Wrecking the Crash Cart
Jindal's Decisions Destabilizing Lousiana Health Care
There were more warning lights flashing this week signaling that Governor Jindal's ideologically driven approach to health care reform is careening out of control. The Governor's decisions put not only the state's public hospital system, but graduate medical education, the financial viability of community hospitals, and the ability of any Louisiana citizen to have regular access to medical care.
On Monday, The Advocate reported that the administration is trying to cover a $340 million funding hole in the LSU Hospital systems that are anchored by the medical schools in New Orleans and Shreveport. The administration is using "The Jindal Way" to resolve the problem -- using one-time money, the paper reported.
Commissioner of Administration Kristy Nichols also made clear that the Governor will insist on getting his hands on the budget surplus left over from the 2011-2012 fiscal year, despite the fact that the money is dedicated to go into the state's so-called 'Rainy Day' fund. The Governor's method of persuasion? Hold what's left of the hospitals and higher education hostage.
"Obviously, our desire is to use the surplus, so that we could mitigate the additional cuts that would have to be made to health care and higher education. We feel very strongly about that decision," Nichols told The Advocate. "I'm certain there's going to be some debate about it."
The process of laying off the 1,500 or so hospital workers that will lose their jobs because of the already announced cuts has begun. Notifications have been sent to Civil Service and the layoffs will begin on January 21.
While the administration remains confident that it will close the budget gap, no public-private partnerships upon which the future of graduate medical education in the state depends have been struck.
Doctor Training at Risk
Concern about the future of graduate medical education spilled into public view on Thursday at a meeting of the Joint Committee on the Budget at the Capitol. Lawmakers specifically asked for assurances that the severe cuts being made to the LSU Hospitals were not jeopardizing the training of future doctors. The head of the LSU Hospitals run by the Shreveport Medical School said he did not think the cuts would disrupt the training of the doctors, which would create a shortage of doctors in Louisiana in future years.
But, the deepest cuts are taking place in the seven LSU Hospitals anchored by the LSU Medical School in New Orleans. The administration did not make Dr. Frank Opelka, the man who runs that system, available to testify at the hearing. Opelka has stated publicly that no public-private partnership deals have yet been reached that would provide continuity for the training of doctors in the state.
The cuts are the result of the Governor's decision to concentrate cuts resulting from the Medicaid clawback provision in the federal Transportation Bill on the LSU Hospitals.
Community Hospitals at Risk
Community hospitals are worried that the cuts at the LSU Hospitals will send tens of thousands of uninsured residents who currently recieve care at the safety net hospitals to their facilities for care. The administration has done nothing to alleviate those concerns and, in fact, has heightened concerns due to another policy decision made by the Governor.
This week Jindal restated his resolve to not to allow Louisiana to participate in the health insurance exchange portion of the Affordable Care Act. The Governor has also declared that the state will not participate in the Medicaid expansion piece of the law.
With Jindal intent on closing the public hospital system, Louisiana community hospitals have cause for alarm. Jindal's opposition to Obamacare means that there will be no reduction in the number of Louisiana residents who don't have health insurance at the same time the federal government will be reducing the funding source that pays for care given to the uninsured.
Jindal's refusal to allow Louisiana individuals, families, small businesses and health care providers access the resources and benefits of the Affordable Care Act even jeopardize his own projects.
At a meeting of the State Bond Commission on Thursday, state Treasurer John N. Kennedy pointed out that the viability of the new teaching hospital in New Orleans which the state is building depends on income that will attach to patients through the Affordable Care Act. Kennedy said that Jindal's refusal to allow the state to fully participate in the Act threatens the financial viability of teaching hospital.
Health Care Access is at Risk
The depraved indifference of the Governor's decision on the Medicaid expansion prompted the normally supportive editorial board of the Times-Picayune to call him out on it on Friday. "Even with the presidential race over and the fight over the constitutionality of the Affordable Care Act settled by the U.S. Supreme Court, Gov. Jindal is still putting partisan politics over the good of Louisiana's residents. That is a dereliction of his duty," the paper said.
Jindal's policy decisions are destabilizing virtually every element of the state's health care delivery system, from the training of doctors to the financial viability of hospitals. Remedies are at hand but he refuses them for political reasons. His eyes are on some prize beyond our borders. Louisiana and its citizens will be left to clean up his mess once he moves on.
The question is whether any of us -- rich or poor, rural or urban, insured or uninsured -- will have access to anything resembling reliable health care before his time here is done? Barring the Legislature finding a backbone or the Governor having some kind of road to Damascus conversion experience, Louisiana will be left to fix a medical system that Governor Jindal will have wrecked by the time his term has ended.