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Landrieu seeks to turn Medicaid to her advantage

Special to the Herald-Guide -   Dec 20, 2012

By John Maginnis

Roll Call, the political magazine of Washington, D.C., recently handicapped Sen. Mary Landrieuís 2014 re-election chances at 50-50. The odds against her were worse three years ago when she was being vilified by Republicans here and nationwide for supporting President Barack Obamaís Affordable Care Act. In those dark days, with conservative commentators labeling her a prostitute for wrangling funding for Louisiana, the unpopular new law was seen as the lodestone that would sink her career.

Now, at the dawn of her re-election cycle, she seeks to turn the law to her advantage by using it to criticize her frequent nemesis Gov. Bobby Jindal. She figures that even if he does not run against her--aiming for the presidential nomination instead--he will be campaigning hard for whoever does. So, earlier this month she took him to task for not implementing key features of the health insurance law: the expansion of Medicaid and formation of a state insurance exchange. "Simply refusing to engage in the process is not leadership," she lectured him in a personal letter, released by her office.

In affirming the act of Congress, the Supreme Court also broadened the political accountability by ruling that each state, usually the governor, must opt in or out on extending Medicaid to those making up to 133 percent of poverty. That would cover about 400,000 adults in Louisiana. In the heat of the presidential campaign, Jindal and seven other Republican governors of southern states said they would refuse the expansion, hoping that a Mitt Romney victory would lead to the lawís repeal.

Depending on who is counting, between 13 and 18 states, most of them carried by Obama, have opted in. With eight or nine out, the rest are undecided. Decisions start to become final early next year, when legislatures meet to write budgets that will go into 2014.

The expansion is financed in a way that is hard to refuse, with the federal government paying 100 percent for three years before its share gradually declines to 90 percent after 10 years.

Jindal opposes expanding Medicaid, calling it flawed and rigid, and argues that even though most of the money would come from the federal government, it is still a waste of American taxpayer dollars.

Landrieu and others argue that, philosophical objections aside, the governorís political responsibility is to see that Louisiana is not short-changed by having federal taxes raised here spent in other states.

Ultimately, Jindal insists this state cannot afford to pay even 10 percent, which, by his health care secretaryís estimate, would amount to $3.7 billion over 10 years. Landrieu cites a 2010 study commissioned by the Jindal administration that projected $1.8 billion in state spending, while a Kaiser Family Foundation study recently put the figure at $1.2 billion. The added uncertainty is will Congress continue paying for 90 percent or shift more of the burden to states in the future.

As with other major health care decisions these days, Louisiana legislators have little say in the expansion. Those who do, however, are the executives and boards of the non-profits currently negotiating taking over operations of the stateís 10 public hospitals. Before assuming responsibility for treating the poor, they will need assurances they will be paid.

With pressure on him and other governors mounting, Jindalís best course is to negotiate concessions that would give the states more flexibility in running their Medicaid programs. As chairman of the Republican Governors Association, he wrote the White House to ask for a sit-down, but is "disappointed" to get no response.

Obama, of course, currently is engaged with another negotiation, with Speaker of the House John Boehner, over the looming fiscal cliff. When the president gets around to the governors, they will find they have even less leverage than House Republicans do now. Jindal & Co. would be demanding that the president not spend money in states that did not vote for him unless he does it their way. What a hard call for Obama.

Jindalís hope is in numbers, that resistance spreads beyond the Deep South, to states red and blue. Otherwise, the governors of a few hold-out southern states could look like a confederacy of chumps, hardly presidential material.

Sen. Landrieu already has taken her lumps on her health care law vote, and is now working it to her favor. The next move is Gov. Jindalís, a decision that will follow him for years to come.

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