“Take a breath, guys,” state Sen. Dan Claitor, R-Baton Rouge, said last week, stepping between a Republican and a Democrat squaring off over Medicaid fraud.

“My breath is fine,” snapped Democratic Sen. Troy Carter of New Orleans. “It’s Mr. Mack appears to be a little edgy,” referring to Republican state Rep. Sherman Mack of Albany.

But the tenseness over Mack’s House Bill 88 is somewhat of an anomaly for the regular legislative session that began March 12 — particularly in contrast to the internecine partisan conflict over the issue in February and early March. Differences over Medicaid, both sides agree, largely caused the collapse of the revenue-raising special session.

For the most part, legislation that would require Medicaid recipients to pay each time they visit the doctor or to have a job — changes Republicans hoped would give them cover for supporting tax increases — aren’t being pursued in the regular session.

What makes Mack’s HB88 something of an outlier is that it directly targets the low-income, disabled and elderly population that uses the health care coverage paid by state and federal taxpayers.

Mack contends his measure isn’t about Medicaid. It would just make it easier to prosecute any applicants for any government service who lie on their application, “anyone at all,” Mack said while testifying next to Ellison Travis, chief of the Medicaid fraud unit for Attorney General Jeff Landry, a Republican.

“Really?,” Carter countered. “It’s not targeting low-income people who need services — roughly a third of the state’s population?

“The AG is to unilaterally decide that we’re going to take a certain segment of people and investigate them because there may be fraud? Are we doing that in the banking industry?” 

House-passed HB88 cleared the Senate Judiciary C committee on a party line vote but was hustled off, via parliamentary maneuvering, to the Senate Finance Committee instead of the full Senate.

First off, says Baton Rouge Democratic Sen. Regina Barrow in explaining her no vote in committee, those who believe that a lot of poor folks are scamming to get a taste of those sweet Medicaid benefits are the same ones who condemn the program for delivering lousy services.

Secondly, the applications are difficult for people trying to differentiate between complex definitions of gross and net income, said Barrow, who represents the poorest section of the state’s most prosperous city. And low-skilled workers generally are employed by companies that set hours based on need, meaning that this month’s pay could dramatically differ from next month’s. That’s why the federal government allows wiggle room of about 20 percent between what’s reported on applications and what’s actually earned, she said.

No, Barrow said, what’s really going on is that Medicaid opponents are trying to throw up hurdles for those who use the service.

That underlying tension — between those who want to rein in the cost of Medicaid and those who want to protect the service — caused the legislative paralysis during the special session, said state Rep. Jack McFarland, R-Jonesboro, who sponsored co-pay bills in the special session.

“It was an unnecessary fight,” he said, adding that’s why he’s now more focused on systemic changes. His House Bill 734 would start trying to figure out why so many Medicaid claims are delayed for so long.

McFarland’s reception in Senate committee was far more cordial, with praise and offers to help tweak the wording to get it passed.

Medicaid is the largest expense in the state’s budget. “I think we all agree that we need to find efficiencies and make Medicaid more effective,” McFarland said.

Rep. Randal Gaines, D-LaPlace, agrees.

As head of the Legislative Black Caucus, Gaines was a key architect in sidelining white Republican efforts to find those efficiencies focused on co-pays and work requirements. The result was no revenue bills passed during the special session.

Gaines said he and House majority leadership came to an implict, though not expressly stated agreement to leave those kinds of bills off the table during the regular session.

But Gaines contends this is only a brief cease fire. Medicaid diverted attention from the real schism: How to raise revenues.

Democrats want to rely on income tax, which would impact higher earners more, while Republicans favor using sales taxes, which puts a greater burden on low-income earners.

“Nothing there has changed and it won’t” when the Legislature reconvenes, probably in May, to find money enough to pay for services that were deeply cut because of an expected shortfall in revenues.

“We’re right back to where we were two years ago,” Gaines said.

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Medicaid woes: Both parties swallow contention after heated debates over taxes, program quality