Republican state lawmakers who have repeatedly rejected efforts to expand Louisiana's Medicaid program and provide government-funded health insurance to the working poor are showing much more interest in the idea.
It's hard to keep turning down the offer of billions of federal dollars for a cash-strapped state. But perhaps more importantly for the debate, the Republican governor who ran a failed presidential campaign that included strong opposition to the federal health care revamp is leaving office in January.
With Gov. Bobby Jindal's exit on the horizon, talk of a Medicaid expansion has gotten serious at the Louisiana Capitol. Democratic Gov.-elect John Bel Edwards has made expansion one of his top priorities for enacting after he takes office Jan. 11.
Many lawmakers hadn't bothered to learn the ins and outs of how an expansion would work before they voted down the legislation. Now, they're getting a crash course.
After a Senate Finance Committee briefing last week, senators instructed the Department of Health and Hospitals to draw up a Medicaid expansion proposal by Jan. 1.
And the request was coming not just from the Democrats.
"I'd like to see how much it costs. I don't think we've ever had a really good estimate of what it costs," Finance Committee Chairman Jack Donahue (R-Mandeville) said after the hearing. "It could be a benefit to Louisiana."
Republican Sen. Bret Allain of Franklin asked the Legislature's financial analysts to study the different models used by other states to determine how they could apply to Louisiana.
If Louisiana decides to expand its Medicaid program as allowed under President Barack Obama's signature healthcare law, as many as 500,000 more people would be eligible for the government-funded health insurance, according to data presented to the Senate committee.
Medicaid expansion covers adults making up to 138% of the federal poverty level—about $33,400 for a family of four. Thirty states already have agreed to expand their Medicaid programs.
Jindal refused expansion, opposing it as too costly for the state and as an inappropriate growth of government spending.
Republican lawmakers saw the issue as a nonstarter with a governor who would veto it or find ways to create roadblocks even if expansion was passed. In addition, it wouldn't have been easy for some GOP lawmakers to explain in an election year to conservative voters who dislike Obama, if Jindal was going to make it a public fight.
But the political winds shifted with Edwards' victory in the runoff election, and even before when the major Republicans running for governor all backed some variation on Medicaid expansion. That signaled to GOP lawmakers an expansion was likely for the new term in office.
One particular area of concern that has several one-time critics considering expansion is a provision of the federal health law that ratchets back a pool of federal dollars Louisiana uses to finance most of its uninsured patient care through the privatized LSU hospital system.
If those dollars lessen in future years as planned, the state either has to pick up millions of those costs itself or find other financing. Giving more people Medicaid coverage, thereby shrinking the pool of uninsured, is one option to keep the state from facing ballooning costs for uninsured care.
Even as an expansion plan seems likely to gain traction, however, Edwards is finding fulfilling his campaign promise might be trickier than he thought.
Questions have been raised about the workability of legislation passed to help cover the state's cost-share of a Medicaid expansion — which will grow to 10% of the price tag over time.
In addition, the health department will need time and staff to enroll hundreds of thousands of people into new insurance coverage. And the state will have to find a way to persuade more doctors to see Medicaid patients to ensure people don't just have a Medicaid card, but have meaningful coverage.
Still, Edwards promises expansion will be a reality in Louisiana, saying: "We are going to expand the Medicaid program in Louisiana. We're going to do it as soon as we possibly can, as responsibly as we possibly can."
Melinda Deslatte covers Louisiana politics for the Associated Press.