Recently, The Advocate ran a series of articles outlining how Louisiana’s nursing home lobby had stymied proposed reforms that could have saved Louisiana's taxpayers as much as $130 million next year. The changes would also have helped the elderly and disabled live outside of nursing homes in less expensive and more independent places — often, in their own homes. State policy currently steers these clients toward more expensive nursing homes, fattening the wallets of the operators. In exchange, elected officials get lavish campaign donations to block reform.
Profits over Patients: The Advocate takes a deep dive into Louisiana's powerful nursing home…
The years-long reluctance to act against nursing home interests, which has included both Republican and Democratic lawmakers and governors, surfaced again last week, when a House panel brushed aside a bill — as it did last year — to implement change. A similar reform pushed by Gov. Bobby Jindal when he was in office also went down in flames when Jindal withdrew the proposal, which the nursing home lobby strenuously opposed. During his campaign for governor, John Bel Edwards also promised to reform the system, but soon as he entered office, he began backing away from his pledge. His retreat from a reform that could save the state a lot of money called into question his suggestion that state government could not work more efficiently and needed tax increases to continue providing crucial services. To back his claims, whenever Republican legislators balked at collecting additional revenues, Edwards’ administration argued that without more taxes, the state would be forced to reduce services for persons with disabilities.
Those scare tactics worked for Edwards’ first year in office, but now House Republicans have called his bluff. The chamber’s GOP majority recently passed a fiscal year 2018 budget that cut spending $237 million, with most of the reduction coming from health care. Further, the spending plan slightly increased expenditures for care of the disabled outside of nursing homes and dictated that cuts couldn’t come in that kind of spending.
Howling from the Edwards Administration predictably followed, utilizing its all-too-familiar rhetoric that the paring would trim critical health services. But that view ignores alternative measures that Edwards could initiate with a stroke of his pen — cost-sharing by Medicaid recipients that would encourage more responsible use of taxpayer resources and instituting the long-term care reform proposal that was previously shelved.
With the Legislature, Edwards also could reduce the cutoff from 200 percent to 138 percent of the federal poverty limit for free health care paid by the state as households in that income range already qualify for heavily-subsidized insurance. Together, these changes would save more than $285 million next year and $355 million annually thereafter.
As long as the House refuses to raise taxes, Edwards only has options like these to plug substantial money into the budget. Spurred by The Advocate series, Republicans brought up long-term care reform during debate on the budget, and even Edwards’ floor leader, Democrat state Rep. Walt Leger, who carried last year’s bill, agreed that this change should move forward.
Edwards isn’t the only policy-maker over time to have feet of clay on the reform issue, but he can reverse that now. If genuinely concerned about avoiding cuts to health care, Edwards should muster the political courage to stop unnecessary redirection of taxpayer dollars catering to the nursing home industry. That would keep a campaign promise and place the general interest above a special one.
Jeff Sadow is an associate professor of political science at Louisiana State University-Shreveport, where he teaches Louisiana government. He is author of a blog about Louisiana politics, www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at www.laleglog.com. Follow him on Twitter, @jsadowadvocate or email firstname.lastname@example.org. His views do not necessarily express those of his employer.