By the time he was 20, Bobby Jindal had graduated from Brown University. At 24 he was heading up Louisiana's department of health. Three years later, he was appointed president of the University of Louisiana System, and now at 33 he is a first-term Republican congressman.
By any measure Jindal is an overachiever-bright, peripatetic and ambitious. Only the second Indian-American ever to be voted into Congress and the first in more than 40 years, Jindal is already regarded as a potentially major player on healthcare matters in the House, with a resume that includes a stint as secretary of the Louisiana Department of Health and Hospitals and assistant secretary for planning and evaluation at HHS during President Bush's first term. He was also the executive director of the National Bipartisan Commission on the Future of Medicare, a panel mandated by the Balanced Budget Act of 1997 and named by the Clinton administration and Congress to explore ways to reform the program.
As he begins his newest career as a national legislator, his major healthcare goal, he says, is pushing for consumer-driven healthcare, a goal he shares with the Bush administration.
"The overarching theme for what I'd like to accomplish is putting control of healthcare back into the hands of patients working with providers," he says.
And to that end, he would like to see a full range of insurance products under Medicare-including point-of-service plans-to allow beneficiaries greater choice in plan designs. He also says he wants to expand a pilot project, set to begin in 2010, to test the ability of market forces to hold down costs while improving care as private plans in Medi- care compete with traditional fee-for-ser- vice Medicare.
On Medicaid, he says he wants greater flexibility for states to use private health plans and allow disabled beneficiaries greater freedom to direct their personal care and choose caregivers, rather than having a home health agency design the care for them. States must now apply for waivers from HHS to do either.
"I look at Medicaid reform as the next step of welfare reform," he says. "Overall, the principles of Medicaid reform that I'm in favor of ... is giving states more flexibility, but then holding them accountable rather than micromanaging them through the waiver program."
When he speaks, he does so at hyperspeed. He overflows with enthusiasm and is congenial. Ask those who have worked with him and they will tell you that nothing daunts him, and without a challenge to confront Jindal will get bored. At an age when many are just getting settled into a career, Jindal is already into at least his fifth. And those close to him say that Congress may not be his last stop.
"I wouldn't be surprised if he were president (of the U.S.) one day," says Michael Woods, now chairman of the University of Louisiana System, who worked with Jindal when he was president of the system, one of the 20 largest in the country with 83,000 students and an annual operating budget of about $800 million.
Jindal first gained national prominence in 1996 when he was appointed by the newly minted governor, Mike Foster, to head the health department in Louisiana at a time when the department was in shambles and in danger of imploding.
From 1988 to 1995, Medicaid spending in Louisiana was increasing at an average annual rate of nearly 25%. By comparison, spending on Medicaid nationally grew by about 15% during the same period, while spending on healthcare by all payers grew by 8% during those years.
The state Medicaid program, which had become a national model of corruption, mismanagement and inefficiency, had a deficit of $400 million in 1995. "The department was spending like drunken sailors, basically," says David Hood, Louisiana's undersecretary of health to Jindal from 1996 to 1998, then the secretary of health from 1998 to 2004.
At the time he was offered the job with the health department, Jindal had little experience save for work as a consultant in Washington at McKinsey & Co., during which he wrote a 25-page paper on Louisiana's healthcare system and the steps he believed were needed to solve its problems. But it was enough to get the governor's attention.
Foster initially offered Jindal the deputy secretary's position, but Jindal wasn't interested. "All along I thought I was going to medical school. I didn't really expect to be offered the job" as secretary of the department, Jindal says. At only 24 years old and without real political experience except for a few summers working as an intern for Rep. James McCrery (R-La.), Jindal was given little chance of turning around the Medicaid program. Inheriting an agency that consumed nearly 40% of the state's total budget, Jindal quickly went about putting the brakes on spending. One of the first steps he took was to cut down on fraud and abuse.
In his first year, his department, working with the state Legislature, removed a significant barrier to the prosecution of provider fraud when it repealed a statutory provision in Louisiana law requiring the department to tell providers suspected of fraud that they were being investigated. The next year the department succeeded in getting the Program Integrity Act passed-with bipartisan support and limited opposition from providers-imposing stiffer penalties if providers were found guilty of Medicaid fraud.
