In his last regular legislative session as governor, John Bel Edwards is still pushing some of the same priorities he first campaigned on back in 2015 — things like a higher minimum wage, once more already rejected by conservative lawmakers, and another teacher pay raise, a big question mark even though there’s money to pay for it.
One promise Edwards had an easy time keeping was the one he considers most important: expanding Medicaid insurance coverage under the Affordable Care Act, largely on the federal dime, so that more than 777,000 mostly working poor Louisianans now have access to preventive care and management of serious illness.
Expanding Medicaid wasn’t just easy because it was the smart choice, both morally and financially. It was also easy because the Democratic governor didn’t have to go through the increasingly Republican Legislature. All he had to do was issue an executive order, which he did to much fanfare on his first day on the job.
The upside is obvious, but there is a downside. One governor may enact a policy via executive order, but the next governor can do the exact opposite.
That’s why a simple yes/no question posed last month to the leading candidates hoping to replace Edwards was noteworthy.
Asked by Public Affairs Research Council president Steven Procopio whether they’d stay the course, none of them said they’d do away with the program.
Treasurer John Schroder offered a tentative "maybe," but the rest of the candidates said they’d keep it, from former Edwards transportation chief Shawn Wilson on the left all the way to attorney Jeff Landry on the far, far right (Procopio didn’t ask Landry this question during the formal event but Landry confirmed his response to my colleague Tyler Bridges, and noted that no state that has adopted expansion has gone back).
Also vowing to stay the course were state Sen. Sharon Hewitt, state Rep. Richard Nelson, attorney Hunter Lundy and former Louisiana Association of Business and Industry CEO Stephen Waguespack. Wilson is a Democrat and Lundy an independent; the other candidates are Republicans.
The benefits of continued participation are clear: cost-saving and life-saving preventive care for patients, fewer worker sick days for employers, a steady stream of income for hospitals required to treat patients who seek expensive emergency care when something cheaper would do, and a lifeline for rural hospitals that have seen similar institutions in non-expansion states close.
The wonder, is, and has always been, why anyone would oppose it.
Elsewhere around the South, powerful forces still do. States many Louisianans look to with envy, including Georgia, Texas and Florida, haven’t expanded. Virginia engaged in a yearslong battle before adopting Medicaid expansion, and North Carolina is still fighting over it.
It’s clear that this is a red state thing. Georgia, Texas and Florida have Republican leadership, and Virginia and North Carolina only made their moves under Democratic leadership, just as Louisiana did when Edwards succeeded die-hard opponent Bobby Jindal.
And it’s hard to see why these governors would resist if not for the politics of it all. Neither Jindal nor the governors of those other states made remotely convincing arguments against accepting a benefit for their residents that was originally 100% covered by the federal government, and is now reimbursed at 90%. That’s taxpayer money from all of us, but it only flows back to states willing to take it.
Who’s even the constituency for rejecting the offer, other than those who still get addled at the mention of former President Barack Obama, architect of the health care law?
The truth is that there never was a policy-based argument for states to have the choice. The ACA was written so that Medicaid expansion would cover everyone too poor to qualify for private sector subsidies; cutting it out only became an option once the U.S. Supreme Court ruled, handing opportunistic state-level politicians — again, see Jindal — a new way to declare themselves anti-Obamacare.
The good news is that here, with the program’s success out there for all to see, that fever seems to have broken, even among the most partisan of potential governors.
That should be a lesson for our allegedly higher-functioning neighbors — take care of your people already! — and also one for anyone from either (or no) party hoping to steer Louisiana through its many non-healthcare challenges: Sometimes, hopefully more often than not, it’s the results that matter.