Jeanne Abadie of The Advocacy Center, a New Orleans based group that advocates for the elderly and disabled, testifies Wednesday, May 10, 2017, in favor of HB152, which would reduce nursing home dependency by expanding opportunities for elderly and disabled people to use home and community-based services. The bill, sponsored by Rep. Tony Bacala, R-Prairieville, was involuntarily deferred, effectively killing it, after a vote in the House Health and Welfare Committee.


At first glance, a recent Advocate story noting that Louisiana's nursing home residents wouldn't be hit as hard as their national counterparts should the U.S. Senate Republican health care bill become law sounded like good news.

The bill, pitched as a repeal-and-replace of former President Barack Obama's Affordable Care Act but in fact, a much more far-reaching restructuring faces a daunting path to passage, given the strong reaction against deep cuts in projected spending on Medicaid.

That's the part that could affect nursing home residents, in a country where people are living longer and even well-off older people are outliving their savings. Nationwide, nearly two-thirds of nursing homes residents rely on the program; that figure is even higher in Louisiana at about 80 percent.

Thanks to provisions in Louisiana law and the state constitution adopted at the behest of the politically powerful nursing home industry, though, Louisiana would continue to increase the rates it pays nursing homes.

But wait, there's more. There always is.

Actually, make that less.

If the bill passes and the state continues to guarantee rate increases every two years for nursing homes — a reality that has already caused spending on nursing homes to climb much more rapidly than on other Medicaid services — the overall cuts would have to be absorbed elsewhere.

That could mean reductions in community-based and in-home care for residents who might otherwise have no choice but to move into nursing homes, services that help people with daily activities such as bathing, dressing and eating, according to Andrew Muhl, AARP Louisiana lobbyist.

These services are already under-funded compared to nursing homes; Louisiana now has roughly 45,000 people on waiting lists for home and community-based services for the elderly, developmentally and physically disabled. Unlike nursing home coverage under Medicaid, which is federally mandated, these popular programs are considered optional, so they'd likely be the first to face severe cuts under the Senate proposal.

It could also mean cuts in other services provided by the broad federal program. Nationally, Medicaid covers an astonishing 20 percent of all Americans in some form, including 49 percent of births, 30 percent of adults with disabilities, 39 percent of children, 76 percent of poor children and 60 percent of children with disabilities.

The ACA's expansion of benefits to working poor adults has given millions, including more than 430,000 Louisiana residents, access to preventive care, drug addiction treatment, mental health services and more. The Senate proposal wouldn't formally end expansion but it would eliminate the generous federal match that makes it possible; Gov. John Bel Edwards and his administration have already said that adoption of the bill would make continuing to offer this coverage impossible.

These are all good arguments against the bill, which U.S. Senate Majority Leader Mitch McConnell is still angling to bring to a vote this month despite resistance from both conservatives and moderates in his own party.

But they're also good arguments against the way Louisiana typically takes care of business.

Advocate reporter Rebekah Allen, who authored the story on the law's possible effect on Louisiana nursing homes, documented in a recent series how politicians have gone to extreme lengths to make sure these facilities are taken care of even during tough fiscal times.

That's the way state government has treated too many favored interests and industries, and a main reason why unprotected budget areas such as higher ed and overall health care keep finding themselves on the chopping block. Yet time after time — including during this year's legislative session, when lawmakers finally seemed ready to tackle reform — they've declined to act.

It's easy to see why various interest groups fight to keep what they have, and politicians are loath to take advantages away. But the underlying lesson here is that if somebody's protected from cutbacks, somebody else is even more vulnerable than they'd be if there were a level playing field.

And that's a lesson that Louisiana lawmakers should take to heart, even if the Senate health care proposal dies a well-deserved death.

Follow Stephanie Grace on Twitter, @stephgracela.