In the aftermath of Scott Brown's huge upset victory last week, some Bay State politicos claim that voter disgust with Democratic deals on the healthcare bill--the Louisiana concession foremost among them--helped to propel Brown's late surge in the polls. Though not the biggest factor, it still counted in the Republican's 100,000-vote margin of victory, which now denies Senate Democrats their filibuster-proof majority and stalls the healthcare bill in its tracks.

   It's not over yet for the Senate bill, vows Landrieu, but it could be for Louisiana's Medicaid fix. If Democrats retreat to the drawing board, the state's $300 million is a prime candidate to be erased. Landrieu will fight to keep it, but her leverage is discounted if she is no longer the 60th vote.

   If the president and the Democrats use the controversial "budget reconciliation" maneuver, requiring only 51 votes to pass a scaled-back version, or if they reach a compromise to win some Republican support, Landrieu's vote won't be needed.

   What a revolting development that would be for Landrieu, who was labeled a prostitute by right-wing critics, to get nothing out of this but grief.

   Back home, opponents of the bill who are so angry at her should instead send her flowers for aiding their cause. They won't, of course, and would still like to recall her, though the U.S. Constitution, which allows only Congress to expel a member, stands in the way.

   She will answer for her vote when or if she seeks re-election in 2014.  According to polling, she went against a majority of her constituents, but not for $300 million.

   Though a long holdout, Landrieu wanted coverage for the uninsured through a bill she could abide, which she mostly got with the elimination of the public option. What she also got for Louisiana was only what it deserved, a temporary Medicaid rate adjustment so that the state would not be penalized for its temporary hurricane recovery economy. It was hardly her idea but rather Gov. Bobby Jindal's No. 1 ask to the congressional delegation, of which Landrieu had the only clout.

   The governor would rather the state's fix be attached to another bill, but he wasn't in position to choose.

   The $300 million would not solve the state's whole Medicaid problem, but it would spare the governor and Legislature, not to mention healthcare providers and poor sick people, much grief of their own.

   Despite hostility back home provoked by her vote, Landrieu remains the go-to person in Washington for the Republican governor, and will be so long as Democrats control the Senate.

   On another vital healthcare issue, she was the major player in resolving the impasse between the state and the Federal Emergency Management Agency over reimbursement for Katrina's damage to Charity Hospital in New Orleans. Had the dispute taken its normal bureaucratic course, it would be tied up in court for years. Instead, Landrieu, with the administration's support, got Congress to order binding arbitration between the state, asking for $493 million, and FEMA, whose last offer was $150 million. The hearing wrapped up last week and a final decision has come out today awarding Louisiana 474.8 million which was close to what the state requested.

Prior to the resolution,  Jindal  promised "shovels in the ground this year" for construction of a LSU teaching hospital in New Orleans, alongside the planned Veterans Administration Hospital on 70 acres near downtown.  Even before the arbitration decision,  the governor said it will be up to the medical complex's governing board to make the numbers work with what can be raised in the bond market.

   When ground is broken on the project, credit should go to Landrieu for moving it off the dime, though she knows by now not to expect much.