Louisiana voters will decide the fate of 14 proposed amendments in the Nov. 4 election. Early voting is scheduled for Oct. 21-28 for the Nov. 4 primary election. Today, The Advocate begins a series of editorials outlining its positions on the amendments. Soon, we’ll publish a recap of our positions in a single format that voters can easily use when casting a ballot. Our complete editorial series on the amendments also will be available online at theadvocate.com.
Here are our positions on amendments 1 and 2.
Amendment 1: Nursing home funding. No.
The amendment would protect from cuts the “medical assistance trust fund” that is now in the law but not given constitutional protection. Funds generated for nursing homes and a few other providers by a Medicaid program fee would go into the fund — the bulk of the money, about $91 million, from nursing homes. The amendment will further straitjacket lawmakers in the future by requiring that the providers would be paid rates no less than the fiscal year 2014 average.
While there are several constitutional funds, it is remarkable that the fees for the covered providers would be set in the constitution.
In both this case and a second amendment on a future hospital fund, there would be a way for future Legislatures to reduce the appropriations for the program beneficiaries, but it would require a two-thirds vote of lawmakers. Any cuts could not exceed the percentage of cuts from other programs.
This is controversial in part because the fund benefits only certain types of health care; home-health providers and other programs would not be protected in the same way.
Our concern is that further reducing budgetary flexibility would make managing the Medicaid program more difficult.
In times of budget shortfalls, the higher education budget as well as Medicaid spending outside the trust fund would, of necessity, suffer more severely.
Amendment 2: Hospital trust fund. No.
Two wrongs definitely don’t make a right, and the same concerns about the medical assistance trust fund apply to this similar hospital fund. In this case, the hospitals would generate new Medicaid matching funds for the state. The funds created in the state budget would go into the “hospital stabilization fund” and would be protected from cuts in a similar fashion to the fund principally benefiting nursing homes.
Louisiana’s hospitals are an influential lobbying group, and as they hope to generate more revenues for the Medicaid program, they want to keep the funds for their institutions. The problem is that, as with the nursing home program under Medicaid, the state’s capacity to manage payments again would be limited.
Adoption of more restrictions on legislative authority could draw a larger bull’s-eye on the funding for state colleges and universities, because that is not protected in the constitution.