Bobby Jindal stakes out far-right health reform territory with Medicaid

Bobby Jindal, uninformed would-be reformer. When we last saw Louisiana's Gov. Bobby Jindal tackle Medicaid, he was furiously backpedalling from his cruel and hugely unpopular decision to cut Medicaid patients off of hospice care. Not letting that bone-headed mistake stop him from wading deeper into the Medicaid morass, Jindal has penned an op-ed in the Washington Post, explaining his entirely political decision to refuse Medicaid expansion fund under the Affordable Care Act.

He pretends that his reasons are economically justified, but it's clear that this op-ed is entirely about positioning himself as a far-right health care "reformer," with Medicaid being his primary target.

The Obama administration heralds this as a tremendous bargain for states. That's simply not the case. The administration overlooks that Medicaid is largely failing current enrollees with its outdated model that costs billions of taxpayer dollars and produces poor outcomes.

Medicaid operates under a 1960s model of medicine, with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility. Expanding the entitlement program as it stands would further cement a separate and unequal tier of health coverage. Without fundamental reform, Medicaid will continue to deliver what it has for decades: limited access, poor quality and budget deficits.

Jindal goes on to identify, in a facsimile of wonk-speak that at least sounds like it might be reasonable (using phrases like "eligibility, benefit design, cost-sharing, use of the private insurance market, financing and accountability") to argue essentially for block grants, for more "flexibility" for the states in choosing who to kick off of Medicaid. If Jindal's argument wasn't predicated on his hypothesis, "Medicaid is largely failing current enrollees with its outdated model that costs billions of taxpayer dollars and produces poor outcomes," some of this might sound fairly reasonable. But it's not. He's starting from the false premise that Medicaid doesn't work, showing either a profound lack of understanding about health care systems or just his crass political ambition.

Insuring people through Medicaid, the CBO tells us, would cost 50 percent less per person for a state than subsidizing private insurance under state exchange. Medicaid has had the slowest rate of growth in costs compared to Medicare and private insurance. Medicaid patients are highly satisfied with the care they receive. Medicaid works.

While Jindal focuses on how much his state would pay for the Medicaid expansion over the next decade, he's ignoring what the state would save with it, including as much as $938 million over six years in uncompensated emergency health care. It would also save some lives, giving an additional 400,000 uninsured Louisianans coverage. That would result in more health care jobs, which sure wouldn't hurt the state's still-struggling economy. But none of that concerns Bobby Jindal. He's got bigger issues to think about than the state of the state he's governing. He's got a 2016 presidential primary to position himself for.