Louisiana has a lot to lose if Gov. Bobby Jindal continues to reject state participation in the federal health care revamp known as the Affordable Care Act.

That was the bottom line of a missive Mary Landrieu, Louisiana’s senior U.S. senator, wrote Jindal this week about the new law.

Landrieu, a Democrat, laid out the law’s benefits to Louisiana as she urged Jindal to reconsider now that the presidential election is over and Jindal’s choice, Republican Mitt Romney, lost.

Landrieu reminded that key deadlines are fast approaching.

Jindal must decide by Dec. 14 whether Louisiana will run its own “health-care exchange” or, as Landrieu put it, “cede the authority” to the federal government to set up and run the marketplace — most likely a website — that will allow consumers to price and compare different coverage plans offered by competing insurance companies.

Regardless of what Jindal announces on Dec. 14, the federal government set a Feb. 15 deadline to have set in place a plan to create the exchange. If Louisiana doesn’t outline by that date what would be included in the “Essential Health Benefits” package, the federal government will decide for the state.

Landrieu also encouraged Jindal to take advantage of the Medicaid expansion the law affords states beginning in 2014. She noted it would provide health insurance to up to 400,000 Louisianans at little or no cost to the state. “This includes up to 240,000 workers who sustain industries that are vital to Louisiana’s economy, including construction, tourism, retail and food service,” she wrote.

Landrieu suggested the expansion would benefit the state budget, with federal funds covering $25 billion of the $26.8 billion estimated cost over 10 years. “That’s an additional $26.8 billion flowing through the state’s economy that will increase state revenues and support our hospitals, other health-care providers, and the myriad of businesses that serve these providers and their patients,” she said.

To date, Jindal has shown no signs of budging from his position, declaring on national television that he continued to oppose the ACA and more legal challenges remained. He wrote a treatise on the ills of the ACA as he notified federal officials that the state would not set up its own health-care exchange.

But there’s discontent forming among the state’s health care provider groups that are considering many of the points Landrieu is making and looking at Louisiana’s continuing budget woes, which have eaten into health-care financing.

Both the Louisiana Hospital Association and the Louisiana State Medical Society have meetings scheduled for next week with the subject on their agendas.

“We stand ready to support patients and their physicians in this time of change,” said LSMS Executive Vice President Jeff Williams.

“I think you will see different groups attempting to get the administration to do something — either Medicaid expansion or some type of negotiation with (U.S.) Health and Human Services,” said LHA Vice President Sean Prados.

Prados said hospitals are concerned because cuts in Medicare payments and uninsured care dollars are being used to help pay for the expanded Medicaid coverage. “We could lose those dollars to other states for expansion,” he said. “It’s multiple hits on providers and patients.”

The financial considerations are coming at time when state health-care officials are negotiating deals with certain private sector operators for LSU hospitals, committing uninsured care and other special health care dollars which could be scarcer under the Affordable Care Act.

“There’s a lot of people talking to a lot of people right now,” said Prados.

Marsha Shuler covers health care policy issues for The Advocate’s Capitol news bureau. Her email address is mshuler@theadvocate.com.