Governor takes the heat on health care

By John Maginnis

For the first time in his career as an elected official, Gov. Bobby Jindal’s job approval ratings have sagged into negative territory. A new poll, commissioned by the State Medical Society, shows that only 46 percent of voters like what he is doing and 48 percent do not.

The best time for the governor to have a bad poll is well into his second term. The best reason is that he is trying to get some hard and controversial things done, and is taking heat for it.

After a conflict-averse first term, Jindal these days is taking strong forward positions on education, health care and taxes, the outcomes of which will largely frame his legacy and enhance, or not, his presidential aspirations.

Even with his school voucher and tenure changes tied up in court, the expansion of charter schools and toughening of teacher evaluations are leaving their mark. Student achievement, ultimately, will determine whether the mark is pass or fail.

His tax quest is to come in the spring session of the Legislature. The governor will try selling lawmakers and the public on his big idea to repeal personal and corporate income taxes, which will require many small ideas on how to fill the $3 billion, probably more, revenue gap.

But the real pressure on him now and part of the reason for his popularity decline is his drive to transform the state health care system within the hostile environment of the historic change of the national health care system.

Jindal’s stand on refusing to participate in the expansion of Medicaid under the federal Affordable Care Act, which would cover 400,000 currently uninsured at no cost to the state for three years, is not backed by public opinion. In the doctors’ poll, when the choice was evenly explained, 51 percent of voters were for the expansion to 43 percent against.

The poll was released in the same week that a varied group of major public interest groups petitioned Jindal in an open letter to accept the billions in federal aid that would benefit not only the uninsured but also non-profit providers and the economy as a whole.

At the same time, Jindal’s line in the sand finds fewer colleagues on his side of it, as more Republican governors reconsider and reverse their earlier opposition to the expansion.

As the pressure ratchets up, it seems so does the governor’s defiance, as expressed by Secretary of Health and Hospitals Bruce Greenstein, who told the Times-Picayune, “I want to make it absolutely clear. We are not expanding, this does not change our mind, this is not a good deal for the state.”

Beyond just taking orders, Greenstein can point to enough gray areas to suggest that expanded Medicaid, which would put almost half of the state’s population in the program-—far more than other states-—might not be as good a deal as advertised.

The secretary concedes that the expansion would save a large chunk of the $134 million in state match money now going to support its safety-net hospitals. Taking the longer view, however, Greenstein is more concerned about the full impact of the change on the entire state health care system, public and private. Which is odd, for the long view is not one this administration takes often when it comes to using one-time money and other short-term fiscal gimmicks to expediently balance its budgets.

Holding to his position that Medicaid is seriously flawed, Jindal, as chairman of the Republican Governors Association, has called on the president to meet with him and negotiate needed changes to the system before he can accept its expansion. He seems surprised to have not heard back. Were the governor to ask Speaker of the House John Boehner about negotiating with the White House, he would be told to expect a long wait.

With so much at stake, the secretary, if not the governor himself, needs to lay out his reasoning and analysis in a guest editorial for newspapers, which would be well read. Otherwise, citizens in growing numbers will assume that state health care policy is being driven by the governor’s national politics.

For now, the governor appears confident that public health care will fare just fine without taking the federal money that most states are accepting. With lives and the quality of them at stake, if there was ever a time for the health care expert to show that he knows what he is doing, it has come.


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