Medicaid expansions are the reason there are so many Louisiana kids with insurance

Appearing on the national news program Meet the Press, Gov. Bobby Jindal said Sunday that Louisiana would not implement federal health care reform, including an expansion in Medicaid eligibility to cover the working poor and childless adults for the first time. This is a misguided policy that could deprive as many as 400,000 low-income Louisianans of health coverage, and would also hurt health care providers and the state’s economy.

Jindal also cited Louisiana’s low rate of uninsured children—around 5 percent of kids in Louisiana are uninsured compared to 8 percent nationally—as evidence that the Affordable Care Act should be repealed and that reform should be left to the states.

What the governor forgot to mention is the reason why so few Louisiana children are uninsured:  The expansion of Medicaid that began in the late 1990s—i.e., the very policy that he now refuses to support.

Congress created the State Children’s Health Insurance Program (SCHIP) in 1997 as part of the Balanced Budget Act, making money available to states to cover children in low-income working families who don’t qualify for regular Medicaid. The SCHIP program marked the largest expansion of Medicaid in 30 years, and it has made a remarkable difference in states like Louisiana with high poverty rates.

Before SCHIP (known in Louisiana as LaCHIP), an estimated 20 percent of Louisiana children were uninsured. As LaCHIP grew between 1998 and 2003, that number plummeted and has continued to drop since. In 2010, more than 150,000 Louisiana children received needed health care due to LaCHIP. Put another way, one in five children who received Medicaid services were eligible because of LaCHIP.

As an added bonus, the federal government pays most of the costs—over the last decade, anywhere from 70 to 80 percent.

LaCHIP has been recognized as a national leader in providing health care to kids—something that the governor and other state policymakers have every right to be proud of. Louisiana has won numerous recognitions and bonus payments from the federal government for its efforts to expand health care coverage to children.

But while Medicaid has done an excellent job of partnering with states to ensure more children are covered, the program has been much less successful in covering the “working poor” – adults who have low-paying jobs and either can’t afford their employers’ health insurance or have jobs that don’t offer coverage at all. It is these people—as many as 400,000 in Louisiana alone – who the latest Medicaid expansion is designed to help.

Beginning in 2014, Louisiana can choose to expand Medicaid eligibility to everyone up to 133 percent of the federal poverty line— around $14,850 for individuals and $30,650 for a family of four.

Making this policy an even better deal is that the federal government will pay for the vast majority of the expansion, including 100 percent of the cost for the first three years, with the state chipping in slowly after that. Even then, Louisiana will never have to pay more than 10 percent of the Medicaid expansion. This is an even more generous “match rate” than is offered through LaCHIP.

But if Louisiana turns its back on the Medicaid expansion, the working poor could be left with even fewer options than they have today. That’s because the federal government plans to reduce the payments that states get for treating the uninsured – money that Louisiana now uses to finance the LSU charity hospital system and that other hospitals rely on as well.

As the LaCHIP experience shows, expanding Medicaid as part of health care reform is the right thing to do for Louisiana.

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