A former Jindal administration Medicaid director and Republican lawmakers say they haven't received enough information to support the GOP governor's refusal to cover more uninsured adults through Medicaid under the new federal health care law.
Jindal's health secretary, Bruce Greenstein, acknowledges his department is relying on research done in 2010. Since then, further details about the law have been provided by the federal government and by other independent reviewers.
Even the governor doesn't cite the cost figures from the 2010 research anymore.
The decision to reject or accept billions of dollars in federal health care aid under the Affordable Care Act has wide-ranging implications on thousands of Louisiana residents' health care, health providers, the private insurance market, businesses, economic development and the state budget.
Rallying cries for more in-depth analysis of Medicaid expansion in Louisiana are growing.
Senate Insurance Committee Chairman Dan "Blade" Morrish, R-Jennings, said the decision must include consideration of "what is really the best thing for Louisiana to do, exclusive of the politics."
The nonpartisan Public Affairs Research Council of Louisiana, a government watchdog group, also is pressing for more examination into the long-term implications of Jindal's refusal to expand Medicaid. PAR's report was co-authored by a one-time Jindal administration health care official, former state Medicaid director Don Gregory.
"The hundreds of thousands of Louisianans who do not have health insurance deserve a comprehensive examination of the expansion option. Also, Louisiana taxpayers deserve an accurate analysis of the estimated costs and benefits," PAR wrote in its report.
If the governor doesn't want to expand Medicaid, how does he intend to care for Louisiana's uninsured, PAR asks, saying the administration needs to offer an alternative or look into compromises with the federal government under the health care law.
Jindal, considered a 2016 White House contender, opposes the Medicaid expansion allowed under the federal health overhaul, calling it inappropriate growth of an inefficient and poorly managed health program.
Estimates are that up to 400,000 more Louisiana residents could be eligible for Medicaid in 2014 and thereafter if the state chooses to expand the program. The nonpartisan Kaiser Family Foundation estimates it would cost Louisiana $1.2 billion over 10 years to cover the additional low-income residents in exchange for $15.8 billion in federal funding.
Jindal said the expansion would be too costly for states. He said insurance is better handled by private companies and states should be free to design health programs tailored to their needs.
"We made the decision to not expand, so we're not putting a great deal of time in what-ifs," Greenstein said.
The health secretary acknowledges the state's 2010 analysis, done by an outside consulting firm, didn't include modeling about whether savings on uninsured care currently paid by the state could help offset Louisiana's costs of a Medicaid expansion.
He said the Jindal administration has sought more flexibility from the federal government to let the state decide how to cover its residents with insurance, but hasn't heard back. But Greenstein said the administration hasn't filed a formal request with the federal health department.
Meanwhile, Jindal's blasted the health law in editorials and in conservative media.
Greenstein said federal officials have provided little guidance about the regulations since the state's last analysis of the health care law to prompt further study.
"Much of the research is difficult to do beyond what we've done," he said.
The House and Senate insurance committees asked Greenstein's Department of Health and Hospitals to dig further into the details and to gather information from states like Arkansas that are working on alternative program models with the Obama administration.
"The people of this state deserve to know whether we're making the right decision, and I can tell you right now I do not know," said Morrish.
Melinda Deslatte covers the Louisiana Capitol for The Associated Press.