Published Online: September 03, 2014
Mary K. Caffrey
Governor Bobby Jindal of Louisiana, among the strongest critics of Obamacare heading into the 2016 presidential race, is facing fresh criticism in his home state for refusing to expand Medicaid, after his administration scrambled to keep the doors open at an emergency room in the state capital.
Yesterday, Democratic state legislators gathered across the street from Baton Rouge General Mid City hospital, which nearly closed its emergency room last week before the Jindal Administration came through with a state-federal cash infusion that totaled $18 million to cover uncompensated care.
Both the legislators and commentators argued, however, that Jindal created the crisis in the first place. First, he will not expand Medicaid, which would extend coverage to 240,000 Louisiana residents in a state with some of lowest income limits in the nation. Second, Jindal’s attempt to convert Louisiana’s unique and historic charity hospital system to a series of public-private partnerships is proving more disruptive than imagined. The closing of nearby Earl K. Long Hospital in the state capital, which is part of that plan, flooded Baton Rouge General Mid City with 400 new patients a month, leading directly to last week’s near-death experience for the emergency room.
“If we want to protect our hospitals, there's one easy solution: We can accept billions in Medicaid dollars to reduce the number of uninsured people in Louisiana," State Sen. Sharon Weston Broome, a Baton Rouge Democrat, told The Times-Picayune
. "This simple action will save our hospitals that are struggling with the escalating costs of uncompensated care.
"As our governor continues to stonewall, our citizens will continue to have accidents, get sick and die. Lives are hanging in the balance."
Jindal Administration officials repeated their position that Louisiana cannot afford Medicaid expansion and said they will address individual crises as they occur. But critics warned to expect other emergency rooms to come calling with requests for help.
Last fall, sources who spoke with Evidence-Based Oncology
, a publication of The American Journal of Managed Care,
predicted that Jindal’s decision to forego Medicaid expansion would prove fateful, and they said that many in the healthcare sector hoped to wait until his term ended and expand Medicaid at that time.
For example, wait times for the uninsured with cancer can vary greatly depending on whether they are in New Orleans or more remote areas. In commenting last year on Jindal’s decision, Moriba Karamoko of the Louisiana Consumer Healthcare Coalition said, “People die as a consequence of this. That is not an exaggeration.”
Watching from afar is the Centers for Medicare and Medicaid Services (CMS), which rejected a financing plan for the public-private partnership model earlier this year and has held off on a final ruling.
The stakes are high for both Louisiana and for Jindal. Louisiana ranks poorly among states in multiple health indicators, according to the CDC: The state ranks first among men in cancer incidence rates, fourth in combined cancer death rates, fourth in the share of adults diagnosed with diabetes, and first in adult obesity, at 34.7 percent. With entrenched poverty and an economy that includes many tourism and agriculture jobs that may not include health coverage, a host of social service and religious advocacy groups have implored Jindal to accept Medicaid expansion, noting that he proposed his own similar plan in the years before the Affordable Care Act (ACA).
But Jindal has refused. While many national Republicans have criticized the ACA, Jindal has stood apart by offering policy alternatives. First, he pressed forward with the privatization initiative to pair most of Louisiana’s public hospitals with private partners. Then, he issued a high-profile proposal in April to repeal the ACA and replace it with $100 billion to the states to create their own health care systems. There would be few restrictions but one requirement: cover people with pre-existing conditions. Jindal also proposed changing tax provisions and capping medical malpractice awards.
Throughout the summer, criticism against Jindal has escalated amid a string of disclosures. The state auditor questioned the numbers in the Jindal Administration’s report on the health insurance program that covers most of the state’s Medicaid recipients. Public employees and retirees face sharply higher out-of-pocket costs for their benefits, due to a shortfall in their health insurance fund. And Jindal’s critics are not all Democrats. Among the most consistent is the separately elected State Treasurer John Kennedy, who charged that the Governor treated the employee benefits program as “a rainy day fund.”
But the near-closure of an emergency room in the state capital has brought Jindal’s refusal to expand Medicaid into sharp focus, coming as it did within days of the agreement between CMS and Pennsylvania Governor Tom Corbett, another Republican, to expand Medicaid there.
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