Maybe it’s the difference in the images: fresh faces brimming with promise versus weary looks of the stress of an all-too-realistic present.

Most of the conversation has focused on the Jindal administration’s plans to cut higher education. Talks about hacking a similar amount from health care budgets have received little attention, even though the cuts will have direct impact on one of every four Louisiana residents.

But that’s not totally true in the world that state Sen. David R. Heitmeier inhabits.

As head of the Senate committee in charge of overseeing how health care is delivered to the state’s poor and uninsured, about the only conversation the Algiers Democrat has these days is what to do about whacking another $250 million or so from the roughly $9.5 billion health care budget.

It doesn’t sound significant, but in the eye-glazing conversation of health care financing, the cuts are huge, possibly devastating, he said. The takeaway is that for every 38 cents put up by state government, the federal government contributes 62 cents.

That means $200 million removed by the Jindal administration translates to about $700 million in real money that won’t be available to pay doctors who care for sick people who are poor.

“I don’t think we can afford to do that to Louisiana’s most vulnerable population,” Heitmeier said.

University leaders mount tableaus of faculty packing their desks and labs gathering dust. Health care, on the other hand, is administered by officials appointed by the governor and apparently they’ve read the memo about keeping their mouths shut.

Jeff Reynolds, undersecretary at the state Department of Health and Hospitals, says until the administration decides which course to take, it’s premature to share the possibilities with taxpayers.

“None of the scenarios is good,” Heitmeier said.

Medicaid is funded partially by the state and largely by the federal government. Medicaid pays doctors, hospitals and other providers for the care given to the poor and uninsured. In Louisiana, that’s more than 1 million people, most of them elderly or children.

Some of the services offered by Medicaid are optional, others are mandatory. Heitmeier says some of the optional services are exposed. There’s money to pay for those folks who don’t qualify for Medicaid but can’t afford adequate insurance on their own. There also are dollars for pharmaceuticals. All that could be cut.

As part of the Affordable Care Act, the standards would have changed to allow more uninsured Louisiana residents to qualify for Medicaid. But there was widespread partisan opposition to the idea.

Gov. Bobby Jindal, who says he believes that everyone should be provided access to health care, opposed Medicaid expansion and it didn’t happen in Louisiana. Jindal argued that eventually even the small portion Louisiana would have been required to pay would be unsustainable for the state’s taxpayers.

Still, the money the federal government would have contributed to expand Medicaid could have filled some existing budget holes. It could have been used to help pay the doctors at the public-private partnerships that replaced the charity hospitals, pay for care of prisoners, and things like that. “It would have definitely freed up some funds,” Heitmeier said.

Jindal established Bayou Health, five private insurers to handle Medicaid rather than a government bureaucracy. Physicians, in general, don’t much like it. And there are questions about whether Bayou Health actually saves taxpayer dollars.

“We have no idea if it’s working or not,” state Treasurer John N. Kennedy said. “How can you manage something that you can’t measure? There has been no objective analysis done on whether we’re saving money, we’re breaking even, we’re spending more. Nobody knows.”

Calder Lynch, the chief of staff at DHH, says that the agency is working with Legislative Auditor Daryl Purpera to identify appropriate evidence. But, for him, the bottom line is that every single U.S. state has Medicaid and the costs grow at about 6 percent each year, largeldrugs are more expensive and because of the general, unchecked inflation of health care expenses. But since Bayou Health was installed a couple years ago, costs have only grown at about 3 percent, he said.

That wasn’t how the program was sold by Jindal and his advisors. They said it would “save money.” Legislators heard “cash in the pocket,” rather than “costs won’t grow as quickly.”

But for Kennedy the real issue is spending.

“It’s simple: We spend more than we take in. We have for years,” Kennedy said. “And if you look at our biggest problem, it’s the fact that we have not controlled the cost of health care.”

Mark Ballard is editor of The Advocate Capitol news bureau. His email address is mballard@theadvocate.com and is on Twitter @MarkBallardCNB. Follow our Politics Blog at http://blogs.theadvocate.com/politicsblog/