Outmaneuvered last year when the Republican-led Legislature passed a bill that addressed what would happen if the misnamed Patient Protection and Affordable Care Act (“Obamacare”) dissolved at the hands of the federal judiciary, after initially opposing it Edwards swallowed his pride and signed it. But to save face, he created using taxpayer dollars a task force stacked with his appointees to try to make the effort look as bad as possible.
Putting on it individuals representing organizations that benefit from the estimated $128 billion in extra federal taxpayer spending nationally on coverage for 2019, joining a couple of legislative Edwards allies Democrat state Sen. Regina Barrow and Republican state Rep. Joe Stagni, they approved the final report, after hearing almost exclusively from Obamacare advocates in its compilation. Unsurprisingly, it alleged an alarmist scenario of nearly 500,000 people losing insurance coverage with $536 million needed to continued subsidization of existing individual coverage and much more to continue Medicaid expansion (which it claims would cost $3.5 billion, which perhaps runs a bit a high as 2018 data suggest a total closer to $3.1 billion).
Of course, the report minimizes, if not dodges, the presentation of information that brings such numbers into great dispute. The fact that a third to a half of expansion recipients already had their own insurance not paid for by taxpayers prior to expansion taking effect, which the report acknowledges only by an obscure reference of “some Medicaid enrollees with insurance through expansion would have access to other sources of Medicaid or private insurance coverage,” this cuts the figure to at most 300,000, and some unspecified portion of that number could afford their own insurance but didn’t choose to pay for it prior to expansion.
It also, as noted in a response from Republican Atty. Gen. Jeff Landry, doesn’t admit that many in expansion could take advantage of other Medicaid programs to have insurance. As well, the state could take advantage of recent federal changes that allow for increasing waiver program offerings, the providing of services to people who have special health difficulties, which Edwards (with the Department of Health buffeted by leadership turnover and legal woes) has yet to do.
Landry’s response also points out that the report used suspect data in making the contention that elimination of the pre-existing condition part of Obamacare would leave a large swath of people uninsured, significantly overestimating the number by an unknown amount as it discounts that many aren’t in the individual market but rather are covered by employer-based plans whose other preexisting protections effectively address their needs. Finally, the response pointed out that the very legislation, Act 412 of 2019, that Edwards grudgingly signed presents a model tried successfully in Maine for sustaining the less-objectionable parts of Obamacare, which the report barely mentioned.
In the context of that, it did devote a small amount of attention to a component of that model, creation of a reinsurance Guaranteed Benefits Pool. Although Republican Insurance Commissioner Jim Donelon plans to issue a report triggered by Act 412 with much greater detail on funding requirements for this to work just prior to the upcoming legislative regular session, the Edwards report glossed over this detail, opining only that “[t]he source of the funds has not yet been identified.”
That doesn’t mean it doesn’t exist. For example, if Medicaid expansion goes away, suddenly the $314 million tax increase levied by the Edwards executive order to pay for expansion becomes an orphan available for use. Better, elimination of free care for the 138 to 200 percent federal poverty limit cohort could provide another $51 million annually, and instituting Medicaid patient responsibility measures could reap $90 million more a year.
But let’s take the report’s questionable numbers and conclusions at face value: it would the cost the state taxpayers a lot to ensure continued coverage. However, that’s because it costs federal taxpayers a lot to ensure current coverage, including Louisianans. That’s the dirty secret Edwards and his allies don’t want the public to realize.
Louisiana federal taxpayers already pay for this, with the only change whether they cough it up on a Form 1040 or on a Form IT-540 and in sales and other state taxes. Contrary to what Edwards wants to dupe the public with, there is no free lunch that would vanish with Obamacare. Termination of Obamacare means the federal government doesn’t have to take the people’s money to pay for it, but would leave it up to the states to do that whichever ones chose to do so.
In the final analysis, that’s actually better. One of the great policy deceptions of Medicaid expansion is that it is nearly “free” because state taxes pay for but a tenth of it. Wrong; that other 90 percent Louisianans pay through their federal taxes. Louisianans pay in total for Louisiana’s Medicaid expansion, but the way they do it obscures the accountability, i.e. it was Edwards who decided the public would be taxed an extra $3.1 to $3.5 billion to redistribute to many individuals who used to take the responsibility to have their own insurance or chose not to, and now receive it off the sweat of others.
For all the disingenuity inherent in the Edwards whitewash, it can’t help itself to reveal this fact. If it sensitizes the public to the fact that Edwards increased spending from their taxes by over $3 billion a year that ultimately ends up in the pockets of health insurers and providers, only that will make it worth the paper on which it is printed.