After three years of refusing, the Louisiana Legislature seems poised to slip in the Medicaid expansion, a key component of President Barack Obama’s health care law.

Everything in medicine is complex, but as simply as possible, a resolution filed minutes before the deadline would allow hospitals to raise much of what the state would need to add uninsured Louisiana residents, about 250,000 in all, to Medicaid, the government insurance program.

Almost everyone involved asks that Obama’s name be in no way associated with this measure. It’s just a way to help hospitals cover their losses from treating people who can’t pay. Really, that’s all: No Obama.

A half-dozen GOP lawmakers, all speaking on condition of anonymity, said pretty much the same thing: They could support the idea provided their constituents don’t see it as a Medicaid expansion related to “Obamacare.”

All four major candidates for governor, three of whom claim conservative Republican credentials, said Thursday that they’re open to expanding Medicaid rolls. The resolution would circumvent Gov. Bobby Jindal’s scorched-earth opposition to the president’s signature health care law. He has no official role in a resolution.

House Concurrent Resolution 75, filed by House Speaker Chuck Kleckley, would put into motion a framework — already approved by two-thirds of the Legislature and 56 percent of the state’s voters in November — by allowing hospitals to levy a fee. The money would go into a fund that would be used only if the Medicaid rolls are expanded by April 1, 2016 — about four months after Jindal leaves office.

The upshot of Jindal’s stand against this key portion of Obama’s Affordable Care Act is that hospitals, clinics, doctors and other medical care providers aren’t getting paid when they treat the uninsured. These are the people from working families who make too much to qualify for Medicaid but not enough to buy adequate coverage.

Expanding the program would allow the uninsured — about 17 percent of the state’s population — to join Medicaid, and that program would reimburse hospitals for the expensive care they provide to these patients, many of whom can’t pay.

Medicaid is the government insurance program for the poor and covers about one of every four people in Louisiana. The federal government pays the bulk of the program’s costs, but state taxpayers also kick in a portion.

While supporters of the resolution avoid mentioning “He Who Must Not Be Named,” Jindal can’t stop himself. His main argument, sprinkled liberally with the president’s name, is that adding all those uninsured people to Medicaid translates to a $2 billion bill for Louisiana taxpayers over the next decade, for a health care system that is outdated and inefficient.

“It’ll be up to the next governor, the next Legislature to decide for themselves,” Jindal said Thursday of the resolution. “I hope they’ll make their views known to voters.”

About an hour into a Senate hearing Tuesday night, after listening to funding complaints from the private administrators contracted to run the state’s charity hospitals, state Sen. David Heitmeier, sounding exasperated, asked if they had any ideas where to find some more money.

The hospital professionals and their lobbyists chuckled, then leaned away from the mics.

“Don’t everybody answer at once,” said the New Orleans Democrat who chairs the Senate Health and Welfare Committee.

David Callecod, chief executive officer at Lafayette General Health, said he’d take a stab and wandered around an explanation about how federal monies for noncompensated care are being cut to pay for expanded Medicaid coverage. Louisiana hospitals are getting hit from both sides: less federal money is available to pay for the uninsured and the uninsured aren’t able to join Medicaid, which would pay.

Heitmeier asked if the states that expanded Medicaid rolls under the Affordable Care Act are having similar financial issues.

“I really can’t answer that question,” Callecod said.

“That’s a smart thing to do,” Heitmeier responded.

They then talked about recent studies that showed hospitals in states that had accepted Medicaid expansion had reduced the number of patients unable to pay by 20 percent to 70 percent.

Earlier Tuesday, when members of the Louisiana Legislative Black Caucus sat down to talk about their legislative agenda, inevitably discussion turned to taking yet another stab at trying to persuade fellow legislators to expand Medicaid. This year would different.

Platitudes about Christian charity and the needs of “the people,” yes that would change the outcome this time around.

Nah, said state Rep. Marcus Hunter, sounding a lot like Michael Corleone: “It’s in the numbers. It’s all economic.” Tight budgets have won over doctors and hospitals and maybe even some Republicans.

Hunter never mentioned the president’s name.

Mark Ballard is editor of The Advocate Capitol news bureau. His email address is

and he is on Twitter, @MarkBallardCNB.