Governor of Louisiana Bobby Jindal dropped by National Review’s New York office on Tuesday, offering insight into his tenure as governor and his vision for the Republican party. After some anedcotes about life at the Louisiana governor’s mansion and his SEC-football rivalry with Florida governor Rick Scott, Jindal jumped straight into policy, tackling the subject at the top of his mind and his area of professional expertise: health care.
“I think the president’s rhetoric on health-care wasn’t bad; it was his policies that were bad,” Jindal said. “I think he was right to say that people with preexisting conditions, people who buy individual policies away from the group or employer markets, sometimes have trouble finding affordable care. I think he’s right to say we need to bend down the cost curve . . . those were all great. . . . The problem was his policies weren’t at all consistent with that.”
When asked about Obamacare’s Medicaid expansion, a policy Jindal decided not to pursue in Louisiana, the governor said implementation in his state means “you’d put over 400,000 [more] people onto Medicaid – that means 41 percent of our population would be in Medicaid.”
“What does that do to the individuals?” he asked. In Louisiana, he said, “about over half the people that would get coverage would otherwise have private insurance if you hadn’t done the Medicaid expansion.” This pushes people from “pulling the wagon, into the wagon.” When asked how he’d defend Republican governors’ in general rejecting the Medicaid expansion, he cited the most rigorous assessment of the program, a study in Oregon that found no improvement in physical health when people gained Medicaid coverage. “Just giving somebody a Medicaid card is not the equivalent of getting them better health-care outcomes,” he said.
Jindal has an alternative: Louisiana’s own modified Medicaid program, BayouHealth, which uses private managed-care plans to cover over 1 million poor and low-income Louisianans.
Since winning the governorship, Jindal’s worked to reform the large hospital system on which the system relies. Back in the 19th century, he explained, “the Catholic sisters started a charity hospital in the city of New Orleans and for hundreds of years that was a noble tradition where anybody and everybody could go get health care if they needed to,” Jindal said. “[Louisiana state political boss] Huey Long expanded that when he was governor [from 1928 to 1932] into a network of state-owned and operated hospitals and today, at least when I took office, there were ten of these state-owned, state-operated hospitals. [The] premise was, if you were willing to wait long enough, you would eventually get health care.”
The system, however good it was in a pre-industrial Louisiana, had become outdated and extremely inefficient, but remained “the equivalent of the political third rail” in the state. Jindal went on a mission to privatize the state-owned hospitals anyway, and was ultimately successful. “Here we are today. . . . Of the ten, we are putting nine in public-private partnerships by the end of the fiscal year. Five are already done,” he said. “At the end you’re going to save taxpayers over $125 million, at least, per year; 10,000 fewer state employees as these hospitals have been privatized; and you’re delivering better health care.”
Asked how the U.S.’s health-care system should be reformed overall — notwithstanding the Affordable Care Act – Jindal was quick to answer with a series of reforms, listing everything from allowing the formation of insurance pools based on existing voluntary civic associations to setting up online price and quality databases so consumers can compare providers and procedures. “We need to have the ability to buy insurance across state lines,” Jindal said. “We need to have serious tort reform” and we need “to pay for outcomes, not just for activity.”
On more immediate matters, Jindal declined to offer a take on the current government-shutdown situation: “I’m staying away from the tactics,” he said. He’s worried about the bigger picture: “The reality is it’s not the debt ceiling, it’s the debt. It’s the fact you’ve got a president who [said] $9 trillion was immoral — but 17 is not. A president who’s never been serious about presenting a budget that balances or reforming entitlement programs.”
In the end, change won’t come by simply electing better politicians, Jindal thinks, it’ll require structural changes. “[We need] a balanced-budget requirement in the Constitution, supermajority votes to raise taxes, supermajority votes to grow the budget faster than the economy and population, term limits, part-time Congress, all of which are in Louisiana’s constitution.” Jindal continued, “People who say ‘well these ideas can’t work’ — well, many of these ideas are already working at the state level.”
Looking to the future, Jindal noted that Republicans have already done an excellent job raising money and reelecting governors (there are 30 GOP governors now, more than either party has had in twelve years), and said it’s time to take those successful principles national. “We want to help identify what it means and define what it means to be a Republican, [and] take the brand back from the dysfunction of D.C. to highlight the success of these governors,” Jindal said.
That’s the idea of the American Comeback Initiative, a project of the Republican Governor’s Association, which Jindal currently chairs. The Initiative has already showcased five Republican governors and their success stories in nationwide ads, and plans to do the same for all 30. “Whether it’s overhauling public pensions, education choice, whether it’s cutting taxes, or growing the private-sector economy, it’s happening at the state level,” Jindal said. “If you want to see conservative principles applied, not just talked about, it’s happening at our state capitols.”