Louisiana would be uniquely penalized in the calculation of federal spending on state Medicaid programs under the Senate GOP’s proposed health law rewrite, Gov. John Bel Edwards said Wednesday.
The Democratic governor said the new per-capita payment calculator that would be used to divvy up Medicaid dollars uses a formula that would downplay an enrollment boost in Louisiana’s program due to Medicaid expansion.
Edwards has widespread problems with the bill, which has been delayed for a vote because Republican Senate leaders can’t rally enough support from GOP lawmakers to pass the measure.
“There’s not a lot of redeeming qualities about the bill. I would hope they throw it out and start over,” Louisiana’s governor said on a conference call with Montana Gov. Steve Bullock, two Democrats leading states that supported President Donald Trump.
Edwards’ heaviest criticisms of the Senate bill center on its plan to significantly shrink spending on the traditional Medicaid program for low-income, disabled and elderly people and to phase out extra money given to states that expanded their Medicaid programs to cover the working poor.
Louisiana would have to end its expansion coverage as soon as the extra money ends, because “it will become unaffordable,” Edwards said. But he noted there’s also a unique financing twist for Louisiana in the cap payment structure the legislation would enact overall for Medicaid.
Louisiana was the last state to expand Medicaid to more people as allowed under former President Barack Obama’s health overhaul. Edwards enacted the expansion when he took office, after Republican former Gov. Bobby Jindal had refused to participate for years.
Medicaid expansion only has been in effect for one year in Louisiana, with 430,000 people enrolled. That delayed start, Edwards said, would skew Louisiana’s per-capita calculation under a formula in the Senate bill that allows states to use their most favorable eight quarters of Medicaid enrollment data. Louisiana won’t have eight quarters under full Medicaid expansion to use, and Edwards said that would lock the state into an artificially low per-capita baseline.
“We’d be punished unfairly going forward,” Edwards said.
He also objected to the adjustment of Medicaid spending based on a consumer price index that he said fluctuates widely and could keep states from being able to predictably budget their Medicaid spending.
Louisiana’s two U.S. senators, Republicans Bill Cassidy and John Kennedy, remain noncommittal about the Senate health care bill, though Cassidy has raised concerns about a similar House-passed measure.
In his most recent statement released Tuesday, Kennedy talked of “the unmitigated disaster that is Obamacare” and said he will work for a “more sensible health care system.” He didn’t say whether the Senate legislation offered the fixes he sought. Cassidy’s spokesman didn’t answer a question Wednesday about whether the senator had decided his position on the bill.
Cassidy, a doctor who spent decades working in Louisiana’s charity hospital system, has faced more pressure from outside groups on the health bill because he’s shown more reticence to the House-approved version. Edwards said he hoped Cassidy would be influential in either helping keep the measure from passage or “making tremendous fixes” to the bill.