Characterizing the issue as both a health and financial emergency, a Baton Rouge state representative urged the Legislature on Thursday to take swift action on a plan that experts estimate would generate $200 million a year while gradually decreasing the state's dependency on nursing homes.
Rep. Rick Edmonds, a Republican, referenced a three-part series by The Advocate that detailed how Louisiana spends an increasing share of its resources to support nursing homes, to the detriment of high-demand alternatives that allow elderly and physically disabled people to be cared for in their own homes. Louisiana's nursing homes -- which are ranked lowest in the nation -- have seen generous increases in their budget even as other state departments have seen their funding slashed. That's because nursing homes enjoy ironclad legislative protections ensuring they get biannual rate increases from the state.
"This is a front-burner issue, colleagues," Edmonds said on the floor of the state House. "We must deal with it and deal with it now, for the sake of quality care and the care of our seniors."
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Edmonds on Thursday tried to amend the House's state budget bill to require the governor's administration to issue a solicitation to expand managed care for Medicaid services to the elderly and physically disabled.
The maneuver would have revived a plan floated by Gov. Bobby Jindal, who privatized all of the state's Medicaid services save for the nursing home and long-term care population. Under managed care, private insurers would evaluate each elderly and physically disabled Medicaid recipients and determine where they would receive the best care at the lowest cost to the state. The measure was expected to gradually shift more elderly people into home- and community-based programs.
Were it implemented, the measure would also generate significant revenue for the state, because the state assesses a 5.5 percent tax on managed-care providers. An expansion of managed care to long-term services would generate anywhere from $100 million to $500 million a year, Edmonds said. Based on projections from the Louisiana Association of Health Plans, The Advocate has reported the tax would generate $130 million the first year and $200 million a year after the second year.
"How valuable will that money be when the fiscal cliff approaches?" Rep. Tony Bacala, R-Prairieville, asked rhetorically, referring to the 2018 expiration of about $900 million in sales tax revenue. "This is smart legislation. We save money and we make money. There's a financial benefit and the quality of care and quantity of care increases."
Edmonds withdrew his amendment because of procedural concerns. Bacala has a bill that would accomplish the same thing, and it will be heard on Wednesday in the House Health and Welfare committee.
Rep. Walt Leger, D-New Orleans, said he supported Edmonds' amendment because he supports the idea -- and he doesn't have much optimism that Bacala's bill will survive the House committee next week.
"I can foresee what will happen in Health and Welfare (committee), because I was there last year with the same bill, and it doesn't look good," Leger said. "Your amendment may be the only way it passes."
Leger sponsored nearly identical legislation last year. On the day his bill was heard -- and killed -- the committee was packed with nursing home owners, who have poured millions of dollars into legislative campaigns across the state. One of them, former state Sen. Joe McPherson, used to serve as chairman of the health and welfare committee. The bill died after legislators and nursing home owners raised concerns about managed care, citing examples of claims being denied by profit-seeking insurance companies.
Opening a new solicitation for bids for managed care might be pretty easy procedurally, if not politically. The state already has a detailed, 372-page request for proposals crafted after two years of study by a team of 30 stakeholders chosen by the Jindal administration. The RFP was abandoned a day after the nursing home association sent an email saying its members didn't want it issued. Jindal's administration said at the time that the decision should be left to the incoming governor. But in an interview with The Advocate, former Secretary Kathy Kliebert said it was a requirement from Jindal that the nursing home industry be on board.
Edmonds also took a jab at Gov. John Bel Edwards' administration for failing to pursue the healthcare overhaul on its own. Earlier this month, in a House appropriations hearing, Edmonds asked Dr. Rebekah Gee, secretary of the Department of Health, why the state wasn't pursuing the cost-savings health reform.
Gee replied: "It's not top priority of the department at this point."
Andrew Tuozzolo, Gee's chief of staff, clarified in an interview that the department has been focusing on the massive task of Medicaid expansion, which has enrolled 420,000 new people, since Edwards took office.
"She was referring to our first priority which was to expand Medicaid, but she was not saying that nothing else is a priority," Tuozzolo said.
Tuozzolo added that even though the department has an RFP, it is two years old at this point and would have to be revised.
"The idea that this could be done in 30 days or so is unrealistic," he said. "It would take a considerable amount of time to deliver a refreshed RFP. I don't think you can just re-issue it right off the shelf."
The legislation proposed by Edmonds is attempted to force action that could be initiated by the Edwards administration on its own. Before being elected, Edwards -- who received more than $400,000 from the nursing home industry for his gubernatorial bid --said he was a proponent of expanding managed care to include nursing homes. But in a recent interview, he told The Advocate he had many concerns about it.
"As the governor has said to you, this is not an easy task," said Richard Carbo, Edwards' spokesman, when asked whether Edwards would support Bacala's bill. "These are conversations he was and is having with a variety of stakeholders, and he refuses to rush into anything. These bills will be heard next week, and the conversations will continue."