Health Care Debate Is About To Shift

Louisiana politicos have spent much time trying to root out the horde of profligates they say have fraudulently joined Medicaid. They're going to have to find a new issue.

Mathematically, the Legislative Auditor has calculated that 83,850 out of nearly half a million enrollees under Medicaid expansion make too much money to qualify. The Louisiana Department of Health has since installed new software that raised questions about 37,000 enrollees who have may been erroneously signed up and now have until March 29 to provide evidence why they should not be cast off Medicaid rolls.

Louisiana Republicans call it "Medicaid Fraud," and it's the issue that they recently have hammered the most frequently to underscore their opposition to the federal Affordable Care Act.

"Just last year, the Legislative Auditor's Office estimated that Louisiana likely misspent $85 million on Medicaid recipients whose income levels should have disqualified them," U.S. Sen. John N. Kennedy, R-Madisonville, said last week in a scathing news release that blasted Democratic Gov. John Bel Edwards for expanding Medicaid rolls in the first place.

But Democrats in Washington are moving the goal posts on that tried-and-true partisan rhetoric.

Though light on the specifics, Democratic presidential candidates Kamala Devi Harris, Elizabeth Warren, Kirsten Gillibrand, Julian Castro and Bernie Sanders have called for some form of "Medicare for All." Legislation has been filed in Congress to do just that.

Medicaid is a state-administered coverage for low-income patients that is paid largely with federal funds. The small bit that Louisiana taxpayers cover amounts to the single largest cost in the state's budget -- and as such is the target of all sorts of meddling. It was the disagreement over how many Medicaid services to cut that was at the root of the bitter 10-session debate over how best to balance state government budgets. Adjusting enrollment qualifications -- Medicaid expansion -- was how Obamacare proponents wiggled around not being legally able to force people to purchase policies from private companies but still provide near universal coverage.

Medicare is the purely federal program that provides health care coverage for every U.S. resident over the age of 65 -- and those with certain disabilities -- who have lived in the country continuously for five years and paid into the system for 10 years. Funding for the government insurance already is deducted from every paycheck.

"Medicare for All" would expand coverage to younger residents.

Though not involved directly in the national issue, few Louisiana lawmakers give the "Medicare for All" idea much of a chance. Still, they recognize that the health care conversation, even as far south as Louisiana, is about to dramatically change.

A coalition of insurers, medical care providers and drug companies has formed to oppose "Medicare for All," The New York Times reported last week. The new narrative by the Partnership for America's Health Care Future is that the Affordable Care Act has some flaws that need fixing. But, as this argument goes, the nearly decade-old program otherwise provides pretty good coverage and shouldn't be replaced with "Medicare for All" as the Democrats want or jettisoned completely as Republicans have tried for years.

The new narrative should provide some entertaining moments, like watching Kennedy shift toward how much more tasty weed killer has become in relation to Obamacare.

In the interest of full disclosure, I underwent a Road to Damascus moment about "Medicare for All" on New Year's Day when my wife was forced onto the government program.

Like about three-quarters of the 155 million Americans with employer-sponsored coverage, my family joined those who polled "generally well satisfied" with our "insurance partner." When my wife contracted ALS, however, most of our health care conversations turned to what she needed to survive and what wasn't covered by her employer-supported policy. To my surprise, Medicare, along with a supplemental private policy, covers pretty much everything at a premium cost that is about the same as the employer-supplemented policy.

The costs of "Medicare for All" certainly will be a point of contention. The conservative Mercatus Center at George Mason University estimates a $32 trillion price tag over the next 10 years. Sanders, a liberal, argues that decreased bureaucracy, employer savings and better health care outcomes will save the nation up to $2 trillion. Following the 2018 midterm elections, a national health plan is a debate voters want to have, according to the Kaiser Family Foundation, a California-based health care think tank whose poll in January showed six out of 10 adults favor a national health plan.

In Louisiana, expect "Medicare for All" to supplant the decadelong conversation about Obamacare.

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