Republicans were angry, as were many voters. But while President Obama voiced some opposition to the special deals cut in Congress in support of his signature legislation, he made an exception for the Louisiana Medicaid adjustment, incorrectly asserting that the language also applied to Hawaii:
Something that was called a special deal was for Louisiana. It was said that there were billions--millions of dollars going to Louisiana, this was a special deal. Well, in fact, that provision, which I think should remain in, said that if a state has been affected by a natural catastrophe, that has created a special health care emergency in that state, they should get help. Louisiana, obviously, went through Katrina, and they're still trying to deal with the enormous challenges that were faced because of that...That also--I'm giving you an example of one that I consider important. It also affects Hawaii, which went through an earthquake. So that's not just a Louisiana provision. That is a provision that affects every state that is going through a natural catastrophe.
However, in November 2011, when the Centers for Medicare and Medicaid Services (CMS) tried to make sense of the legislation, they came up with a much larger number: $4.3 billion. This was, in part, because the text of the law didn't phase out the adjustment in two years, as originally intended, but rather increased the federal subsidy in out-years.
The language in Section 2006, wrote CMS, "results in increased, rather than phased down, financial assistance to [Louisiana] each year, and allows [the state] to continue to qualify for assistance after their underlying FMAP has stabilized. The resulting assistance will be higher than initially projected."
You can say that again. In fiscal year 2012 alone, the federal government sent about $700 million in supplemental funds to Louisiana's Medicaid program, with another $3.6 billion to be spent in fiscal years 2013-2015. In FY13, the law changed the feds' share of Louisiana Medicaid spending from 61 percent to 72 percent: a billion-dollar adjustment for the Bayou State.
In Louisiana French, lagniappe means "something given as a bonus or extra gift," like a 13th doughnut. When Republicans took over the House in 2011, they added Sen. Landrieu's "Louisiana Lagniappe" to their list of PPACA provisions slated for repeal. Indeed, the latest payroll tax extension deal between Republicans and Democrats does contain some language addressing the FMAP adjustment. Section 3204 of this new bill, Republicans claim, "eliminates funding for the 'Louisiana Purchase' contained in ObamaCare beginning in FY2014. CBO estimates this provision would reduce spending by $2.5 billion." In other words, the bill keeps the FY2013 spending intact, sending another $1.1 billion in error to Louisiana's Medicaid coffers.