Putting politics ahead of policy

When politics gets in the way of policy, you end up with the situations like what is happening now in Texas and Louisiana, where Governors Rick Perry and Bobby Jindal, respectively, both strident and vocal Republican opponents of "ObamaCare," are on the record as saying they will not expand Medicaid in their states. This despite the fact the expansion will be funded at 100 percent by the federal government through 2016 and at no less than 90 percent in ensuing years.

If any states could use money to help fund its healthcare program for the poor, it is these two, which have two of the highest rates of residents without health insurance. Louisiana has about 900,000 uninsured residents or nearly 20 percent of its population. And in Texas, the numbers are staggering: 6.2 million uninsured or a quarter of the population.

But neither of these two governors will step up to the plate and take the money allotted in federal health reform to expand Medicaid. Jindal reportedly may have his eyes on a potential slot as Mitt Romney's running mate. Perry, whose presidential aspirations for 2012 flamed out, is eying his re-election for a potential fourth term as governor of Texas and could even be considering another bid at the presidency, should President Obama win re-election.

In other words, in the current landscape of the Republican Party, the only chance either Jindal or Perry have of advancing their careers is to earn their stripes through completely denouncing the Affordable Care Act.

But that comes at a steep price to the states' coffers and the hospitals serving the poor in both states. In Texas, not expanding Medicaid will deprive the state's healthcare providers of more than $70 billion over six years. In Louisiana, Jindal has been actively slashing the state's Medicaid budget to the bone; even before announcing the state wouldn't look to expand using federal dollars. A recent round of more than half a billion dollars in cuts resulted in $353 million of those cuts affecting one provider: the public health system run by Louisiana State University.

Critics contend there is no place for politics when it comes to the health of the poor and uninsured. The people of Texas are fed up with "political grandstanding and saber-rattling, just so politicians can position themselves as 'Washington outsiders.' And we're fed up with the damage that comes in the wake of these political moves - actions that will force millions to continue without insurance and put taxpayers on the hook for their medical bills, while throwing away billions of tax dollars that rightfully ought to come to Texas," wrote Texas State Senator Leticia Van De Putte, in a recent editorial.

The Texas Hospital Association  -  while agreeing that the current Medicaid system in Texas is flawed and probably couldn't handle the influx of new patients inherent with expansion  -  was blunt about the state of healthcare affairs in the state. "Without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured, and increasing uncompensated care to healthcare providers. With a strained state budget, it's hard to imagine addressing the uninsured problem in Texas without leveraging federal funds," read a statement from Dan Stultz, MD, president and CEO, of THA.

The Louisiana Hospital Association is likewise faced with a grim situation after the recent round of cuts, which John Matessino, president and CEO of LHA said "dealt a huge blow to health services in our state."

"The DSH cuts to rural hospitals will be critical and will lead to reductions in services and possible hospital closures," Matessino said in a statement in reaction to the cuts. "This could leave gaps in healthcare delivery for patients in rural areas, as well as economic losses to those communities."

The head of the Louisiana Democratic Party, state senator, Karen Peterson, was blunt in her assessment of what can happen when politics gets in the way of policy. As she told the Associated Press in July: "It's selfish as (Jindal) goes around the country touting his resistance to federal laws to bolster his own vice presidential predictions while the Louisiana healthcare system crumbles."

And while Perry and Jindal use their Medicaid programs as political wedges, many of the poor, uninsured residents of Texas and Louisiana are left holding the bag and their hopes of gaining access to healthcare only gets farther and farther away.