Governor Jindal has built his entire argument against Medicaid expansion on this assumption: The Affordable Care Act gradually reduces the federal government’s “Disproportionate Share” payments, which is, essentially, the money the government provides to cover uncompensated care. The idea, of course, is that the more people who are insured, the less the government needs to pay for uncompensated care. However, if people don’t sign up for insurance in Louisiana, the state may be on the hook, at least for 10%. In other words, Jindal is suggesting that Medicaid expansion will cost the state $1.7 billion over ten years because he’s banking on people remaining uninsured, which would drive up Louisiana’s exposure. Either way, though, it’s all ridiculous, because Medicaid expansion is funded fully by the federal government for the first three years and then gradually drops to a 90/10 split by Year Ten. It’s a sweetheart deal, a win/win.The key here is that, "if people don't sign up for insurance in Louisiana." It's possible that some day we're going to read the political history of the Affordable Care Act and it's going to be all about the genius of the Republican strategy from start to finish. Their initial freak out killed the public option component. They darn well nearly killed the entire bill. Their governors neglected to set up state exchanges and refused the Medicaid dollars necessary to make it work.
They've nearly succeeded in delaying and damaging the thing long enough to get to the next election where "repealing Obamacare" is still a cause for them to campaign and fundraise on. If they come out of that election with the House and Senate in hand, they'll continue to monkey with things until 2016 when they can use the big "failure" they've created as a campaign cudgel. And if that works, then they really can undo it altogether. This isn't to say that strategy is going to work, of course, but it is pretty much what Republicans have in mind.
So maybe Jindal's making a "dumb" decision if we're assuming the goal is making the ACA work for Louisiana. But if we see it for the political maneuver it is, then he's just playing his part.