BATON ROUGE, La.—If Hillary Clinton and the Democrats win the November elections, four or five more Southern states will expand their Medicaid programs under the Affordable Care Act next year, Louisiana's new Democratic Gov. John Bel Edwards said Tuesday.
“If it becomes obvious the Affordable Care Act won't be repealed, a number of states will opt into the expansion fairly quickly,” he said.
Edwards said his executive order in January to extend Medicaid to low-income adults was “the easiest big decision I'll ever make” given the state's large uninsured population, poor health status, budget problems and the burden of uncompensated care on healthcare providers.
Talking to a group of healthcare reporters on a trip organized by the Kaiser Family Foundation, Edwards said the state already has signed up 204,000 people for the expanded Medicaid program since enrollment started June 1, with coverage starting July 1. He, along with of state Health Secretary Dr. Rebekah Gee and Medicaid enrollment director Ruth Kennedy, described the intensive planning that enabled the state to get so many people signed up so quickly, with the goal of enlisting 375,000.
The key was automatically signing up the tens of thousands people already participating in other state health programs for the poor and contacting everyone receiving federal food stamp benefits. In addition, there has been a broad outreach campaign involving hospitals, clinics, health plans and schools. The new enrollees will be automatically enrolled in one of five Medicaid managed-care plans run by large national insurers, and they will have 90 days to switch plans if they want to.
Edwards said he and his team overcame the resistance of the state's Republican-controlled Legislature by stressing that the Medicaid expansion was funded by dollars Louisiana already was paying and that were going to other states. “That resonated with conservatives,” he said.
It also helped, he said, that he was elected by a large margin after campaigning heavily on Medicaid expansion, and that the state needed the federal Medicaid dollars to help close a big budget shortfall left by the previous governor, Republican Bobby Jindal.
Right now, Edwards said his priority is to win passage of a health insurance premium tax that would raise $187 million for the next fiscal year to pay the state's nine public-private safety net hospitals for treating the poor and offering graduate medical education.
After that, he and Gee have in mind an ambitious program of payment and delivery reform in the expanded program, including raising rates to providers, possibly through some type of shared-savings program tied to quality performance and patient outcomes.
Edwards said his political advisers initially warned him against talking about Medicaid, with its links to the politically toxic Obamacare. “There was the idea that Medicaid was just another welfare program for those who don't work.” But he was able to turn that around by emphasizing that 70% of the beneficiaries would be full-time workers in low-paid jobs in construction, tourism, restaurants and other industries. Polls showed that 69% of Louisianans backed the expansion.
The governor has gotten personal feedback on the expansion. A young mother he knows at his church recently came up to him and his wife and told them that because she was able to sign up for Medicaid, she's going to be able to receive an operation she has needed. Edwards said the three of them cried together.
“It's not right versus left,” Edwards said about the nature of the political struggle to expand Medicaid. “It's right versus wrong.”