Ever wonder what it looks like when a problem is identified and addressed?
Well, it looks kind of like what’s happened lately with Medicaid enrollment in Louisiana.
After determining that they earned too much to qualify, the state recently removed roughly 30,000 people from the rolls of the public insurance program that aims to provide low-income people with health care.
The move came after a report by Legislative Auditor Daryl Purpera late last year found that Louisiana's Medicaid expansion under the Affordable Care Act, a major initiative by Gov. John Bel Edwards, may have cost the state as much as $85 million on ineligible enrollees. There’s been considerable debate over just how damning the findings really are — some patients are likely newly ineligible due to recent changes in their personal situations, for example — but the report did identify a legitimate shortcoming.
Just as importantly, the audit drew on data from before an upgraded computer program designed to check eligibility went online. The system has been long in the works, and Edwards administration officials note it was held up under previous Gov. Bobby Jindal. Improvements include the ability to check a recipient’s income status quarterly as opposed to annually, and to incorporate more wage data into the calculations.
This is good news, or it would be in a world in which the goal is to improve government accountability rather than jockey for political advantage.
Of course, some of us don’t live in that world. So expect to keep hearing about the problem, but not the solution, throughout this election year.
To hear certain critics of Edwards tell it, the audit is simply evidence of horrific mismanagement, end of story.
Soon after it came out, U.S. Sen. John Kennedy called on Health Secretary Rebekah Gee to resign. In typical, over-the-top fashion, Kennedy told reporters that the report was “an insult. It's a whiz down the leg of every taxpayer in Louisiana and America.”
After the administration formally removed those 30,000-odd people from the rolls this week, Attorney General Jeff Landry accused Edwards of intentional recklessness in creating the program in the first place.
“This multimillion dollar mess could have been avoided had the governor properly vetted these welfare applicants, not simply rushed to get as many recipients on the rolls as possible,” Landry said.
At a recent campaign event, U.S. Rep. Ralph Abraham, a Republican like Kennedy and Landry and one of two announced challengers to the Democratic governor this fall, pointed to the audit as an example of how “the taxpayer is getting hosed over and over.”
That’s one way of looking at things. Here’s an alternate story line: Soon after the audit came out, Commissioner of Administration Jay Dardenne explained to the legislature’s joint budget committee that the new system would allow the health department to make “more determinations with real-time, accurate data." Purpera described the new system as "a very good change."
And more recently, the Trump administration’s top official overseeing Medicaid, Seema Verma, responded to a pair of congressional Republicans looking to highlight the audit by calling it “deeply troubling.” But she also acknowledged that, “as we understand, recent upgrades to Louisiana's eligibility systems will help to address some of the issues identified."
And more broadly, Medicaid expansion has now helped roughly a half million Louisianans, mostly working poor, access health care largely on the federal dime. According to the Edwards’ administration’s running tally, it’s covered more than 64,000 breast cancer screenings, more than 35,000 colon cancer screenings, outpatient mental health treatment for more than 79,000 people and outpatient substance abuse treatment for just over 15,000 Louisianans. People are going to the doctor, getting diagnosed with conditions such as diabetes and hypertension, and getting treatment. This is a good thing.
So when we talk about Medicaid expansion, the legislative audit and the new eligibility protocol, a little perspective and appreciation of nuance are in order.
I know, that’s a lot to ask in an election year.