One Winner Looks Likely in Louisiana Governor's Race: Medicaid Expansion

It’s not clear who will emerge the victor in the upcoming election to succeed Louisiana Governor Bobby Jindal. But there’s already an apparent winner: Medicaid expansion seems certain no matter the outcome.

That’s the consensus among pundits and business groups following the contest among a Democrat and 3 Republicans who face off October 24, 2015. Years of state budget problems have left Democrats and Republicans alike looking for new revenue sources. Hospitals have felt the pain in particular, after private institutions were asked to assume responsibility for managing parts of Louisiana’s former public hospital system.

Jindal’s privatization scheme hasn’t worked quite as promised. First, there’s there the need for an infusion to shore up the new University Medical Center New Orleans, which opened this year as the permanent replacement for Charity Hospital, which closed after Hurricane Katrina. Second, the LSU hospitals in New Orleans and Shreveport were left with $56 million in “legacy costs” for former employees that are not the responsibility of the private parties now running them, and legislators are searching for a solution.

The stubborn unwillingness of Jindal to expand Medicaid, despite his state’s poverty and the continued fallout after Katrina, has frustrated public health and business leaders. Groups like the Council for a Better Louisiana, Blueprint Louisiana, and the Baton Route Area Chamber have endorsed expansion, rejecting Jindal’s harsh ideology for the pragmatism of keeping hospital doors open and saving jobs. This is especially true after Baton Rouge lost a charity hospital and later, one of its emergency rooms. Frustration is especially high because Jindal once called for a Medicaid plan not unlike the one in the Affordable Care Act, but he abandoned it after it was included in President Obama's landmark legislation.

Louisiana is one of the nation's poorest states with high rates of diabetes, obesity, and cancer; the state also has abnormally high rates of Medicare spending, including high use of nursing homes and home health care, as beneficiaries reach age 65 with multiple chronic conditions that have gone unattended. Because so much of the state's economy is tied to tourism, a higher than normal share of its workers are part-time or self-employed, serving as waiters, hotel staff, musicians, artists, or in jobs in New Orleans' growing movie industry.

Some who spoke with Evidence-Based Oncology in 2013 said many business and hospital leaders were quietly waiting out Jindal, and that the next governor would almost certainly expand Medicaid. In fact, Louisiana’s legislature has already passed a measure to lay the groundwork for expansion next year.

Of the 4 candidates, Democratic State Representative John Bel Edwards most strongly supports expansion and has said he would set it in motion immediately. The 3 Republicans have mentioned various conditions, including US Senator David Vitter’s call for a work requirement that the Obama Administration has thus far not granted in the form Vitter wants. (However, HHS Sylvia Mathews Burwell did recently tell a gathering at the National Governors Association that she is not opposed to “encouraging work.”)

The other 2 Republicans, Lieutenant Governor Jay Dardenne and Public Service Commissioner Scott Angelle are expected to craft some type of waiver that puts their personal stamp on Louisiana’s version of expansion, lest they be seen as accepting “Obamacare” unchanged. But observers see this as election season posturing. No one thinks any of the current candidates will turn down the money.

Louisiana may have a Governor-elect in 10 days, although that’s unlikely. Under the state’s unique “jungle primary;” if no candidate gains more than 50% of the vote, the top 2 will have a runoff regardless of party. Assuming there is a runoff, that vote will take place November 21, 2015.