In it, but not of it. TPM DC
Jindal appears to be one of the few advancing this rhetoric, which he published earlier in another op-ed for Politico magazine titled "Obamacare Is Anything But Compassionate." The conservative Heritage Foundation also laid out the same argument in a critique of the law last November.
The theory starts with the fact that Obamacare offers enhanced federal funding, 100 percent for the first three years and never less than 90 percent after that, for states to expand Medicaid eligibility to 138 percent of the federal poverty level. The expansion will generally cover childless adults, many of whom weren't previously eligible for the program. It is one of the two pillars, along with subsidized private coverage, through which the law covers the uninsured.
Jindal argues that because the law provides such generous funding, more generous than the traditional Medicaid program, to cover childless adults, it "prioritizes" that population over the disabled, many of whom are enrolled in the traditional Medicaid program. He notes in the Politico piece that, according to the non-profit, non-partisan Kaiser Family Foundation, more than half a million seniors and disabled are on state Medicaid waiting lists for home and community-based services. He writes that Obamacare would "jeopardize the care of our most vulnerable citizens" by "devot(ing) resources to covering thousands of childless adults through Medicaid, while leaving individuals with disabilities out in the cold."
But there are a few huge problems with Jindal's rationale, which effectively undermine the whole line of attack. First, some disabled people could actually qualify for health coverage under the Medicaid expansion, according to MaryBeth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.
"People with disabilities can be within the new expansion group," she said. "The ACA provides the opportunity for some people with disabilities to qualify for Medicaid who never qualified before. Their incomes, while still low, could have been above the very, very low limits states had set or they may not have been eligible at all if they fell into the category of single, childless adults. So it creates an expanded opportunity for people with disabilities to gain coverage."
Second, Obamacare should have no policy bearing on the traditional Medicaid program. Federal funding for the traditionally eligible population remains exactly the same, and the states retain the same flexibility to manage their programs as existed prior to the law. The ACA brings a new population into the program, but there is no policy reason that it would lead to "discrimination" -- as Jindal calls it -- or any other detrimental effects for disabled people enrolled in the traditional program.
"I think that's right," Musumeci said when asked by TPM if the Obamacare's Medicaid expansion should have no effect on traditional Medicaid. "What the Medicaid expansion essentially does is it creates a new eligibility category. Like any other time Congress has expanded eligibility of the program, it is adding statutory authority to cover this new group of people."
"But it's built into the same underlying Medicaid program. States still have all of the flexibility that they previously had in terms of how they structure their care delivery system, their benefits packages, and all of those things."
Third, and perhaps most devastatingly to Jindal's theory, Obamacare actually expands programs and funding for so-called "long-term services and supports" under Medicaid -- the kind of long-term care that the disabled would utilize. What's most puzzling is Jindal should know this because, according to Kaiser's tracking, his state has participated in three of the demonstrations authorized by the law.
One of those, Money Follows The Person, provides 12 months of enhanced federal funding to help people to move out of institutions into community-based care. Obamacare upped the funding and expanded the program's eligibility, according to Kaiser. Likewise, the Balancing Incentive program encourages states through enhanced funding to adopt reforms that expand access to community-based care as an alternative to institutional care. Obamacare also expands the home and community-based services plan option available to states, making more people eligible and covering more services.
None of this should be news to Jindal. Louisiana has signed onto each of those programs at some point. A proposed budget for the state's Balancing Incentive program included $82.2 million in enhanced federal funding. A report on Money Follows The Person found that Louisiana had achieved the largest decrease in its rate of reinstitutionalization under the program.
Separately, but also of note, the American Association of People with Disabilities published an explainer on health care reform's impact on the disabled, including a section on Medicaid. It does not mention of any of the potential negative effects forwarded by Jindal.
TPM contacted Jindal's office Tuesday with questions based on the above reporting. His office said that the op-ed stands for itself and declined to comment further.