It should be clear by now that, regardless of criticism and public opinion, Gov. Bobby Jindal is not going to change his mind about opting out of the expansion of Medicaid and not setting up state insurance exchanges under the federal Affordable Care Act. Similarly, Republicans in Congress can vote for a 41st time to repeal Obamacare and still not prevent it from taking effect next year. Despite the best efforts of their enemies, neither course is going to change, or change much, for now.
Jindal is not merely rejecting or ignoring the key tenets of President Barack Obama's health care law, but, rather, he is building a competing model. By going his way, the governor and his team could still achieve the same level of health care for the currently uninsured, but at a greater cost than by going Obama's way, certainly in the short run.
For the good of those to be covered, it may be just as well that the federal government and not the state set up and operate the insurance exchanges. When the Jindal administration's head and heart are not into doing something right from the start, the results can be like the waste- and scandal-ridden $750 million home elevation grant program, which was federally funded for the state to run, starting in 2008.
The more consequential difference between Obama's and Jindal's health care approaches is how to provide for 260,000 Louisiana adults in the coverage gap, who are eligible for neither Medicaid nor subsidized health insurance.