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Repeal and Replace -- With What?

Fron row, L to R: Mike Pence, Paul Ryan, Steve Scalise (LA-R)

With a new Congress in place, it’s item one on their agenda:

“We’re going to repeal Obamacare,” Vice President-elect Mike Pence declared last week, and initial legislation for repeal is expected to start moving through the congressional process this week. But what happens after repeal?

“We have a plan to replace it,” U.S. House Speaker Paul Ryan says. “We have plenty of ideas to replace it.”

Louisiana’s Governor John Bel Edwards is not so sure.

“I don’t think we know enough about the plan,” Edwards said during a press conference Friday afternoon.

Earlier in the day, he released a copy of the letter he’d sent to U.S. House Majority Leader Kevin McCarthy. It was in response to McCarthy’s request to state governors for input on possible replacement plans for the Affordable Care Act. In his letter, Edwards urged that any replacement plan retain Medicaid expansion.

“We now have about 370,000 working poor people in Louisiana with health insurance – who didn’t have it before July 1st,” Edwards said.

In addition, a new report from the Urban Institute says repeal without replacement will leave 558,000 Louisiana residents without medical insurance.

The governor also says losing Medicaid expansion will put people out of work.

“And there have been an awful lot of people hired in Louisiana to work in the health care sector because of the influx of these federal dollars.”

A report from George Washington University’s Milken Institute School of Public Health estimates Louisiana job loss at 37,000 if Medicaid expansion goes away.

The governor also says loss of the Medicaid expansion program would wreak even more havoc on the state budget.

“The Medicaid expansion saved our state $184-million State General Fund this year,” Edwards says, noting that’s one tenth of the budget shortfall expected just one year ago.

One hopeful note: one of the architects of the Obamacare replacement plan is Louisiana’s Senator Bill Cassidy. He indicates he’s looking at something like a “cafeteria plan” to give more flexibility for those who use and pay for health insurance.

“We’ve got to replace it with a plan that gives them the power to choose their benefits, therefore the power to choose how much to pay.”

The Governor says he’s encouraged that Louisiana will have some say in what will happen.

“I expect to work closely with Senator Cassidy, and I’m optimistic that if he’s working on the replacement, that he will work to make sure the replacement includes the Medicaid expansion component.”