Louisiana Gov. Bobby Jindal’s (R) proposed Medicaid reforms are getting a lot of press. Jindal proposes to expand eligibility for Medicaid, enroll Medicaid patients in private managed‐​care plans, and do other things to improve the quality of care. Writing in The American Spectator, Joseph Lawler says the approach is “market‐​based” and “could forestall universal health care.”


A friend asked my thoughts about Jindal’s proposal. Here’s what I emailed back:

Why is it that when politicians propose giving taxpayer dollars to private companies, people think that’s “market‐​based”?


Jindal’s plan is not market‐​based reform. As a general matter, market‐​based charity care is just that: private charity. So the only market‐​based Medicaid reforms are those that remove people from the Medicaid rolls — e.g., federal block grants, eligibility restrictions, etc.


Jindal wants to expand eligibility. For a welfare program. And we call that market‐​based?


Jindal may be able to improve the quality of care through greater coordination. Which looks good on paper. But if the quality of care in Medicaid improves, more people will enroll. Only 2/3 of those eligible actually sign up for the program. (Many of the 1/3 who don’t enroll actually have private coverage.) So improving Medicaid benefits could cause enrollment to increase 50 percent. And that’s before Jindal expands the eligibility rules.


With all the additional cost pressure, what’s going to happen to Medicaid payments and enrollees’ access to docs? (There are reasons why Medicaid pays so little.)


Louisiana’s Medicaid program could someday achieve the most coordinated system of care that no one can access. Should we pull people out of private health plans for that?

Expanding enrollment in a government‐​run health plan is supposed to forestall universal coverage? Discerning consumers of market‐​based ideas should keep shopping.