Medicaid was always bound to be an issue in this fall’s governor’s race.
That’s particularly true because Gov. John Bel Edwards considers expansion of the program to cover many working poor Louisianans — more than a half million at last count — both a political and moral high point of his term. It’s also true because Medicaid in general sucks up an astonishing 41 percent of Louisiana’s spending, and anyone looking to label the Democratic governor a tax-and-spender would naturally look there.
Just how it will play out, though, has been something of a mystery. Would Edwards’ Republican rivals go so far as to propose reversing the governor’s 2016 executive order adopting the expansion?
The answer, apparently, is no.
Edwards’ two Republican rivals started to clarify their positions at an event this week in Baton Rouge staged by the Republican Governors Association and hosted by the local chapter of Associated Builders and Contractors. And neither called for an all-out abolition of the program, which is largely financed by federal dollars that would otherwise be spent in other states, as Edwards is fond of pointing out.
U.S. Rep. Ralph Abraham, a physician who represents a relatively poor northwest Louisiana district, said that he would not roll back Medicaid expansion, but would rather seek to reduce the enrollment in other ways such as tighter oversight and expansion of other options.
“I want the voters to understand nobody’s going to get kicked off the rolls. But are we going to make this program better for the taxpayer and those that need the program? Absolutely, and that’s just good common sense,” he said.
The other Republican in the race, Eddie Rispone, wasn’t quite so definitive. He told the audience that he’d try to “freeze” the program to stop adding new people and embark on a deep evaluation. What that would mean for patients who meet eligibility requirements, and how long they’d have to wait, are two huge questions Rispone's position would raise.
The larger point, though, is that Medicaid expansion appears to be here to stay.
This really shouldn’t surprise anyone. Although former Gov. Bobby Jindal refused to adopt expansion, originally a key part of President Barack Obama’s Affordable Care Act but later deemed optional by the U.S. Supreme Court, Jindal's opposition was clearly aimed at a national political audience. By the time he was ready to leave office, even the Republicans running against Edwards to replace Jindal agreed that expansion was a good deal for the state, although none quite so enthusiastically as Edwards.
Since the governor took office, he’s frequently touted the benefits of the program — not only the influx of federal money and the economic growth it’s fueled but also individual stories of Louisianans who are getting preventive care, discovering diseases while they’re treatable and getting chronic conditions under control. He obviously feels a good deal of pride in what’s happened on his watch, as he should.
That doesn’t mean there haven’t been controversies.
For a while, Attorney General and regular Edwards critic Jeff Landry was pushing the tenuous argument that expansion could lead to an increase in opioid abuse, although he’s since moved on to picking other fights.
And quite a few Republicans have zeroed in on a legislative audit that showed that some $85 million in Medicaid money might have been misspent. Their concerns are serious but are also undermined to some extent by the administration’s new system aimed at better ensuring that enrollees meet all eligibility requirements.
The GOP-controlled Legislature also briefly considered adding work requirements for enrollees, and Edwards said he’d consider supporting it depending on the specifics. But legislation turned out to be complicated, and the potential savings versus cost of enforcement questionable. Nothing ever passed.
All this is happening against a national backdrop that suggests many Americans, even in conservative states, support the program. Several Republican states have recently followed Louisiana in adopting Medicaid expansion, including some by public referendum. The most recent to move in that direction is Kansas, where Democrats and moderate Republicans in the House this week passed an expansion measure.
That doesn’t mean Medicaid won’t be a topic for plenty of debate. After all, both sides see an advantage is using it to score points.
It does mean that, as Abraham said, people who’ve gotten insurance through the expansion don’t have much reason to worry that their benefits will disappear.