What happens when the dog actually catches the car it chases? Louisiana Republicans could face this reckoning with Medicaid expansion.
Ever since Gov. John Bel Edwards expanded Medicaid unilaterally, the Democrat and his administration’s functionaries have campaigned relentlessly to distract the public from this lemon of a deal. As the program’s history keeps unfolding, this becomes increasingly difficult.
Early on, the administration argued that expansion “saved” money. This claim resembled truth only in that triggering expansion also instituted a fee increase — essentially a tax increase — on health insurance policyholders and the sick treated in many hospitals to fund the state’s portion of expansion costs. Without that, it was a net drain on the budget.
Soon, even these hikes won’t cover the added costs. By 2020, the state's share of payments will increase to 10 percent or up to roughly $310 million annualized, more than offsetting the entire tax increase.
The Edwards administration also touts expansion coverage of just over a half million people (50 percent more than projected), as if these enrollees previously had been bereft of health insurance. In reality, the Louisiana Department of Health’s own health insurance survey suggests that nearly half of the covered population before accepting expansion used to procure its own insurance. Their switch to the government dole will cost state taxpayers directly about $150 million extra this next fiscal year.
Most recently, LDH questioned through the mail more than 37,000 Medicaid clients, almost all qualifying through expansion, about their eligibility. This came on the heels of the Louisiana Legislative Auditor determining the expansion population has prompted a surge in improper payments. Just from a small recipient subgroup, the auditor's office estimated that ineligible participants cost the state as much as $35 million a year since expansion started.
LDH officials tried to explain away their slowness to question Medicaid clients by suggesting they couldn't really drill down on the data until a new eligibility verification system was recently installed. But LDH could have mitigated such waste if, just after Edwards took office, it hadn’t relaxed stricter eligibility verification requirements commonly used in other states. The Edwards administration also automatically enrolled into Medicaid expansion food stamp recipients, who have a 6.3 percent rate of illegal participation.
By extending as vigorously as possible a free government goodie to many who already could afford it — and growing government to match — the expansion has served as a vote-getting scheme for Edwards in his reelection attempt this year. And that’s the problem for the GOP.
Its gubernatorial and legislative candidates can hammer Edwards and Democrats on how expansion became just another wasteful way to redistribute wealth. But they can’t threaten to end it just like that.
Besides, with some legal scholars believing states that accepted expansion can’t back out, human nature makes that politically risky. Once people become accustomed to receiving a government freebie, they often look askance at politicians who want to take it away without an alternative. Ending expansion without a replacement will cause some of its beneficiaries who typically vote for Republicans to defect in 2019.
So, GOP campaigners should promise to keep expansion temporarily while imposing small monthly premiums, co-payments for services, and work-like requirements on its recipients — all allowed by federal law or regulation. It’s the least those receiving this gift from taxpayers can do to pitch in, especially as the federal government estimates Medicaid spending growth will surpass economic growth — particularly in expansion states — over the next decade.
Medicaid expansion put Louisiana on an unsustainable path. The most effective message from Republicans this year would be a pledge to stop the bleeding now on the way to curing the patient in the future.
Correction: My March 3 column stated that spending from state revenue sources (excluding federal dollars) increased 40 percent during the tenure of Gov. John Bel Edwards. In fact, that spending increased 11 percent. I regret the error.
Jeff Sadow is an associate professor of political science at Louisiana State University-Shreveport. He is author of a blog about Louisiana politics at www.between-lines.com and writes about Louisiana legislation at www.laleglog.com. Follow him on Twitter, @jsadowadvocate or email firstname.lastname@example.org. His views do not necessarily express those of his employer.