Dardenne leaves door open to Medicaid expansion
Interviewed by Advocate columnist Stephanie Grace last week, Lt. Gov. Jay Dardenne said everything you’re supposed to say about health care reform if you’re a Republican who hopes to be elected governor of Louisiana next year. Dardenne called the Affordable Care Act “one of the worst pieces of legislation ever to come out of the U.S. Congress,” and said he opposes a “pure expansion” of Medicaid. But the state’s second-in-command then indicated he would be open to looking for ways that Louisiana might accept the billions of federal dollars available for expanding coverage to low-income adults who are largely shut out of the insurance market. “(Dardenne) said he’s open to exploring waivers or other avenues that would allow the state to tap into the money, a possibility that, he noted, Jindal’s ideological intransigence has short-circuited. ‘The jury’s still out on what we should do,’ he said. ‘I don’t think Louisiana has made the kind of inquiry of whether there’s a potential waiver to be negotiated.’”
That, of course, puts the lieutenant governor in the same camp as the conservative governors of Ohio, Pennsylvania, New Jersey, Indiana and Florida, who all have studied the numbers (the federal government pays 100 percent for three years and no less than 90 percent of the cost after that) and decided they are simply too good to pass up. And it practically guarantees that Medicaid expansion will be a key issue heading into the pivotal 2015 governor’s race.
Gov. Bobby Jindal says Medicaid expansion hurts the disabled
In the meantime, op-ed columnist Bobby Jindal floated the bizarre notion that expanding health-coverage to low-income adults is a form of discrimination against people with disabilities. Jindal, who also is governor, wrote in the Lafayette Advertiser that he opposes expansion because it comes with a more favorable federal match rate than other parts of the Medicaid program that fund services for the disabled. “That’s a case of skewed priorities if I ever heard of one,” Jindal wrote. “I truly believe in a government safety net. But a vast expansion of government-run health care will jeopardize the care of the most vulnerable in our society. With more than half a million individuals with disabilities already on waiting lists for Medicaid services nationwide, we need to protect access for people with disabilities.”
Given this latest argument, it bears repeating that nothing in the Affordable Care Act discourages states from investing in the disabled. Having a higher match rate for the expansion population does not prioritize that group over others. It is simply a financing mechanism. What does endanger Louisiana’s most vulnerable residents is balancing the state’s operating budget by draining a trust fund set aside for nursing home residents and people receiving home-care services. In fact, Medicaid expansion would actually help the disabled community, by freeing up state dollars that are now being spent on treating the uninsured in state-owned charity hospitals. The Legislative Fiscal Office estimates the state could save more than $100 million next year alone — money that could be used to reduce the long waiting list for services.
The Advocate throws its support behind prisoner re-entry programs
Perhaps the most welcome trend in this young political year is the growing interest — by people on the left and right — in doing something about Louisiana’s world-leading incarceration rate. Tyler Bridges of The Lens noted it first with a “strange bedfellows” story that focused on the ways that conservatives like the Pelican Institute are teaming up with the ACLU and conservative business leaders to push sentencing reform. Then new Advocate columnist Quin Hillyer parroted the same line in Sunday’s editions. Now The Advocate’s editorial page is weighing in on the subject, saying that new focus is needed on workforce training and other initiatives to support the 15,000 Louisianans who get released from prison each year, often with few if any skills needed to successfully rejoin the workforce. “The (Louisiana Association of Business and Industry) called for ‘education and training partnerships to facilitate a successful transition into the economy and the community,’ according to a recent policy statement. ‘A key component of this approach will provide employers the protection and comfort they need to fully utilize this population of workers.’ If LABI is a conservative voice, Mayor Mitch Landrieu is a prominent Democrat, and he sees the same issues for New Orleans. In December, he unveiled a ‘comprehensive workforce re-entry initiative’ focusing on providing the skills for those getting out to have a chance in society.”
Krugman: Is race at the root of opposition to Medicaid expansion?
Conservatives have lately taken to denouncing the expansion of Medicaid in the same breath as they decry the modest cuts to Medicaid Advantage that were included in the Affordable Care Act. (And to be clear, the Medicare Advantage program, in which public dollars are used to buy private plans, is already more expensive than regular Medicare, and the 1.9 percent cut in the ACA is designed to bring the costs of the program in line with the public program). Now New York Times columnist Paul Krugman is asking whether this strange juxtaposition is due to racial animus. “We are told, for example, that conservatives are against big government and high spending. Yet even as Republican governors and state legislatures block the expansion of Medicaid, the G.O.P. angrily denounces modest cost-saving measures for Medicare. How can this contradiction be explained? Well, what do many Medicaid recipients look like — and I’m talking about the color of their skin, not the content of their character — and how does that compare with the typical Medicare beneficiary? Mystery solved.”