Though he acknowledged problems, Gov.-elect John Bel Edwards said Tuesday that he would sign the order expanding Medicaid by at least his second day in office and those new enrollees should be carrying their cards by July 1.
Changing the rules that would allow more low-income people to enroll in the government health insurance program has many obstacles, both legal and administrative, that many feared would slow Edwards’ timeline. He promised on the campaign trail to expand Medicaid his first day as governor.
“There is not a challenge there that we won’t meet and overcome,” Edwards said in his first detailed comments about rolling out the program.
“We will set in motion the Medicaid expansion very early on. It may actually be the second day, but within 24 hours of being sworn in, we will issue the executive order,” he said. “That will start the process of expansion, which we believe we will do on July 1, 2016.”
Edwards made his comments as he announced a new health department chief who will spearhead those details after he takes the oath of office Monday.
One of the first comments made by Dr. Rebekah Gee, who was named secretary of the state Department of Health and Hospitals, was that the new administration would have to hire 248 employees to handle the surge, which is expected to add about 300,000 new enrollees to the government program that already provides health insurance for about 1.4 million Louisiana residents.
“This governor,” Gee said, referring to Gov. Bobby Jindal, “has downsized considerably the human resources that we have to tackle big problems.”
The new hires will determine eligibility and enroll the new applicants. The federal government would pay 75 percent of Louisiana’s costs for the hires. “So that’s a little more than $2 million that we’ll need to find” to pay the state’s portion of the hiring expenditures, Gee said.
Gee, of New Orleans, teaches health policy and management at LSU and is the state Medicaid medical director. Escalating Medicaid costs is one of the key issues the Edwards administration will have to tackle.
DHH has 19 agencies, about 7,000 employees and a budget of $9.7 billion to provide services for the mentally ill, developmentally disabled, the elderly and the addicted, as well as public health and medical services under Medicaid. Medicaid spending alone is about a third of the state’s $25.1 billion budget.
Among the reasons Medicaid spending has been growing annually are inflation and more people joining the program.
“I am familiar with the budget problems we’re inheriting,” Gee said. “They are humbling, but we’ll address them.”
Gee was one of nearly a dozen staff and Cabinet announcements Edwards, a Democrat, made at his transition headquarters.
Medicaid expansion is one of the key elements in President Barack Obama’s Affordable Care Act, which was staunchly opposed by Jindal and his Republican allies in the Louisiana Legislature. Jindal argued that Medicaid expansion would saddle the state with unsustainable costs even with the federal government footing 90 percent of the costs for the next four years.
Edwards countered that health care would help the working poor better stabilize their family economics and keep them from slipping into poverty as easily.
U.S. Sen. Bill Cassidy, R-La., has strongly opposed the federal Affordable Care Act and specifically Medicaid expansion, but he told The Advocate editorial board on Tuesday that he sees it as inevitable under Edwards’ administration.
“He made that a campaign promise, and I don’t expect him to retreat from that,” Cassidy said. “I’m all for covering people; it’s just that Medicaid is a broken system.”
Cassidy will be Louisiana’s senior senator when U.S. Sen. David Vitter, Edwards’ opponent in the gubernatorial runoff, leaves office in a year. Cassidy said he suspects that Medicaid expansion will help boost the state’s revenues for a few years, but little savings will be seen in the long run, and by 2020, he predicts, the expansion will become a burden for the state budget.
About a quarter of the state’s population is enrolled in Medicaid.
Expansion would open the rolls to people in households making up to 138 percent of the official poverty level, a complicated formula but, generally, a $33,465 annual income for a family of four.
The U.S. Census Bureau calculates about 11 percent of the families in Louisiana make between the current standard and the new one.
For the next few months, Gee said, she will be working out details, such as who will be covered and for what, with the federal government. At the same time, Gee said, she will be working with doctors, hospitals, clinics and other providers about the paperwork, the procedures and possibly about increasing what they are paid for the services they provide Medicaid patients.
“July 1 is the day I believe that the expansion will actually take place in terms of having Medicaid cards in people’s wallets,” Edwards said. “Between now and then, the administration will work through the eligibility and qualification issues.”
Elizabeth Crisp, of The Advocate Capitol news bureau, contributed to this report. Follow Mark Ballard on Twitter, @MarkBallardCNB. For more coverage of government and politics, follow our Politics Blog at http://blogs.the advocate.com/politicsblog.