Gov. Bobby Jindal lost me at “waste.”
OK, he never had me in the first place, certainly not when it comes to his rejection of $16 billion in federal money to provide health insurance for roughly 240,000 of his most struggling constituents. On its face, Jindal’s blatant attempt to shore up his anti-Obama bona fides by refusing to accept the Affordable Care Act’s Medicaid expansion is cruel, short-sighted and remarkably self-centered.
Even so, it was jarring to hear Jindal respond to tough questioning on the subject on last week’s “Meet the Press” by asking, “Why waste these tax dollars?”
As if providing coverage and a modicum of security for those too poor to qualify for private market subsidies amounts to taking a match to a stack of dollar bills.
As if the Medicaid program’s shortcomings would somehow prevent any of that $16 billion from helping people stay healthy or helping hospitals pay their bills.
As if the health and well-being of people who work for a living but barely make one — and that’s the bulk of the population we’re talking about — just aren’t their governor’s concern. Not when he’s got a political point to make on national TV.
Of course, that’s not all Jindal said under host Chuck Todd’s persistent questioning.
He also threw out tired talking points about how Medicaid expansion, financed under the law at 100 percent for the first three years (although for hold-outs like Louisiana, mostly red states led by Republican governors, that window’s all but closed) and at least 90 percent thereafter, is bad because it’s a top down, big government approach.
And he cited an Oregon study, a favorite of Medicaid opponents, which he suggested proves that Medicaid doesn’t improve health outcomes. The much-dissected study itself painted a more nuanced picture; it showed, for instance, that Medicaid improves access to care and reduces the risk that health care costs will cause financial devastation.
But he left out more than a few things. Among them:
- A majority of Louisiana voters, 62 percent according to a recent University of New Orleans survey, want the state to take the money.
- Those who are open to it include two major Republicans who hope to succeed him next year, Lt. Gov. Jay Dardenne and U.S. Sen. David Vitter. Both profess a profound distaste for the ACA, yet both also understand that rejecting the money out of hand is irresponsible.
- Congress didn’t intend to leave out those most in need. It was the U.S. Supreme Court that, while upholding the ACA’s overall constitutionality, decreed that the federal government can’t force states to expand Medicaid. So while governors like Jindal who refuse the money are not violating the law, they’re definitely not complying with either its spirit or its legislative intent.
- The high court has now decided to rule on whether a drafting mistake means that those who buy their insurance through the federal exchange no longer qualify for subsidies.
That means Jindal’s intransigence — specifically his refusal to set up a state exchange, as the law clearly envisioned — has put a second large group of constituents at risk. According to a new estimate by the Kaiser Family Foundation, up to 254,000 Louisiana residents, people who make more than those who’d benefit from Medicaid expansion but too little to afford private insurance policies without help, could lose out on subsidies. The actual number is likely far lower, but still significant; nearly 102,000 residents signed up for insurance on the exchange for this year, a figure that includes those who make too much to receive the subsidy benefit, according to an earlier Kaiser analysis.
Of course, other than Jindal’s particularly harsh word choice last week, this isn’t a new conversation. Nor are his forays into the national spotlight, his attempts to carve out a niche in a crowded field of possible GOP presidential candidates.
Now that the 2014 elections are all but over, though, the jockeying for 2016 is really starting — and so, presumably, is some serious outside scrutiny over how Jindal’s doing in Louisiana.
Last week, Todd got the ball rolling by not only quizzing the governor about health care, but also bringing up the state’s budget woes and his low approval rating among those who know him best, a mere 40 percent in that UNO poll.
Sadly enough, dismissing the real needs and concerns of so many constituents — not to mention leaving the state more financially vulnerable than necessary — may actually win Jindal some points, at least in GOP primary circles.
But it’s definitely not going to help with those dismal Louisiana poll numbers.