We can recall a Gov. Edwards with a penchant for getting his way with the Legislature, particularly with taxes. He’d threaten to cut off the dialysis machines for state patients because the budget was so short.
Edwin Edwards never really went that far, but a new governor named Edwards — no family relation — is almost at the same point.
Gov. John Bel Edwards said that with the state $750 million short of money for the fiscal year beginning July 1, there is not enough money to pay for the public-private partnerships that replaced Louisiana’s old charity hospital system.
The contracts for nine communities are not funded in the budget.
Does this mean that, a la Edwin, the state will threaten to end lifesaving treatments for the unfortunate?
Not really, we think, but the budgetary problems facing the state are real enough.
We believe Edwards and his commissioner of the Division of Administration, Jay Dardenne, are legitimately trying to put the state on a sounder financial path. That means a shortfall isn’t merely an accounting fiction but a gap that has to be filled with real dollars generated by taxes, not by the gimmicks and short-term financing of the last administration.
And if money is truly as short as they say, hundreds of millions paid to management contracts for hospitals are in danger.
“With that level of cuts, we are going to struggle to keep our safety net hospital system alive,” Edwards told health care workers Tuesday. “We’re going to prioritize the hospitals that are important for private medical education, those being in Shreveport and in New Orleans.”
While it is true that the graduate medical education is focused on the two cities with medical schools, the fact is that all the public-private hospitals benefit from the labor of residents, doctors in training. The implicit threat of failing to find more than $50 million apiece for the Baton Rouge partnership with Our Lady of the Lake Regional Medical Center and the similar arrangement with Lafayette General Health Center ought to worry everybody.
And that, like the hand on the plug of the dialysis machines, is part of a very real game of political maneuvering.
While it is certainly true that the state can find some money tucked away in the $8 billion Medicaid budget, there are two types of funding there. The state’s general funds are matched with federal dollars, so more than half of the eventual spending on doctors, hospitals and nursing homes is from the U.S. taxpayer’s payment for the state match.
But those general fund dollars are precious and require new taxes. Any dollar cut in general fund spending on health care immediately endangers almost $2 in additional federal funding.
Making health care funding work, even with the new partnerships and other innovations, is going to require a lot of money. That is the real message of Edwards’ remarks, and legislators are going to hear from community leaders across the state about even an implied closure of the new partnerships.
Have we done away with almost a century of charity hospitals, only to fail to come up with the day-to-day financing to make the new partnerships work?