BATON ROUGE, La. -- Louisiana's Democratic governor, John Bel Edwards, moved quickly to expand Medicaid when he took office in 2016, making his state the only one in the Deep South to embrace that signature piece of President Barack Obama's health care law.
And in a conservative state that solidly supports President Donald Trump, the $3 billion-plus Medicaid expansion program that is Edwards' hallmark achievement isn't going anywhere, even if the Democratic governor is ousted by a Republican in this fall's election.
Edwards' two main challengers on the Oct. 12 ballot — U.S. Rep. Ralph Abraham and businessman Eddie Rispone — aren't pledging to rip expansion out by the roots in a state where about 10% of residents get the coverage.
Instead, Edwards' opponents strike at one of his primary selling points by slamming the administration's rollout of Medicaid expansion rather than the program's creation. The GOP contenders accuse Edwards' health department of millions in wasteful spending and suggest they would tighten controls.
"They have to be careful in how they are framing their critique because it's a popular program," said Michael Henderson, director of Louisiana State University's Public Policy Research Center.
Nearly 460,000 Louisiana adults, mainly the working poor and many of them voters, receive the government financed health coverage. LSU's annual survey of Louisiana public opinion shows 76% approval for Medicaid expansion, including 57% backing from Republicans.
To criticize Edwards on expansion, "you have to make a complicated argument that says, 'Hey, I like this thing the governor did, but boy, I wish we'd done it differently. Let me do it differently,'" Henderson said. "That's a tricky argument to make."
Thirty-six states have agreed to expand their Medicaid programs under the federal health overhaul, few in the South.
Louisiana's program started in July 2016. Adults ages 19 to 64 with incomes up to 138% of the federal poverty level — about $16,750 annually for a single adult or $28,680 for a family of three — are eligible for coverage. The federal government pays nearly all the Medicaid expansion cost. State lawmakers passed a tax on health maintenance organizations and hospital fees to cover the state's share.
The Democratic governor said thousands of people have been newly diagnosed with hypertension, diabetes and cancer because of expansion. He credits the billions in federal tax dollars received with spurring health industry job growth. And he touts Census data showing 8% of Louisiana's residents are without health insurance, lower than the national average and below the uninsured rate of neighboring non-expansion states.
"Expanding Medicaid is the biggest, easiest decision that I'm going to make as governor," Edwards said. "Unlike the other Southern states across the country, Louisiana has not had a single rural hospital to close. And that's due in large part to the Medicaid expansion."
Edwards campaign ads show people who received treatment for lupus, glaucoma and cancer through the program. In fundraising emails, Edwards says his Republican opponents "won't hesitate to dismantle" the program if they win.
But Abraham and Rispone step gingerly when asked about plans for the expansion program, insisting they don't want to kick anyone off the coverage if they qualify.
Abraham, a doctor and third-term congressman from northeast Louisiana, voted repeatedly to repeal the entire Affordable Care Act.
"Obamacare? A complete mess, absolutely," he said. But asked if that assessment applies to Medicaid expansion, Abraham replied: "Not necessarily."
Abraham and Rispone said Edwards mismanaged expansion, with rampant fraud and abuse. They cite legislative audits that documented money spent on ineligible services and that suggested millions could have been spent on people who earned too much for the coverage, including 1,600 people with six-figure incomes. They note thousands have been kicked off the Medicaid rolls after the Edwards administration started doing quarterly, rather than annual, wage checks.
"The governor made the decision to take one of the worst versions of Medicaid expansion available, rushed it to market knowing full well that they did not have the tools available to administer or ensure that the people that were enrolling were even eligible," Abraham said.
Rispone, a Baton Rouge businessman largely self-financing his campaign, said he'd "freeze" enrollment at current levels until he could assure wasteful spending is eliminated, though critics have questioned if federal law allows that. Rispone also said he'd consider trying to enact work requirements for the expansion program.
"I'm going in there and making sure that everybody that's on it should be on it and they're the ones that have the most need," he said.
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