Louisiana’s New Governor Signs an Order to Expand Medicaid

BATON ROUGE, La. — On Tuesday, his second day in office, Gov. John Bel Edwards signed an executive order expanding Medicaid coverage under the Affordable Care Act, fulfilling a campaign promise that will expand health coverage to hundreds of thousands of people in one of the nation’s poorest states.

The action by Mr. Edwards, a Democrat, under President Obama’s health care law was expected to be one of the most significant and immediate results of his election in November, when he defeated Senator David Vitter, a Republican whose campaign was tainted by a prostitution scandal.

Mr. Edwards, the only Democratic governor in the Deep South, in some ways ran as a conservative Democrat, opposing abortion and gun restrictions. But he has also vowed to address the plight of the roughly one in five Louisiana residents who live in poverty, according to federal census figures.

“We are consistently ranked one of the poorest and unhealthiest states, and this cycle will not be broken as long as anyone in Louisiana has to choose between their health and their financial security,” Mr. Edwards said Tuesday at a signing event at the Louisiana Capitol. He was flanked by health care industry representatives and a handful of the 300,000 working-class Louisiana residents who he said would be newly eligible for Medicaid when the expanded coverage takes effect on July 1.

“This will not only afford them peace of mind,” Mr. Edwards added, “but also to help prevent them from slipping further into poverty and give them a fighting chance for a better life. “

With the change in Louisiana, 31 states and the District of Columbia have now expanded their Medicaid programs under the Affordable Care Act, accepting billions of dollars in federal funds to cover nearly everyone with incomes below 138 percent of the poverty level. That comes to $16,242 for a single person and $33,465 for a family of four.

In Louisiana, 298,000 uninsured adults will be eligible for Medicaid under the expansion, according to an analysis last year by the state’s Legislative Fiscal Office. An additional 224,000 adults with private insurance would also be eligible.

Mr. Edwards’s predecessor, Bobby Jindal, a Republican, staunchly opposed the expansion of Medicaid. In a July 2013 editorial in The Times-Picayune, the New Orleans newspaper, Mr. Jindal said he was worried that thousands of people in private plans would switch to Medicaid. He also argued that the state, which must eventually contribute 10 percent of the cost of the Medicaid expansion, would ultimately be saddled with rising costs, draining money from other priorities.

“Our federal government is already drowning in entitlement spending; now the feds are trying to drown us as well,” he wrote. “States do not need to mindlessly follow this example.”

Mr. Edwards criticized Mr. Jindal’s legacy on Tuesday, saying that low-income people had suffered because of “the previous administration’s refusal to expand critical health care services.”

Republicans control both houses of the Legislature, but the decision to expand Medicaid falls within the scope of changes to health care policy that the governor can make unilaterally, said Robert Travis Scott, the president of the Public Affairs Research Council of Louisiana, a private, nonpartisan policy group.

“Now, it is possible that a well-organized legislature could find ways to disrupt it, or block it, or find de facto ways that it can be disrupted,” Mr. Scott said. “So far I haven’t seen any strong signs that that’s going to happen.”

On Monday, Representative Alan Seabaugh of Shreveport, a Republican and one of the most conservative House members, said he was going to start an effort to block Mr. Edwards’s Medicaid expansion plan. Mr. Seabaugh gave only scant details of his strategy.

With new legislative sessions about to begin around the country, Republican governors in two other holdout states — Matt Mead of Wyoming and Dennis Daugaard of South Dakota — are trying to persuade their legislatures to expand the program.

In Nebraska, Gov. Pete Ricketts, a Republican, remains opposed to expanding Medicaid. But a number of Republican legislators there are pushing a new proposal that would use federal funds to buy private health insurance for about 77,000 low-income people rather than enrolling them in Medicaid. But it is not clear whether the plan can win enough legislative support to override a veto by Mr. Ricketts.