothing to do with any expansion decision here —– even this argument misleads. Much of the reputed “savings” comes from the state not paying for charity hospital health care for individuals in the 138 to 200 percent federal poverty limit range, accomplished without expansion simply by changing the law to mirror other non-expanded states’ eligibility requirements.
While Edwards peppered his campaign throughout with deceit, he did fulfill his promise to expand Medicaid through power foolishly granted the governor by the previous Legislature. However, he’s broken his pledge “to be open and transparent with the people of Louisiana and give them the facts” by withholding the analysis supporting his pie-in-the-sky assessment of Medicaid expansion from public, independent scrutiny that could assess its quality.
Maybe as he’s trying to sell us a lemon.
Jeff Sadow is an associate professor of political science at Louisiana State University Shreveport, where he teaches Louisiana Government. He is author of a blog about Louisiana politics at http://www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at http://www.laleglog.com. Follow him on Twitter @jsadowadvocate. Write to him at email@example.com. His views do not necessarily express those of his employer.