A new analysis by the nonpartisan Legislative Fiscal Office said accepting the Medicaid expansion envisioned by the federal health care law -- but so far refused by Gov. Bobby Jindal's administration -- would save Louisiana between $532 million and $544 million over the next five years. The analysis, released late Monday, came just two days before a House committee...
A new analysis by the nonpartisan Legislative Fiscal Office said accepting the Medicaid expansion envisioned by the federal health care law -- but so far refused by Gov. Bobby Jindal's administration -- would save Louisiana between $532 million and $544 million over the next five years.
The analysis, released late Monday, came just two days before a House committee is set to consider several bills that would require Jindal to accept the expansion, which would be largely underwritten by the federal government and which would provide health insurance to as many as 653,305 poor Louisianians.
Proponents of the expansion gathered on the Capitol steps Tuesday to urge the governor to reconsider his position. Jindal has consistently said he'll refuse to expand the program because he believes it is badly flawed and must be reformed first.
The analysis by the state legislative budget crunchers found that the law could end up saving Louisiana money even 10 years down the road, as the federal subsidy shrinks, although the estimated savings ranged from $185 million to $510 million. The fiscal office evaluation of the expansion offers a more positive assessment of the expansion's potential financial impact than a recently released report from the Louisiana Department of Health and Hospitals.
However, even Jindal's health agency found that under certain scenarios expanding the federal health insurance program for the poor could benefit the state budget.
But in an op-ed printed in newspapers around the state this week, Jindal argued that it will result in too many people in the government-run program.
"By expanding President Obama's healthcare law, 41 percent of Louisiana's population would be dumped into Medicaid," he wrote. "Soon there will be more people riding in the cart than people pulling the cart."
In his op-ed, Jindal cited the highest potential 10-year cost in the DHH evaluation.
Jindal reiterated those concerns during a meeting with reporters on Tuesday.
"We think there are better ways and continue to think Medicaid expansion would be the wrong step for Louisiana," he said.
On Wednesday, the House Health and Welfare Committee will debate five different measures that would force the Jindal administration to accept the Medicaid expansion. It's unclear whether those measures will earn the support of legislators, who would almost certainly have to first pass the measure, and then overcome a veto by the governor.
But two of the measures are resolutions, which do not go to Jindal for approval and would not be subject to a veto. However, the governor has already said this year that he does not consider the administration to be bound by resolutions - as opposed to laws - passed by the Legislature.
Another bill will come up for debate in the Senate Health and Welfare Committee at the same time.
The theme of Tuesday's rally -- led by Together Louisiana, a recently formed coalition of religious and civic groups, and the American Association for Retired People -- was that if Jindal doesn't like the Medicaid program, he should insist on certain conditions while accepting the expansion.
Pastor Melvin Rushing, a leader of Together Louisiana, said that governors of several other states had accepted the Medicaid expansion, but with strings attached. Arizona, for instance, is taking the federal largess, but the state has vowed to bow out if the federal subsidy of the expansion dips below 90 percent, he said.
"We believe you can make a deal that meets your vision for the state, but to do so, you must negotiate," Rushing said, as demonstrators chanted and waved signs reading "Negotiate, Mr. Governor."
Perhaps the most interesting appearance at the rally was that of state Sen. Fred Mills, a Republican from Breaux Bridge. Mills, a pharmacist, told the assembly that he's watched many impoverished customers wrestle with the choice of whether to buy food or needed medication. He said he has spoken with two former heads of the state Department of Health and Hospitals as well as a number of private hospital executives, and all have said the Medicaid expansion is needed. Mills urged Jindal to come up with a compromise position.
"I promise you, if the New Orleans Saints were leaving tomorrow, we could get creative," he said.
As vice chairman of the Senate Health and Welfare Committee, which will consider the expansion if the House bills make it that far, Mills could potentially be a powerful ally for those seeking to sign on to the program.
Under the Medicaid expansion, the federal government pledges to pay 100 percent of the cost for new Medicaid enrollees over the next three years. That percentage eventually drops to 90 percent, which is still much higher than the share historically picked up by the feds.
The state health agency's assessment of the Medicaid expansion found it could end up saving the state $367.5 million over 10 years under a scenario where fewer people than expected enrolled in the program. If the most people possible enrolled, it could cost Louisiana $1.71 billion, the analysis found.
However, that $1.71 billion assumes that Louisiana would raise the rates the state pays Medicaid providers, something not envisioned in the legislative analysis. Without the rate increase, the DHH analysis shows Louisiana breaking even over 10 years if Medicaid expands, even with a high number of new enrollees.
The rates Medicaid pays health-care providers are low, which many cite as a reason for not participating in the program. State agency leaders argue it would be necessary to increase rates as Medicaid becomes a bigger part of the health-care landscape.
"It is difficult to believe that the current health-care system could withstand the weight of hundreds of thousands of new Medicaid enrollees, many coming from better paying private coverage, without increases to provider reimbursement," the health agency argued in a statement issued on Tuesday.
One other difference between the two evaluations is that the fiscal office analysis calculates the potential savings by allowing the state to use the Medicaid program to cover inpatient hospitalization of state prisoners. Currently, Louisiana must tap state tax dollars to pay for inmate health care, which is slated to cost $50 million in 2014. Tapping the Medicaid program for a portion of inmate care would save the state $26.2 million annually, or $262 million over 10 years, the office concluded.
Note: This story was updated with comments from Gov. Bobby Jindal and information about the bills that will be heard on Wednesday.