April 3, 2014; The Advocate

In light of today’s Cohen Report on the nonprofit impacts of the Affordable Care Act, opponents of the Act have another agenda in mind when they call for alternatives. Louisiana’s Republican governor, Bobby Jindal, has unveiled through a conservative activist group called America Next an alternative to the ACA. His Freedom and Empowerment Plan would create a $100 billion 10-year pool, much less expensive than the overall contours of President Obama’s program, to subsidize families to purchase private health insurance.

At a minimum, Jindal’s plan comes in briefer than the ACA, at only 23 pages, but it comes with the usual array of conservative charges against Obama. “The law (Affordable Care Act) is fiscally unsustainable, its tax increases economically damaging, and its enshrinement of greater government control of every aspect of health care is more dangerous than some in Washington appreciate,” Jindal wrote in his brief proposal.

Two elements of Jindal’s proposal ought to be of concern to nonprofits. One is his attack on Medicaid, which he said is a program that is structurally incentivized for states to spend more on Medicaid than on other priorities such as education, transportation, and corrections. It’s not that Jindal opposes expanding Medicaid. He links it with what he called a problem of “rampant fraud in governmental health care programs” and suggests that states “game” the system to get more federal Medicaid subsidies. If that were the case, 21 states wouldn’t have refused to expand Medicaid to provide insurance coverage for persons above the federal poverty level.

The other element of his plan is more insidious: In the context of healthcare reform, Jindal calls for a permanent ban on federal funding for abortions. Given the federal subsidization element of his plan, it is easy to see how the Jindal concept would quickly lead to many insurers and many employers limiting or dropping coverage for contraceptive services.

The opposition to the Affordable Care Act isn’t simply one of federal government cost or conservatives’ inexplicable support for private insurers. There are ideological components concerning the treatment of poor people and the promulgation of social policies on contraception and abortion embedded in what the ACA’s opponents have in mind. Restrictions on rights for the poor and rights for women are never far from the surface of conservative alternatives to the ACA. The ACA might be very problematic as it currently stands, but the fixes that Jindal and others have in mind often have other big agendas.—Rick Cohen