Since the Supreme Court made taking part in the Medicaid expansion under the Affordable Care Act optional, several Republican governors and state legislatures have decided to reject it. One of the most prominent governors to reject the expansion was Bobby Jindal (R-LA) who recently wrote an op-ed defending his decision.
First, as a general principle, we should not move people from private insurance onto government-run programs. It seems a matter of common sense that we should want to encourage self-sufficiency and target taxpayer spending only for those most in need. But Medicaid expansion would have moved up to 171,000 Louisianians off private insurance and stopped another 77,000 people from obtaining private insurance. To cover 214,000 low-income uninsured people in Louisiana, Obamacare would add more than twice that number – more than 450,000 people – to the Medicaid rolls. This makes no sense.
The Obama administration has denied multiple requests to target expansion, impose stricter anti-crowd out policies, require more robust cost sharing, allow flexibility on benefit design or the use of premium assistance, or otherwise mitigate this unnecessary displacement from the private sector to the public sector.
This is just one of six points Jindal highlighted. He also opposes expansion because it will cost the state some money and he doesn’t think the federal government should be “borrowing from China” to expand Medicaid.
It is worth familiarizing yourself if Jindal’s argument because Medicaid expansion is likely to be a very big political and policy issue in the next few years at both the federal and state level. Republicans want to make Obamacare a top issue in federal elections and Medicaid expansion will potentially go directly before voters in several states, thanks to ballot initiative campaigns. It should also play a big role in several gubernatorial elections.
Since Jindal is considered a top “thinker” among Republicans it is likely his same basic argument against Medicaid expansion will be parroted by Republicans across the country. Expect to see these same lines repeated repeatedly over the next few years. Jindal does a good job summarizing what is basically the entire Republican case against it.
Photo by Gage Skidmore under Creative Commons license