It’s been obvious from the beginning that a big part of the GOP strategy for demonizing Obamacare has been to convince existing beneficiaries of federal health programs that ACA coverage would come out of their hides. Thus the constant efforts to convince Medicare enrollees that ACA was financed by “Medicare cuts” (not at all true with the exception of the reductions in super-subsidies offered to the Bush-era conservative pet rock of Medicare Advantage policies offered through private insurers). There’s also a nasty ideological and even racial undertone to this campaign aimed at white middle-class retirees who view their Medicare benefits as earned (via both payroll tax contributions and a lifetime of work), as opposed to the “welfare” being offered to those people supported by Medicaid or Obamacare.
But leave it to Bobby Jindal to come up with a line of attack that pits existing Medicaid beneficiaries against those who would qualify for coverage if, over his dead body, the ACA’s Medicaid expansion were to be enacted in Louisiana. TPM’s Dylan Scott has the story:
Engaged in all-out war with the liberal group MoveOn.org over a pro-Obamacare billboard, Louisiana Gov. Bobby Jindal (R) has accused the organization — and liberals in general — of endorsing discrimination against the disabled through their support of the federal health care reform law and its Medicaid expansion.
“Liberal groups like MoveOn.org won’t say one word about caring for individuals with disabilities, or how Obamacare prioritizes coverage of childless adults ahead of the most vulnerable,” Jindal wrote in an op-ed in the Shreveport Times last Thursday. “They just want to intimidate states into accepting Obamacare’s massive new spending programs.”
What does Bobby mean by “prioritizing” coverage of childless adults? Simply that expanded coverage comes with a higher federal match rate than is available for traditional Medicaid (not high enough, of course, to convince ideologically motivated Republicans, especially in the South, to execute an expansion that in many cases would represent a fiscal windfall for state governments while significantly reducing the ranks of the uninsured).
How, exactly, does that hurt people with disabilities, or others currently qualifying for Medicaid? The short answer is that it doesn’t, as Scott explains with some help from experts:
[T]here are a few huge problems with Jindal’s rationale, which effectively undermine the whole line of attack. First, some disabled people could actually qualify for health coverage under the Medicaid expansion, according to MaryBeth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.
“People with disabilities can be within the new expansion group,” she said. “The ACA provides the opportunity for some people with disabilities to qualify for Medicaid who never qualified before. Their incomes, while still low, could have been above the very, very low limits states had set or they may not have been eligible at all if they fell into the category of single, childless adults. So it creates an expanded opportunity for people with disabilities to gain coverage.”
Second, Obamacare should have no policy bearing on the traditional Medicaid program. Federal funding for the traditionally eligible population remains exactly the same, and the states retain the same flexibility to manage their programs as existed prior to the law. The ACA brings a new population into the program, but there is no policy reason that it would lead to “discrimination” — as Jindal calls it — or any other detrimental effects for disabled people enrolled in the traditional program.
“I think that’s right,” Musumeci said when asked by TPM if the Obamacare’s Medicaid expansion should have no effect on traditional Medicaid. “What the Medicaid expansion essentially does is it creates a new eligibility category. Like any other time Congress has expanded eligibility of the program, it is adding statutory authority to cover this new group of people.”
“But it’s built into the same underlying Medicaid program. States still have all of the flexibility that they previously had in terms of how they structure their care delivery system, their benefits packages, and all of those things.”
It would be interesting to know how well people with disabilities, and other current Medicaid beneficiaries, would fare in Louisiana if the national Republican “reform” of Medicaid, a block grant that reduced federal funding over time, were to be enacted. Let’s hope we don’t find out. But in the meantime, the “prioritization” argument against the Medicaid expansion is just another effort to frighten one group of safety net beneficiaries they have a stake in excluding others. It’s exactly what we’ve come to expect from self-styled conservative Christian warriors like Bobby Jindal.
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