Preposterous Obamacare speculation flees reality

Sometimes the media go with a story just so far detached from reality, one must marvel at their obliviousness. Louisiana readers received one such treat last week after Democrat Gov. John Bel Edwards unwisely decided to expand Medicaid.

Just after that happened, Pres. Barack Obama visited the state and there proclaimed that he would authorize the period in which the federal government picks up all reimbursement costs of expansion (Louisiana still will have to fork over several million dollars extra the first half of the next fiscal year to cover administrative costs) to the first three years of it for a state, not in the 2014-2016 period as the law reads. As it currently stands, Louisiana would receive total reimbursement for care costs only during the first six months of its next fiscal year.

Keep in mind that Obama typically operates in a dictatorial mode whenever Congress insists on following the Constitution in its power to make law by refusing to pass Obama’s requests; he responds by issuing extra-constitutional executive orders and signing statements to attempt to bypass the rules by which this representative democracy exists, so he has gotten into the habit of saying he will make things happen that constitutionally he cannot. The fact is, he can promise only to put this idea into the budget for the Republican-led Congress to do with it whatever it sees fit.

The New Orleans Times-Picayune subsequently produced an article wondering if the move presented some kind of “trap” for the state’s Republicans in Congress. Apparently without jest, it speculated that they would feel pressure to go along with this proposal. I imagine my professional colleague when asked to comment about the notion for the article had to keep from laughing as he gave input regarding this ridiculous presumption. And others of the state's media, while not going this far, actually seemed to treat seriously the thought that this additional money could come Louisiana's way.

Let’s see, so some doubt unbelievably remains that the majority of GOP congressmen from Louisiana who have voted dozens of times to get rid of the misnamed Patient Protection and Affordable Care Act (“Obamacare”) that includes expansion, and of whom all within the last month voted to send a budget bill that included eliminating Obamacare to Pres. Nyet who vetoed it, would approve of a budget designed to encourage the failing law’s adoption in the states? That they would support a plan to spend more money to produce worse health outcomes?

Simply put, this speculation has nothing to do with the real world. Obama’s request on this score is dead on arrival in that, on pragmatic policy grounds, every Republican would vote to amend out that provision in the budget they send to him, Louisianans included. My Advocate colleague Stephanie Grace seems a bit puzzled by that forecast reaction, with her observation that this cooperation should come, because “Whether or not they like the health care law, it’s the law of the land, and there are strong arguments in favor of helping to ease the cost of complying with it in a state that’s facing a massive budget shortfall.”

Except that, odds are, two years from now Obamacare with its Medicaid expansion component, battered by its continually escalating costs now double the original laughable predicted amount, no longer will exist in its present form as law of the land. As providers continue to lose money with the expanded population compared to treating them as uncompensated care patients and with expansion forcing higher private insurance premiums, the unsustainable system born broken (perhaps intentionally, following a familiar Obama tactic of taking a problem, making it worse, then blaming it on anybody else and suggesting more of the same will solve the problem his less-intense application exacerbated) will not survive – especially as chances increasingly favor continued Republican control of Congress and retaking of the White House.

That’s the path the Louisiana GOP members will follow – tear down the entire rotted structure of Obamacare and replace with something like Sen. Bill Cassidy’s demonstrably superior Patient Freedom Act. And they should, for this represents the best path to stopping deleterious Medicaid expansion in Louisiana in its tracks.

Ultimately, any discussion of Louisiana receiving three years’ worth of full reimbursement from the federal government on Medicaid expansion flees from reality if it does not acknowledge that existence of any such opportunity ranges from extraordinarily unlikely to not a chance in the real world.