Don’t look now, but the Louisiana Legislature has finally come around and voted for Medicaid expansion.
Not literally, of course. This year, just as in legislative sessions past, lawmakers rejected proposals to accept federal money to expand insurance coverage for the poor via President Barack Obama’s Affordable Care Act. So as of today, Louisiana taxpayers are still paying for residents in other states to be covered, while anywhere from 190,000 to upward of 240,000 folks here — the estimates vary — go without. All this despite the fact that federal ACA subsidies for the somewhat better off remain in place.
But by overwhelmingly adopting House Concurrent Resolution 75, which allows private hospitals to pool dollars to put toward the state match of up to 10 percent, the Legislature went on record in support of the obvious: that Louisiana needs the money and that no matter what anyone thinks of the president and his health care plan, there’s no good reason not to take it.
Many members who voted “yes” don’t admit that. And House Speaker Chuck Kleckley, the measure’s author, walked a rhetorical tightrope in assuring colleagues that they weren’t voting for expansion, even as he pointed out the benefits of doing just that.
On the one hand, Kleckley said, “This resolution does not expand Medicaid nor does it make it easier. It gives an option for the next governor.” On the other, the hospital contribution would free up $100 million to $200 million that the state could sure use for other needs.
“These are real dollars we can save in the state general fund,” he said.
That’s the beauty of HCR75. It allows lawmakers to pave the way for the state to tap into the money, without having to vote for anything associated with the dreaded “Obamacare” in an election year. And because resolutions don’t require gubernatorial signatures, it also bypasses Jindal, who has drawn a line in the sand on the issue as he prepares to seek the Republican presidential nomination. Jindal has gone so far as to dispute the premise that expanding insurance coverage is a worthy goal, an extreme position even among Affordable Care Act opponents.
Despite the governor’s obstinance, there’s a quiet but growing consensus that refusing the money makes no sense — particularly in an era of extreme budget anxiety and at a time when the alternate federal funding for coverage of uninsured patients, upon which Louisiana has long relied, is expected to dry up.
Hospitals are absolutely on board; in fact, the Louisiana Hospital Association is pushing the idea. All four major gubernatorial candidates — not just Democrat and longtime expansion proponent John Bel Edwards but also Republicans Scott Angelle, Jay Dardenne and David Vitter — have signaled they’ll look for a way to take the money, even if they’ve attached conditions to make it clear that they’re not simply swallowing the ACA whole.
And by voting as they did, lawmakers essentially said the same thing. In the end, the margin wasn’t remotely close. The Senate approved the measure 31-8. The House originally passed it unanimously, although five Republican members subsequently switched from the “yea” to the “nay” column.
In doing so, they even put the decision on a fast track. The next governor will take office in early January, and the resolution specifies that, to tap into the money, Medicaid expansion would have to happen by April. That may sound unrealistically fast, but given the dire budget situation expected to greet Jindal’s replacement, perhaps it’s not.
It’s all a lot more complicated than a simple vote on the policy merits. But given the environment in Baton Rouge, the resolution is about the best anyone can expect. This, after all, is a season of workarounds to either comply with or sidestep Jindal’s personal agenda. It’s about time lawmakers found a way to work around him on an issue as important as this.