City officials in New Orleans are taking matters into their own hands while Gov. Bobby Jindal (R-LA) continues to resist implementing an Obamacare provision that would expand the Medicaid program in his state to cover additional low-income Louisianans.

Despite the fact that about 20 percent of Louisiana residents lack health insurance — one of the highest rates of uninsurance in the nation, behind just Texas and Nevada — Jindal refuses to accept federal funds under Obamacare’s proposed Medicaid expansion to address this coverage gap. In an effort to provide low-income residents with affordable health coverage even without the federal expansion of the Medicaid program, officials in New Orleans are working to circumvent Jindal’s decision:

Jindal said the Affordable Care Act, including the Medicaid expansion, is too costly and he is one of nine GOP governors who declined to implement the Medicaid expansion. [...] But New Orleans officials said they are encouraged by a Medicaid waiver that has allowed the city to provide preventative care at no charge to uninsured low-income residents and at sliding scale, based on income, for others. That waiver expires in 2014, and the city hopes it will be able to continue to provide universal coverage through expansion of Medicaid envisioned by the health-care overhaul law, Health Commissioner Karen DeSalvo said.

“Should the governor not expand Medicaid as allowed through the Affordable Care Act, our administration is working with the (federal) Department of Health and Human Services on looking into some options to provide universal coverage for our residents,” DeSalvo said.

Louisiana Department of Health and Hospital Secretary Bruce Greenstein didn’t explicitly say that his agency would reject the proposed Medicaid expansion in New Orleans, but he did note that New Orleans officials wouldn’t be able to move forward without its approval. In a statement, he said that expanding the Medicaid program to extend coverage to Americans who currently struggle to afford the health insurance they need is a “bad idea and expensive for taxpayers.”

New Orleans isn’t the only city with frustrated officials working to provide health coverage for their low-income residents without their governor’s help. In Texas, the state with the unfortunate distinction of having its health system ranked the worst in the nation, several counties are exploring the possibility of setting up their own Medicaid expansions after Gov. Rick Perry (R-TX) refused to do so.

Hurricane Isaac tore through Louisiana this week, flooding sections of the state and leaving hundreds of thousands of residents without power. Isaac came right on the anniversary of Hurricane Katrina, the storm that devastated New Orleans seven years ago, but fortunately did not impact the region with the same magnitude. As the Times-Picayune points out, though, Louisiana’s health care system is still struggling to recover from the damage wreaked by this week’s storm:

Overall, 21.5 percent of the state’s nursing homes were operating on generator power after losing electrical service, state officials said. Across the state on Thursday, at least 59 nursing homes housing 6,366 residents, along with 36 hospitals, were operating on generator power.Officials were planning to evacuate six more nursing homes across the state that were endangered by floodwaters. [...]

Another concern for health officials was what to do about residents who rely on home medical equipment, many of whom did not evacuate the city and lost power during the storm. A medical special needs shelter was set up in New Orleans on Thursday to provide electricity and support with the help of federal disaster medical teams.

City officials worked well into the night Wednesday for a third night to help bring back a range of healthcare assets that, [New Orleans' health commissioner] said, “often get forgotten.” Those included dialysis units, psychiatric hospitals, and substance abuse and mental health living programs.

The city’s emergency rooms saw an influx of patients over the past few days, and medical professionals had to pool their resources to cope with evacuations, blackouts, and compromised facilities. One hospital CEO noted that the public health sector in Louisiana is able to be resourceful partly because they are already accustomed to dealing with shortages and budget cuts.

While Isaac was hitting the Gulf Coast, Republicans were gathering at their national convention in Tampa, focusing most of their time on decrying government assistance’s role in bolstering the success of American individuals and programs. However, Louisiana Gov. Bobby Jindal (R) adopted somewhat of a different attitude after contending with the hurricane’s effect on his state — he reached out to President Obama for more federal aid to provide emergency disaster relief services for his constituents. His party has endorsed a budget that would slash these very funds.

Yesterday, Louisiana Gov. Bobby Jindal (R) appeared at the First Baptist Church of West Monroe to sign HB 636, a measure that “requires women to be informed of their specific legal rights and options before they undergo an abortion procedure.” Abortion providers will now have to post signs around their facilities stating that “it is illegal to coerce a woman into getting an abortion, that the child’s father must provide child support, that certain agencies can assist them during and after the pregnancy and that adoptive parents can pay some of the medical costs.” The law also creates a Department of Health and Hospitals website and a mobile platform to deliver information “about public and private pregnancy resources” for avoiding abortions.

Jindal said he couldn’t understand why anyone would oppose the bill, comparing the new notices to Miranda warnings for women who receive abortions — a constitutionally protected procedure — to criminals:

“When officers arrest criminals today, they are read their rights,” he said. “Now if we’re giving criminals their basic rights and they have to be informed of those rights, it seems to me only common sense we would have to do the same thing for women before they make the choice about whether to get an abortion.”

The analogy, however, may be somewhat apt, since Louisiana already has some of the harshest anti-choice laws in the country. According to NARAL, the state still has an unconstitutional and unenforceable measure that prohibits abortion by anyone other than the woman unless necessary to preserve the woman’s life or if the pregnancy was the result of rape or incest. Louisiana outlaws second-trimester abortion procedure with no exception to protect a woman’s health and in 2006 “enacted a near-total ban on abortion, to become effective if the Supreme Court overturns Roe v. Wade.”

Under the state’s Right To Know law, abortion providers in Louisiana are already required to distribute pamphlets with information about pregnancy, termination, and alternatives. Women must also sign a statement that they have received the state information and are not being coerced into an abortion before undergoing the procedure.