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Gov. John Bel Edwards

By any reasonable standard, the expansion of Medicaid in Louisiana appears to be a success.

The Louisiana Department of Health said that the number of new enrollees topped 326,000. That's about 50,000 short of the overall goal of getting those eligible under the new rules to sign up.

While we applaud this achievement, undertaken by Gov. John Bel Edwards and his administration, the facts are that there are several significant issues ahead.

One is always going to be cost, although the U.S. government will pay all or close to all of the added costs for Louisiana. The expansion, under the Affordable Care Act, authorizes Medicaid cards for folks up to 150 percent of the poverty level, basically adults working in low-wage jobs; we've got a lot of those in Louisiana.

Health care costs, in the private as well as the public sector, tend to rise at a level greater than the general, and currently quite low, rate of inflation. The Louisiana Budget Project, which supported the expansion, nevertheless highlighted a Kaiser Health News report that Medicaid spending is expected to climb 4.4 percent in the nation in 2017, compared to 2.9 percent in 2016.

At the same time, premium costs have been rising dramatically for the separate exchanges where people buy "Obamacare" policies from insurers. It's a different market, but the increases are also a sign of a cost pressures in health care.

For Medicaid, Louisiana is one of eight states planning to use provider taxes or fees to pay for part of the additional costs. Under former Gov. Bobby Jindal, the state also moved to a managed-care model for Medicaid, with insurers supervising care and seeking to avoid duplication and otherwise get the best bang for the public's buck.

The enrollment goals achieved are good, but the governor, the Legislature and health officials ought to be alert to see that waste is avoided and that the quality of care is high. These are not challenges, obviously, unique to public-sector medicine. But there is a political dimension to this issue.

In this fall's U.S. Senate race in Louisiana, candidates have tended to split on party lines on Obamacare, with Republicans criticizing and Democrats defending it, even if the latter also support improvements if possible. With the issue likely to be a hot one even when its namesake departs the White House, the state that has just expanded Medicaid cannot allow the impression that this is a spendthrift program.

We believe that the good that has so far been achieved far outweighs the costs. Thousands are seeing doctors, perhaps for the first time in years; preventive care can make people healthier, and those with diseases detected early have a fighting chance, even against cancers.

Saving lives, not to mention a healthier Louisiana workforce, is certainly worth it.