Revised Medicaid Expansion Backed by Louisiana House Panel

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A proposal that would tap into federal funding available to offer insurance to the working poor narrowly received the backing of the House health committee, after two Republican lawmakers sided with Democrats to advance the bill.

But one of those Republicans said his vote was a mistake.

The House Health and Welfare Committee already rejected a proposal that would have expanded Louisiana’s Medicaid program as allowed under the federal Affordable Care Act.

Supporters of the expansion offered a modified proposal that would seek to use the federal Medicaid expansion dollars to pay for private coverage for the uninsured, similar to a plan that Arkansas is negotiating with the federal government.

That won the committee’s support in a 10-9 vote. A similar proposal is advancing in the Senate as well, despite strong opposition from GOP Gov. Bobby Jindal.

Republican Reps. Kenny Havard, R-Jackson, and Rogers Pope, R-Denham Springs, were the swing votes. Havard said he hasn’t heard a well-defined alternative from the Jindal administration about how to provide health care to the uninsured.

“Right now, this is the best plan I think,” he said.

Pope said he didn’t realize he was voting to support House Bill 233, saying he had been in and out of the hearing as he handled bills in other committees at the same time.

“I made a bad vote, plain and simple. I voted wrong, and I didn’t mean to. That was not my intent,” Pope said. “I just plain messed up.”

Pope’s vote got the bill out of committee, heading to the House floor.

Supporters of the measure by Rep. Patricia Smith, D-Baton Rouge, said Louisiana should pursue negotiations with the federal government to offer more insurance coverage, as required under Smith’s bill. They said the private insurance model should end concerns cited by Jindal about expanding an inefficient, government-run Medicaid program.

“We need to declare war on the idea that people don’t need health coverage and they can do without and still be healthy. That’s not the case at all,” said David Hood, health care secretary for Republican former Gov. Mike Foster.

About one in five Louisiana residents are uninsured. Estimates are that as many as 400,000 uninsured people would be eligible for Medicaid if the expansion were approved.

The health care law pushed by President Barack Obama allows the expansion to cover adults making up to 138 percent of the poverty level – less than $32,000 for a family of four. The federal government would pay for most of the coverage, covering the full costs from 2014 to 2016 and require states to pay up to 10 percent after that.

Jindal opposes the expansion, saying the increased insurance coverage would be too costly for Louisiana and could shift people from private insurance to government-funded health care. His health secretary, Kathy Kliebert, said the modified bill seeking to use the federal Medicaid money for private insurance doesn’t change the administration’s concerns.

Kliebert, interim secretary of the Department of Health and Hospitals, said the private insurance model is unworkable because of federal restrictions governing the Medicaid funding, and she said the Affordable Care Act doesn’t offer enough flexibility to tailor an insurance program to Louisiana’s needs.

“We do not see the Arkansas model as the worthwhile plan and path forward for Louisiana,” Kliebert said.

The nonpartisan Legislative Fiscal Office estimates the Medicaid expansion could save Louisiana as much as $510 million over 10 years, with the state receiving up to $15 billion in federal funding to cover about 500,000 people through Medicaid.

The Jindal administration disputes the fiscal office analysis, citing a DHH study that suggests the costs could reach $1.7 billion over a decade. But that DHH analysis also says the state could save money with an expansion under certain scenarios.

Smith urged lawmakers not to follow the lead of the governor, whose office is on the fourth floor of the Louisiana Capitol.

“The fourth floor didn’t elect you. The people of your districts elected you. You ought to be concerned about the people in your areas who are uninsured,” she said.