According to The Advocate article appearing Wednesday, Feb. 6, “Letter urges Medicaid expansion,” Gov. Bobby Jindal’s response to the dozens of advocacy groups and individuals that signed the letter was to say: “Medicaid relies on an outdated model that costs taxpayers billions of dollars and produces poor outcomes.”

Let’s get one thing straight in all this discussion over expanding Medicaid. It’s the state that controls the “model” for delivering those services. Yes, CMS (Center for Medicare and Medicaid Services) has to approve the state’s model, but for the past few years — in fact predating the Obama administration —- CMS has been giving the states wide latitude in developing their model through the Medicaid waiver program. If the state’s model is outdated and produces poor outcomes, it’s the state’s fault, not the federal agency.

Just because Department of Health and Hospitals Secretary Bruce Greenstein wants even more flexibility to design the Medicaid program than he already has, doesn’t mean he doesn’t have enough. There are massive changes happening in the delivery of health care in Louisiana, and much of it is happening because of Louisiana’s new Medicaid waiver program championed by Gov. Jindal and Secretary Greenstein.

According to the governor and the secretary, these changes will bring about much more efficiencies in the system and provide better health-care outcomes. If efficiencies translate into cost savings, then where’s the financial argument for expanding services? If it also means improved outcomes, what’s the financial and moral issue with expanding services to cover 400,000 more Louisianans?

Stewart Clark

medical practice management consultant

New Orleans