Jindal versus Obama on Medicaid
5th February 2013 · 0 Comments
By Christopher Tidmore
In the Washington Post newspaper last week, Bobby Jindal challenged President Barack Obama with an editorial entitled, “Let’s meet on Medicaid, Mr. President.” The Louisiana governor highlighted the need to reform the federal healthcare program before it was expanded under the Affordable Care Act, dubbed “Obamacare” by conservatives.
Jindal left unsaid, however, that at home, his administration plans to cut that healthcare spending drastically this spring to plug a looming $1.2 billion state budget deficit. At the same time, the Louisiana governor also left ignored an idea that a fellow GOP governor employed in Arizona. The concept could forestall this year’s cuts in the state’s healthcare budget, and meet the goal of providing health care to those up to 133 percent of the poverty level without impacting Louisiana’s budget. The excess hospital revenue could lessen this year’s cuts, and perhaps plug the funding gap endangering the construction of the new University Medical Center in Mid-City.
Says Jindal, “Medicaid operates under a 1960s model of medicine, with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility.”
“Expanding the entitlement program as it stands would further cement a separate and unequal tier of health coverage. Without fundamental reform, Medicaid will continue to deliver what it has for decades: limited access, poor quality and budget deficits.”
Jindal then maintained, “Fortunately, after nearly a half-century of running this program, states know its problems and how to address them.”
It was a clarion call for Obama to embrace block granting of Medicaid dollars to the states, a favorite concept of neo-federalist conservative reformers but also an idea embraced by several progressive thinkers seeking to slow the growth of the healthcare program for the poor. Both New York and California Democratic governors Andrew Cuomo and Jerry Brown have been open to the concept.
Jindal—once considered such a wunderkind of healthcare reform that Gov. Mike Foster appointed him state head of the Department of Heath and Hospitals at age 24 and Sen. John Breaux later recommended him as staff head of the President Clinton’s bipartisan commission on Medicare reform—outlined several concepts for the President. As he explained in the editorial, “Our ideas to fix Medicaid target several areas for reform: eligibility, benefit design, cost-sharing, use of the private insurance market, financing and accountability.”
The “eligibility standards” argument was a direct reference to the Affordable Care Act’s requirement that in exchange for states accepting drastically increased Medicaid funding, they would cover the poor up to 133 percent above the federal poverty level, which would amount to incomes of almost $26,000. Under the law, the federal government would pay the full cost of enrolling newly eligible people from 2014 to 2016, after which the share would gradually shrink until it reached 90 percent starting in 2022, with state treasuries making up the difference.
That’s the essence of Jindal’s complaint.
States have been slow to embrace this aspect of Obamacare, despite the unprecedented level of federal financing for Medicaid. Louisiana has joined Texas, Oklahoma, South Dakota, and five other states in refusing to expand Medicaid, stating the impact to their state budgets in three years would be catastrophic.
Jindal’s critics note that the added funds this year would avert nearly all of the proposed healthcare cuts under the current state deficit, and provide the added funds to complete the UMC Hospital project in New Orleans’ Mid-City. A 19th-century African-American neighborhood was demolished to build a medical complex that would succeed ‘Big Charity’, but despite promises, the state is currently is more than $150 million short in the funds to complete the new medical district as envisioned.
The Republican governors in New Mexico, Indiana, and have asked if it would be possible whether to offer benefits to fewer people by extending eligibility to some level of income below 133 percent of poverty. In December, the Administration replied, “No.” States that partially expand will not receive the enhanced funding that would come with a full expansion.
“The law contemplated that every American would have a way to get health insurance coverage, and Medicaid expansion to 133 percent of poverty to low-income adults was the method identified in the law,” Cindy Mann, the director of the Center for Medicaid and Children’s Health Insurance Program Services, said during a conference call with reporters.
“Some states have asked whether they could get the 100 percent federal match and expand Medicaid coverage to less than the 133 percent of poverty level specified in the law,” Mann said. That amount is “a rate that Congress reserved for the full expansion, and so we are going to remain true to that intent of Congress,” she said. There is no deadline for states to decide on the Medicaid expansion, and they can join at any time, she said.
That led Louisiana Gov. Bobby Jindal, in a statement released by the Republican Governors Association, to call the decision to not allow states more flexibility on Medicaid “as disheartening as it is short-sighted,” and helped precipitate the WP editorial.
In an opposite reaction, the ruling helped convince Arizona GOP Governor Jan Brewer to reverse her previous decision to refuse the added funds. Instead, her state will accept and increase Medicaid spending up to 133 percent, adding what she described as a “circuit breaker,” which would automatically shrink the state’s Medicaid program in the event that the federal government were to decrease funding.
Facing mid-year draconian cuts, Louisiana public hospitals—and private ones that handle uninsured cases regularly such as New Orleans’ Touro Infirmary—might easily opt for a tax in three years of part of an influx of millions of additional dollars today.
Proposing such a tax, though, would put Jindal in opposition to the Conservative intelligencia and activist core that view embracing any part of the Affordable Care Act as betrayal, and could endanger the Louisiana governor’s increasingly open bid for the White House in 2016.
It does not matter that Jan Brewer continues to reject the federal healthcare exchanges who’s regulations were the center of the right’s complaint against “Obama?care,” as having the potential to skyrocket insurance premiums. The Arizona governor has still been castigated within the pages of National Review. Nor does the fact that her neighbors in New Mexico and Nevada, the GOP’s rising Hispanic Gubernatorial stars Suzanna Martinez and Brian Sandoval, have also accepted the Medicaid money provide any cover for her.
Nor would Jindal have any political cover, not a great position for a GOP presidential candidate. However, before Barack Obama can legitimately have a conversation on Medicaid block grants, and giving states more flexibility to administer the programs according to their unique geographic and societal needs, Jindal may find himself needing to meet the President halfway.
And, if he does not, might a Louisiana legislator, being courted for his or her vote in April to repeal income taxes, insist on a “yea” only in exchange for the enhanced Medicaid dollars—and enacting a funding mechanism, a hospital tax, that would cost the Louisiana State Treasury nothing?
Time will tell.
This article was originally published in the February 4, 2013 print edition of The Louisiana Weekly newspaper