If you happen to catch the Republican Governors Association’s new ad attacking Democrat John Bel Edwards for wanting to “expand ‘Obamacare’ in Louisiana,” take the accusation with a big grain of salt.
Not because he wouldn’t do it if elected. As head of the state House’s Democratic caucus, Edwards has been pushing for Louisiana to accept the Affordable Care Act’s Medicaid expansion ever since the U.S. Supreme Court declared that provision of the health care law optional.
But here’s the catch: So, in all likelihood, would all three Republicans on the Oct. 24 gubernatorial ballot. And if that happens, whoever is elected to replace Gov. Bobby Jindal come January would be backed by several big business and reform outlets, groups that speak for some of the state’s highest-profile conservatives.
In fact, one remarkable undercurrent to the race is the candidates’ across-the-board rejection of his harshly ideological opposition to the expansion. Same goes for groups such as the Council for a Better Louisiana, the Baton Rouge Area Chamber and Blueprint Louisiana, each of which recently endorsed expansion for the first time.
That these generally cautious organizations weighed in points to just how obvious a plus Medicaid expansion would be for Louisiana, once you remove Jindal’s presidential posturing from the mix. They don’t ignore the moral imperative of helping people get health care, but they each focus their arguments on the pragmatic advantages.
“If we strip away emotion, there’s a layer of practicality,” said Adam Knapp, BRAC’s president and CEO. His organization is circulating a Power Point outlining the revenue the state is slated to lose without expansion — more than $23 billion over 10 years, according to the Urban Institute. The new federal dollars would support 15,600 new jobs across all sectors and create $1.8 billion in economic activity within two years, the analysis says, and could save $267 million in uncompensated care costs over a decade.
Phillip Rozeman, a Shreveport physician who chairs Blueprint Louisiana, made a similar case.
Rozeman said expansion would be a win for low-income patients, including many who “have jobs that don’t pay a lot but are trying to support their families,” as well as providers like himself, graduate medical education and the state’s precariously funded public-private hospital partnerships.
“It’s hard to watch tax dollars go to the federal government from Louisiana and we don’t get anything back from it,” he added.
Rozeman, Knapp, and CABL’s Barry Erwin said the endorsement discussions weren’t terribly contentious, even among those who don’t like the Affordable Care Act.
While it’s clear that Jindal’s imminent departure creates opportunity for a change in policy, all said the campaign is just one of many factors: Others include the state’s immediate and long-term fiscal woes, the needs of the privatized hospitals, the certainty that the law isn’t going away now that it has survived several legal challenges, the looming reduction in a separate federal revenue stream for uncompensated care and new legislation that allows the state to turn to private hospitals to come up with the local share, which will gradually rise to 10 percent after this fiscal year.
The legislation to adopt the expansion, though, carries a tight deadline of April 1. That won’t be an issue if Edwards wins, since he advocates accepting the expansion immediately. The three Republicans, though, have attached conditions and plan to seek the sort of waiver to create a custom plan that some other states have received — a process that can be slow and contentious.
Lt. Gov. Jay Dardenne has said he’d appoint a bipartisan expert commission to craft an application, and Public Service Commissioner Scott Angelle talks of a free-market approach. Jindal already privatized much of Medicaid through the Bayou Health managed care program, so it’s unclear what more Angelle could demand. U.S. Sen. David Vitter’s terms are most problematic: He wants a work requirement, something the Obama administration rejected when Pennsylvania tried it.
Some of this is surely election-year posturing by candidates who want voters to think they’re eager to stand up to the president, and hopefully whoever wins will keep his eye on the ball.
Unlike the outgoing governor, the next guy is going to have a lot more to worry about than proving his anti-Obama cred.
Stephanie Grace can be contacted at firstname.lastname@example.org. Follow her on Twitter, @stephgracenola.