Our Views: Insurance for working poor isn’t cheap but it’s a bargain for society

When Gov. John Bel Edwards leaves office in January 2024, he will be able to point to a dramatic advance for Louisiana under his watch: expansion of Medicaid insurance coverage for the working poor.

In a state with below-average incomes and much poverty in rural areas and cities alike, the move that Edwards campaigned on in 2015 and affirmed immediately on taking office has been a valuable contribution to family lives ever since.

And if Edwards needed any validation of his decision — he doesn't, he's proud of it — he can look to state after state headed by politicians who balked at Medicaid expansion: Seven times, now, voters have overruled the politicians.

Last week, South Dakota voters were the latest to approve Medicaid expansion in their state.

That's even as they thumpingly reelected expansion opponent and "conservative firebrand Gov. Kristi L. Noem" suggesting "that voters are more complicated than many political observers often assume." That conclusion by The Washington Post editorialists isn't unreasonable. GOP-led states, including Louisiana under presidential aspirant Bobby Jindal, originally balked at the 2010 "Obamacare" law allowing for the expansion, which the U.S. Supreme Court later made optional for individual states. Among other conservative states, Idaho, Nebraska, Oklahoma and Utah were among those since voting in the expansion.

Noem is popular in her state and opposed expansion, but the voters disagreed. Tuesday's vote means that about 45,000 folks making less than 113% of the federal poverty level, and around $18,000 for an individual, will now have access to government-sponsored health care coverage.

This does cost states money, here and in the other 38 expansion states, although the bulk of the cost is picked up by the feds.

But as the average family doesn't have enough money in the bank to cover minimal deductibles for health care, and vast numbers of Americans carry medical debt, people working at low-wage jobs won't be able to make it otherwise.

A key word here: working.

The Affordable Care Act changed much in America's system, although much less than desired by advocates for single-payer insurance systems like that of Canada and European countries.

Medicaid is also a system that has drawbacks, including low reimbursements for many medical providers. As it is a state-local program with matching funds required to pay for services, states must constantly work on adjustments to ensure that providers are willing to take on Medicaid patients.

But though it is a fact that medical care is expensive, the working people who benefit from the Medicaid expansion are contributors to society, and often would not be absent treatment for chronic conditions and early detection through screening for major illnesses.

In the heated debates surrounding the ACA passage in 2010, politics was front and center. Although the law has been tweaked a few times and Republican lawmakers in Congress sought its repeal — without offering a meaningful alternative, in our view — it is now part of the larger health care system in this country.

Medicaid expansion has proved itself, even if there may still be objections to other parts of the ACA. Rural hospitals and clinics need Medicaid expansion as much as inner-city facilities do. We suspect that the political drawbacks to joining Texas, Mississippi and other Deep South states in rejecting Medicaid expansion will make it impossible for Edwards' successor to attempt to pull the plug.

"The past few elections have proved the ACA is not going anywhere," the Post editorialized after South Dakota's decision. We believe that is also true of Medicaid expansion in Louisiana after the 2023 election for a new governor.