Given the urgent to-do lists, maybe both men seeking the state’s highest office ought to contemplate whether it’s going to be the plum they seem to think.
Another warning of serious financial flaws in Gov. Bobby Jindal’s administration was issued before the Senate Finance Committee on Monday.
It’s not news that the state is taking a beating on the costs of Medicaid insurance for the poor, not just in health insurance but in long-term care costs in nursing homes, also covered by Medicaid.
But there’s also an official admission that Jindal’s private contracts to operate the former charity hospital system are flawed.
State Department of Health and Hospitals Secretary Kathy Kliebert’s brief comment was that the contracts need to be “restructured.”
It marked the first time an administration official talked about the need for changes in the deals that the outgoing governor points to as one of his successes. Others, though, have been concerned from some time.
The current state budget appropriates $1.26 billion for the deals involving nine LSU hospitals, including those in Baton Rouge, New Orleans and Lafayette. Costs are projected to keep going up because more patients are receiving health care. Sufficient funds may not have been appropriated for the current fiscal year, which started July 1. The hospital private partners receive much higher levels of Medicaid reimbursement than other community hospitals.
All that puts strain on Medicaid, which is jointly a state and federal responsibility. Louisiana gets about $2 for every $1 it puts into the program, but federal officials hold key purse strings.
One of them is that you can’t cut basic services, to balance the budget, if it harms recipients; one key issue is access, and Louisiana can’t cut hospitals and other providers so much that they’ll stop taking Medicaid patients.
Whatever way you slice it, we’ve got a to-do list of three items for the new governor and Legislature in January.
One is that the costs of operating the public hospitals isn’t sufficiently covered in the state budget. Who is surprised, given the Jindal record?
Another is that we’ve tried to limit costs by using a combination of public hospitals and among the lowest Medicaid income standards in the country. The privatized hospital contracts are under strain because a huge number of our citizens are working at low-wage jobs without insurance, hurting the workforce and individuals in pain. And we’ve refused as a state to take advantage of higher reimbursements if we raise the income standards under the Affordable Care Act.
Finally, we might be able to better control costs by imposing stricter “managed care” requirements on providers, but the political pushback on that is going to be substantial for a new administration in office.
It’s a mess that Democrat John Bel Edwards or Republican David Vitter will inherit.