Years from now, when we look back at Louisiana’s 2015 gubernatorial race, I suspect we’ll view this week as the campaign’s real beginning.
U.S. Sen. David Vitter’s acknowledgement that, if elected governor, he’d consider the Medicaid expansion that Gov. Bobby Jindal absolutely, unequivocally refuses to entertain marks a genuine turning point. It’s the end of the era in which partisan absolutism and one politician’s national ambitions dictate what’s possible, and the beginning of a more pragmatic, more responsible and long overdue conversation about what’s best for the state and its residents.
Of all the politicians either running or contemplating a campaign, Vitter’s the one whose position sets the parameters of the debate. Republican Lt. Gov. Jay Dardenne is already on record cracking the door open, but he’s always been somewhat moderate. State Rep. John Bel Edwards favors the expansion, but he’s a Democrat.
Vitter’s the hard-liner, the one who claims to detest the Affordable Care Act as much as the governor does, who holds the field’s right flank. He also happens to be about the most deliberate politician around. If he says he’s open to the idea, then there’s a very good chance it could happen, that the state will find a politically palatable way to take the federal money available, insure hundreds of thousands of its neediest residents, and shore up its health care system’s balance sheet.
Make no mistake, Vitter didn’t endorse the Medicaid expansion in his address Monday to the Press Club of Baton Rouge. Nor did he say a kind word about President Barack Obama’s vast health care revamp; this is a guy, remember, who’s spent months pursuing a misleading, headline-chasing effort to deprive members of Congress and their staffs of the employer subsidy that people who work for most large organizations still enjoy, all in the name of erasing some supposedly special exception to the ACA.
What Vitter did say was this: “We need to improve and reform Medicaid, and I want to look at everything that could be brought to bear to do that. Now, could more federal resources help to do that? They could, if it’s done right and if it’s done in a constructive way.”
The conditions he named sound suitably tough and skeptical of the ACA. But when you think about it, they’re also pretty easy to meet.
Vitter said any expansion shouldn’t divert money from higher ed. It wouldn’t, because as everyone who even casually follows state finances knows, health care and higher ed are the two major unprotected budget areas, and often find themselves competing for scarce resources. More federal money for health care would leave higher ed better positioned, not worse.
The senator said he’d want to make sure Medicaid expansion wouldn’t provide disincentives to work, but that too is unlikely to happen. Under the current system, able-bodied adults only qualify for Medicaid if they have dependent children and earn 12 percent — that’s right, just 12 percent — of the poverty limit. Expansion was designed to cover people, regardless of parental status, who make up to 133 percent of the poverty limit, at which point they shift over to the health care exchanges. Eligibility is not linked to job status, and there’s really no incentive to try to make less in order to receive Medicaid because those who make slightly over the limit have access to generous subsidies for private insurance.
Vitter also said he’d only consider accepting the money if the “pretty broken system” can be reformed. Other Republican-led states have been negotiating various waivers with the feds, and there’s no reason Louisiana couldn’t attempt the same. As Dardenne has said, “I don’t think there’s been adequate discussion of what’s possible.”
That Vitter too is ready to have this discussion is huge. It suggests that, contrary to his assertion Monday that he’s still doing his homework on state issues, he understands perfectly the financial picture he’d inherit if elected. (Years ago, when I profiled him for The Times-Picayune, his wife, Wendy, told me that her husband actually likes to look at budgets. “Most people consider that boring,” she said. “He enjoys it.”)
Thanks to Jindal and the legislators who refused to put the matter to a statewide vote, Louisiana will likely never get to tap into the ACA’s three-year, 100 percent match for Medicaid expansion. By the time the next governor takes office, passes a budget and puts the pieces it place, the program’s first three years will be up. Instead, the feds would contribute 95 percent in 2017, and a little less each year until 2020, when the match would bottom out at 90 percent.
Even so, Medicaid expansion is still a great deal, especially considering the likelihood that federal compensation for uninsured care, which Jindal’s plan relies upon instead, will likely dry up in coming years, given the policy shift toward much wider coverage.
And it’s about time the people who want to lead this state start looking for a way to take it.