Can af­ford only two of nine con­tracts to run state hos­pi­tals

Modern Healthcare - - NEWS -

IN FE­BRU­ARY, NEW LOUISIANA GOV. JOHN BEL ED­WARDS DE­LIV­ERED AN UN­PRECE­DENTED 12-MINUTE SPEECH on prime-time TV and said the state’s bud­get cri­sis meant the health­care sys­tem was “on the verge of im­plod­ing” and faced “cat­a­strophic cuts.”

“The health­care ser­vices that are in jeop­ardy lit­er­ally mean the dif­fer­ence be­tween life and death,” the Demo­crat said. “Fund­ing for vi­tal ser­vices like hospice care and end-stage kid­ney dial­y­sis would be im­pacted.”

Lois Simp­son, ex­ec­u­tive di­rec­tor of the Ad­vo­cacy Cen­ter of Louisiana, said she has had clients call and say their 50 hours a week of home health­care has been cut to 20. She can help ap­peal some de­ci­sions, but she said there are many more who don’t ask for help.

“They’ll have no re­course but to get ser­vices at an in­sti­tu­tion, which a lot of peo­ple don’t want and which is more ex­pen­sive for the sys­tem,” she said. Men­tal health ser­vices in the state, which were “al­ready abysmal,” will also see cuts. That is likely to lead to more peo­ple out on the streets or serv­ing time be­hind bars when they should be get­ting treat­ment, she said.

“Pol­i­cy­wise, it just doesn’t make any sense,” she said.

In 2012, Louisiana Gov. Bobby Jin­dal, a Repub­li­can, pri­va­tized the state’s pub­lic char­ity-care hos­pi­tals.

Re­cently, the state De­part­ment of Health and Hos­pi­tals said it would be able to af­ford only two of the nine con­tracts this year, said Jan Moller, di­rec­tor of the Louisiana Bud­get Project, a not-for-profit that mon­i­tors state pol­icy.

Louisiana has been in a bud­get cri­sis since about 2008. Jin­dal, like Kansas Gov. Sam Brown­back, cut taxes re­lent­lessly and saw state rev­enue plum­met. With the ad­di­tion of ex­tremely low oil prices drag­ging the econ­omy down fur­ther, the state faces a $750 mil­lion short­fall for the fis­cal year that be­gins in July, Moller said.

Ed­wards re­versed Jin­dal’s stance and ac­cepted the ex­pan­sion of Med­i­caid in Louisiana im­me­di­ately af­ter tak­ing of­fice in Jan­uary. That is ex­pected to al­low cov­er­age for an ad­di­tional 400,000 res­i­dents, but whether there will be enough providers re­mains to be seen, Moller said.

“We just don’t know yet be­cause it’s early in the game,” he said.

Michael Can­non, di­rec­tor of health pol­icy stud­ies at the lib­er­tar­ian Cato In­sti­tute, said the states’ strug­gles show the in­her­ent flaws in govern­ment-pro­vided health­care more than bud­get mis­steps.

Politi­cians “love to prom­ise ben­e­fits, but they hate to de­liver them,” he said. And he doesn’t see Med­i­caid ex­pan­sion as a so­lu­tion. He says the fed­eral dol­lars just al­low states to leave a bud­get un­bal­anced and prompt more un­ful­filled prom­ises.

To fix prob­lems with ac­cess, he sug­gested loos­en­ing state li­cens­ing re­quire­ments and al­low­ing caps on mal­prac­tice dam­ages as some al­ter­na­tive ways to re­duce costs and ex­tend cov­er­age.

Jesse Cross-Call of the Cen­ter on Bud­get and Pol­icy Pri­or­i­ties says taxes on Med­i­caid man­aged care and in­creas­ing en­roll­ment in those plans boosts rev­enue.

“If you get peo­ple cov­er­age, the pres­sure on state bud­gets de­creases be­cause the state has to spend less money,” he said.

Clients will “have no re­course but to get ser­vices at an in­sti­tu­tion, which a lot of peo­ple don’t want and which is more ex­pen­sive for the sys­tem.” LOIS SIMP­SON

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