BATON ROUGE — A proposal for Louisiana to tap into the federal health overhaul money available for expanding Medicaid narrowly won approval Tuesday from the state Senate's health committee, despite opposition from Gov. Bobby Jindal.
The Health and Welfare Committee voted 4-3 to send a modified Medicaid expansion bill to the full Senate for debate. One Republican voted with three Democrats to advance the proposal.
The measure seeks to provide health insurance coverage to adults making up to 138 percent of the poverty level — less than $32,000 for a family of four — as allowed under the Affordable Care Act pushed by President Barack Obama.
The federal government would pay for most of the coverage, covering the full costs from 2014 to 2016 and require states to pay up to 10 percent after that.
Sen. Karen Carter Peterson's bill was heavily rewritten by Sen. Ben Nevers, D-Bogalusa, to require the state Department of Health and Hospitals to seek federal approval for a program that would use the expansion dollars to provide private insurance. It would expire in 2017, without legislative reauthorization.
Any chance of getting an expansion bill through the full Legislature is a long-shot.
The House health care committee has rejected one expansion proposal, and House Speaker Chuck Kleckley, R-Lake Charles, has said he doesn't believe any bill could make it through the House this session because of questions about the financial implications.
Jindal cites cost estimates nearing $1.7 billion over a decade, while a nonpartisan analysis done for lawmakers suggests savings above $500 million over 10 years.
Supporters of the expansion say it would give health insurance to thousands of working adults who can't afford it, improve health outcomes in a poor and unhealthy state and pump billions of dollars into the state economy.
"I have heard the arguments against expanding Medicaid coverage, and frankly, I don't think they hold water," U.S. Sen. Mary Landrieu, a Democrat, wrote to state lawmakers.
About one in five Louisiana residents are uninsured. Estimates are that as many as 400,000 uninsured people would be eligible for Medicaid if the expansion were approved.
Opponents say the increased insurance coverage would be too costly for Louisiana, could shift people from private insurance to government-funded health care and would expand an inefficient Medicaid program.
"We continue to be opposed to Medicaid expansion. We think this would be bad for Louisiana, bad for our taxpayers, bad for our people," Jindal said after the vote.
Two of Louisiana's former health secretaries spoke in support of the expansion: David Hood, who worked for Republican former Gov. Mike Foster, and Fred Cerise, who worked for Democratic former Gov. Kathleen Blanco.
Hood said the state has embraced expanded Medicaid coverage for children, and he said Jindal backed that expansion even though it had financial uncertainties. He said now more than 96 percent of Louisiana's children have coverage either through private insurance or Medicaid.
"This is important enough I think that we need to move ahead and work through those things," Hood said.
Jindal's interim health secretary, Kathy Kliebert, said federal funding commitments could change rapidly, and she repeatedly talked of uncertainties in the federal law.
Voting for the bill were Mills, Nevers and Sens. Yvonne Dorsey-Colomb, D-Baton Rouge; and Elbert Guillory, D-Opelousas. Voting against the bill were Sens. Bret Allain, R-Franklin; Sherri Buffington, R-Keithville; and Dan Claitor, R-Baton Rouge.