Since the passage of the law, the department has increased the Medicaid reviews it performs from less than 200 per year before 1997 to more than 1,000 annually, according to a December 2003 report from the Louisiana health department. At the same time, Jindal tripled the number of staff members in the department to help investigate such cases and installed new computer software to weed out questionable Medicaid claims. In total, the steps "had the effect of shutting down fraud," Hood says.
But to seriously rein in the state's Medicaid spending, Jindal had to dramatically slash the budget; in his first year he cut the program by $197 million, including $42 million that in part compensated some hospitals for services provided to the uninsured and underinsured. Nursing homes took a $26 million cut.
John Matessino, then vice president of operations and education at the Louisiana Hospital Association, says the cuts were not welcomed by providers but in the end were necessary to make the Medicaid program affordable for the state.
"Did we agree with all of his decisions? No," says Matessino, now president and chief executive officer of the association. "Did he get the program on the right footing? Yes."
Under Jindal's leadership, the health department turned a $400 million deficit into a $48 million surplus. The following year, the agency posted a surplus of $170 million.
Admirers and detractors
There is no question that Jindal has his admirers. Former HHS Secretary Tommy Thompson, who recommended him for the assistant secretary's position, calls Jindal a genius and gives him much credit for the Medicare Modernization Act of 2003, saying many of the recommendations Jindal made while on the Medicare commission were eventually incorporated into the act.
"His fingerprints are all over the Medicare bill," Thompson says.
Woods, the chairman of the University of Louisiana System, also credits Jindal for righting the eight-school system. When Jindal arrived, two of its schools, Grambling State University and the University of Louisiana at Monroe, were on probation with the Southern Association of Colleges and Universities, an accrediting body, because of financial problems.
Jindal got each college to audit its books and file quarterly reports on how money was being spent.
"You had to be accountable and in a lot of circumstances, people didn't know where money was going," Woods says.
In Washington, however, some say that his work on both the Medicare commission and at HHS was marked by dissension and partisan politics. Several members of the commission, both Republicans and Democrats, either declined to be interviewed or did not respond to requests for comment. But according to some with intimate knowledge of the commission proceedings, speaking on the condition that they not be identified, the commission became highly politicized. The ideas of more liberal Democrats on reforming Medicare were passed over and information was not shared with Democrats, say critics, putting the blame squarely on the shoulders of Jindal, who as executive director had responsibility for the commission's day-to-day operations.
During the commission's work, some members questioned the accuracy of some information that Jindal and his policy staff presented and whether the data was biased. One commissioner, Bruce Vladeck, who was a CMS administrator when it was called HCFA, has said that one set of estimates given by Jindal and his staff was prepared with "magic wands" (Feb. 7, 1998, p. 6).
The 17-member commission never made a final report on how to reform Medicare: the commission co-chairs, former Sen. John Breaux (D-La.) and Rep. Bill Thomas (R-Calif.), failed to get the 11 votes needed to approve a plan under which the government would offer premium support to seniors who would buy their healthcare insurance from a set of government-approved private plans.
In recent interviews with Modern Healthcare, Jindal says he is proud of the work he did with the commission, and the criticism of him may stem from unhappiness over policy recommendations the commission made.
"It was based on my work on the commission that John Breaux actually recommended me to the president to come back and work at HHS," he says.
There are also rumblings that while under Jindal's leadership, HHS' Department for Planning and Evaluation suffered a massive brain drain with many of the best policymakers at the agency leaving because they felt stifled by Jindal.
Jindal, however, says that while he was at HHS, his department became more involved with the White House over policy decisionmaking.
"When you talk to (CMS Administrator) Mark McClellan, when you talk to Tommy Thompson, when you talk to the members of Congress, (my department) had a much higher profile during the time I spent there," he says. "I think that in large part we were able to make (the department) much more central to policy discussions and the debates."
A lesson in politics
In 2003, Jindal left HHS to run for governor of Louisiana. Born in Baton Rouge, Jindal says he decided to run for the top job after seeing too many friends leave to pursue better economic opportunities.
