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Court’s Obamacare vote opening bell for Louisiana U.S. Senate election— Cassidy vs. Landrieu?

maginnisHowever the U.S. Supreme Court rules on the healthcare law, the national argument over what to do about it resumes with a vengeance heading into the fall elections. But determining what's next for healthcare will wait until a new Congress convenes in January. Congressman Bill Cassidy will be ready. The Baton Rouge Republican, a doctor, has filed a bill to revamp how the federal government and states pay for Medicaid, which will be with us, bigger than ever, after the high court speaks.

If Cassidy drums up support among colleagues for his bill to be considered, he becomes a player in the overall healthcare debate that is bound to consume the next congressional term, leading up to the 2014 elections, when he is expected to challenge Sen. Mary Landrieu. That's getting ahead of the game a bit, but clearly Cassidy aims to make his mark on the policy issue that could drive politics in the elections to follow.

While the two-term representative seeks to play a role in healthcare legislation, the senior senator has been there, done that and has the scars to prove it. Landrieu's support of the healthcare act in 2010 was widely unpopular in Louisiana, but she was more excoriated for what she got for it: extra Medicaid assistance that even Gov. Bobby Jindal said was rightly due the state. The original fix was pegged at $300 million, but that ballooned to $1.7 billion over four years, through Landrieu's persistence and Congress' faulty math. Without getting much thanks for it, she has done more to balance the state budget than all the Republicans in the congressional delegation put together.

Still, Cassidy makes the point that the aid was temporary, and that the state would not have been in such a bind if Medicaid funding rules made sense to start with. His bill would set a standard low state match rate, but would end the creative financing by states to come up with their share, including using other federal funds. The bill would base funding on the kinds of recipients--elderly, blind or disabled, children and adults-and the degree of care they require, instead of on a one-size-fits-all per capita basis. That, coincidentally, would favor Louisiana with its deep poverty and high levels of diabetes, hypertension and kidney dialysis. It also would grant states more flexibility and encourage innovation.

Cassidy's legislation already has a major fan in state Health and Hospitals Secretary Bruce Greenstein, who sees advantages for the state Medicaid program's transition toward a managed care system. It's been in healthcare, rather than the more ballyhooed ethics and education agendas, where the Jindal administration is causing the biggest change in state government. It needs to, for the vast expansion of Medicaid in the healthcare law figures to increase its coverage in Louisiana from 26 percent of the population now to about 40 percent in two years.

How Cassidy handles his healthcare bill will test him as a legislator, but he already has proven to be an adept politician on a fast track. In 2006, he was a gastroenterologist and medical professor at the LSU charity hospital in Baton Rouge, when he up and ran in a special state Senate election and defeated an experienced Democratic legislator. Two years later, with a 48 percent plurality, he beat Congressman Don Cazayoux, a Democrat, whose base was split when a black legislator also ran. In redistricting, Cassidy expanded his base by giving up African-American precincts in Baton Rouge and reaching south to new voters in the river parishes and bayou country. While saying nothing about the 2014 Senate race, he appears to be preparing for it. Though unopposed so far this year, he has engaged consultant Timmy Teepell, the governor's main political man, which politicos take to mean that Jindal does not plan a Senate campaign himself.  Though Cassidy once was a tough critic of Jindal's healthcare policies, some major fence-mending seems to have taken place, with the GOP path now cleared for the congressman.

If such is the case, Landrieu, planning to run for a fourth term, could face her most formidable opponent after three close elections-one positioning himself to challenge her on an issue that has defined her career.

John Maginnis is a political writer and blogger. Follow his website at www.lapolitics.com.

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