BATON ROUGE (AP) — While Gov. Bobby Jindal repeatedly refused to take billions in federal health care money to expand Louisiana's Medicaid program, the men seeking to follow him into office are less reluctant to accept the cash.
The four main contenders vying to be Louisiana's next governor on the Oct. 24 ballot all say they'd be willing to extend government-financed health insurance to the working poor, as allowed under President Barack Obama's signature health overhaul.
That includes the three GOP candidates.
But those Republicans — Public Service Commissioner Scott Angelle, Lt. Gov. Jay Dardenne and U.S. Sen. David Vitter — have caveats on what type of expansion program they'd be willing to enact and how they'd craft it.
"I am open to walking down that path, but we need to make sure that if we do it, we do it on Louisiana's terms, not on Washington's terms," Vitter said.
Democratic state Rep. John Bel Edwards doesn't equivocate. He says he'd "do it day one" if elected.
"It's the right thing to do, both as a matter of fiscal policy and as a matter of moral responsibility," Edwards said.
Thirty states have agreed to expand their Medicaid programs, with the federal government picking up most of the tab. But Louisiana, with its governor running for president and its majority-Republican Legislature, has rejected the idea.
Medicaid expansion would offer government-funded insurance coverage to adults making up to 138 percent of the federal poverty level — less than $33,000 for a family of four.
Expansion supporters in Louisiana say it would extend health coverage to up to 240,000 people, like waitresses, hotel workers and people in minimum-wage jobs who can't afford insurance and whose employers don't offer it. They say it would help health care providers burdened with uninsured patients and lessen state costs for uninsured care.
Jindal, who is term-limited and seeking the Republican presidential nomination, has opposed the idea as too costly for the state and as an inappropriate expansion of government-funded health care.
But the drumbeat for expansion is increasing, with the health care industry calling for it, along with prominent business leaders and organizations around Louisiana. Add in the state's deep financial troubles and the offer of billions in federal health financing appears enticing to the men seeking to follow Jindal into the governor's office.
Rather than funnel more people into Louisiana's existing Medicaid program, Angelle and Dardenne say they'd seek a federal government "waiver" that allows states to sidestep certain Medicaid requirements and tailor expansion programs differently. A handful of states that agreed to the Medicaid expansion have done so through such waivers.
Angelle has provided few specifics on what he'd like to see in a waiver.
Dardenne said he'd appoint a task force to develop a waiver application that can be submitted to the federal Medicaid agency within 45 days. He said the application should give Louisiana protection if federal financing drops below promised levels and should be tailored to work with Louisiana's privatized hospital system that cares for the poor and uninsured.
"I think we can do that, and then we will accept the money," Dardenne said.
Edwards said developing a waiver application rather than expanding eligibility in Louisiana's existing Medicaid program will cause unnecessary delay. He said those applications can take more than a year to negotiate.
"We're paying federal taxes that instead of coming back to Louisiana to take care of the working poor here, they're going to send those dollars to the 30 states that did expand the Medicaid program so their working poor get taken care of," Edwards said.
Vitter has the most extensive criteria for taking the expansion, saying it would have to provide significant authority for Louisiana to devise a state-specific program. He said he'd want a plan structured like a private insurance model, and he'd want to include a work requirement for coverage — though he acknowledges federal officials have rejected that in other states.
Negotiations would take months, Vitter said, so a Medicaid expansion wouldn't help the state deal with its short-term budget problems.
"My plan is to deal with the budget crisis apart from this and not to depend on this," he said. "Obviously, this can help down the road a year from now."
Any plan would require Louisiana to come up with a share of the financing for the expansion, eventually reaching 10 percent of the price tag.
Lawmakers recently approved a financing tool devised by the Louisiana Hospital Association that involves hospitals pooling their money to help pay Louisiana's share of the expansion cost. But it expires if the governor doesn't expand the Medicaid program by April 1.
– by AP Reporter Melinda Deslatte