"We are the only state in the South that's lost more population because people are moving out faster than they're moving in ... and I wanted to be part of turning that around," Jindal says. "I wanted to make my state a better place."
Until the final week Jindal was ahead in the polls, but in the end Kathleen Blanco won 52% to 48%. His supporters say the drop in support came after Blanco's supporters injected race into the contest. At one rally, Jindal was called Arab-American and "the Republican token attempt to mend bridges long burnt with the Arab-American community," according to published reports.
His supporters also contended that in one TV commercial aired by the opposition during the final week of the campaign, a picture of Jindal with disheveled hair was deliberately retouched to make Jindal look darker.
Jindal finesses around questions about how the fact that he is an Indian-American may have affected the election or what he learned from the loss. "It was an incredible experience. I wouldn't take it back even if I had that chance. I have no regrets about the race I ran," he says.
But according to Woods, who worked on the campaign, Jindal was devastated by the result. "None of us saw it coming," Woods says. Jindal had always been able to overcome any obstacles his race many have presented through sheer force of will and intelligence, he says. That and the fact that his opponent was a woman made him unprepared for what happened.
"Had he been running up against a white male, his guard would have been up a little more," Woods says.
Susan Howell, a professor of political science at the University of New Orleans, however, says that while Jindal may have lost some support in the northern part of the state-where support for him was always soft-once race was injected into the election, the bigger problem was an ad run by Blanco's campaign that attacked his record at the state health department. In that ad, a doctor speaking into the camera stated that the Medicaid cuts implemented by Jindal's department had hurt patients and their access to healthcare.
Jindal refused to reply to the ad, saying he had made a pledge not to run a negative campaign and that he was going to stick to his promise. But without a response from Jindal, Howell says, voters began believing the ad.
"After the ad came out ... that's when (his) support started to drop. It was precipitous," she says.
After the loss, Jindal says he decided to run for Congress, because, with the retirements of Breaux and former Rep. Billy Tauzin from public service, Louisiana "was losing a lot of seniority." Given his experience in Washington, he says, he thought his chances for a successful congressional race were high. And according to Woods, Jindal chose not to run for Breaux's seat in the Senate because Jindal was still hurting from the governor's contest and not ready for a statewide campaign.
Once in Congress, Jindal went quickly about establishing himself. During Bush's State of the Union address this year, Jindal arranged for members to dip their fingers in purple ink, then hold them up during the address as a sign of solidarity supporting the Iraqi elections.
Jindal is also president of the House Republican freshman class and is on the Committee on Homeland Security, Committee on Resources and Committee on Education and the Workforce. While those committees don't have healthcare as their main area of jurisdiction, that won't stop him from pushing onward with his ideas, he says.
Jindal supports changing the medical liability system, encouraging provider adoption of healthcare information technology, and other Republican-backed ideas such as association health plans and health savings accounts.
"I'm absolutely a conservative who believes that there's a right to healthcare," he says. "We need to make sure that everybody in America has access to affordable healthcare. What makes my views on healthcare conservative is that I think healthcare can be delivered in the private sector. I think that there are a lot of problems with our healthcare system, but I'm a very strong proponent of our healthcare system as opposed to a single-payer" system.
"The overarching theme for what I'd like to accomplish is putting control of healthcare back into the hands of patients working with providers."
--U.S. Rep. Bobby Jindal (R-La.)
Birthplace: Baton Rouge, La.
Family status: Wife, Supriya, and two children, ages 3 and 1.
Education: Bachelor's degree in biology and public policy, Brown University, Providence R.I., 1991; graduate degree in political theory, Oxford University, 1994, where he was a Rhodes scholar.
Previous jobs: Secretary of the Louisiana Department of Health and Hospitals, 1996-98; executive director of the National Bipartisan Commission on the Future of Medicare, 1998-99; president, University of Louisiana System, 1999-2001; assistant secretary for planning and evaluation at HHS, 2001-03; named a Modern Healthcare Up & Comer in 1997.
Personal tidbit: Jindal's birth name is Piyush. He says he changed it to Bobby, after Bobby Brady from "The Brady Bunch," when he was just 4 years old.