By John Maginnis
If Sen. Mary Landrieu would just get out of his way, Gov. Bobby Jindal could fully focus on his quest to be the leading critic of President Barack Obama this side of the Beltway. Outside of Washington, where congressional Republicans are being blamed as much as or more than the president for the fiscal crisis of the month, there is a competition to be the leading voice of dissent from the GOP heartland--and Jindal is right in there.
As chairman of the Republican Governors Association, he used a recent meeting of governors at the White House to call for the president to avoid the across-the-board budget cuts of sequestration by delaying implementation of the Affordable Care Act, particularly the expansion of Medicaid. The White House, of course, ignored him, but Jindal did succeed in combining the two prime GOP beefs against Obama.
Back home, though, Landrieu again tore into the governor for putting his national ambitions ahead of whatís good for the state by his refusal to accept the Medicaid expansion. It would cover adults with incomes of up to 138 percent of the poverty level, which would cost the state nothing for three years and 10 percent in 10 years.
Leaving it to his press office to dismiss Landrieu as an Obama stooge, the next day Jindal was back on message to a national audience, penning an editorial for National Review Online entitled "The Era of Government Greed."
We can expect this trend to continue because, in raw political terms, the senatorís and the governorís respective positions on the Medicaid issue are working quite well for both.
Landrieuís support of the expansion, which a recent State Medical Society poll showed Louisianians favor 51-43 percent, helps her with her base and the middle-of-the-road voters she needs for her 2014 re-election.
Jindal seems just as comfortable with his opposition stance, even as more Republican governors abandon it, as did New Jersey Gov. Chris Christie and Florida Gov. Rick Scott recently. Their difference from Jindal is that Christie is running for re-election this year and Scott next year, both in states Obama carried last year. The more that GOP governors take the expedient course the more Jindal stands out for upholding Republican principles, now and leading up to the 2016 presidential primaries.
While his defiant position serves his politics, can he continue to sustain it in the face of mounting public and editorial opinion at home, where his approval rating has slipped into negative territory in two recent polls? The answer is yes, for now, with help from an unlikely source.
In a situation that only Washington could create, the governor can afford not to accept hundreds of millions of dollars from the federal Medicaid program because he is taking hundreds of millions of dollars from the federal Disproportionate Share Hospital program. The latter sends federal funds to hospitals which treat mostly poor, uninsured people, of which Louisiana has plenty of both. LSUís unique network of safety-net hospitals in every major metropolitan area is tailor-made for DSH. Even though the Affordable Care Act cuts back future DSH funding, state health officials say Louisiana uses only a fraction of the available aid, enough to continue treating the uninsured.
Itís not free, costing the state $134 million in matching funds, a large chunk of which the state would save if it took the Medicaid expansion. Yet the position of the Jindal administration is that the cost is worth it for the sake of the stateís entire health care system, public and private.
Currently, the only treatment option for most uninsured patients is at public clinics and hospitals. With a Medicaid card, up to 400,000 more people could go to any doctor or hospital that participates in the program. If fewer of these new Medicaid patients continued going to public hospitals, that would reduce the cash flow just as the administration is trying to privatize the management of those facilities. Also, many people with private insurance would be displeased with a big increase in Medicaid patients at the hospitals and doctorís offices they go to now.
Medicaid expansion could deal a final blow to the historic class segregation of the state health care system, and many private-pay patients might blame the governor who let it happen.
The Obama administration could change things quickly by tightening DSH rules and thus turning the screws on recalcitrant states like Louisiana. But so long as the feds enable him, Jindal will keep standing up to them.