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22.6.05

Blanco, legislature do little this session regarding health care costs

It’s all over but the shouting, and almost nothing happened this legislative session to introduce necessary health care fiscal reforms that could save taxpayers hundreds of millions of dollars and/or vastly increase the level and amount of service to those using state health care resources.

On the budgetary side, Gov. Kathleen Blanco completely whiffed. Earlier in the year she talked of restructuring long-term care reimbursements to reduce the nursing home bias in provision and enabling more services to more people at a cheaper cost. She reneged on this when the state’s fiscal picture improved – in other words, like a smoker considering cutting back on the activity because of lack of funds, but then discovering some extra money and deciding to smoke up instead of kicking the habit.

(The Senate did add more money to fund the New Opportunity Waiver program to allow 50 more people to get home-based care. Whether it survives conference and passes Blanco’s muster remains to be seen.)


On the legislative side, SB 272 epitomizes non-reform. Pushed by nursing home advocate and owner state Sen. Joe McPherson, all it does is to continue money flowing to nursing homes, only that it asks the money to be used in a different way. Instead of some funds supporting traditional warehousing of patients, this portion can be used only to semi-warehouse them.

In no way does this legislation address the fundamental problem: the existing system encourages over-utilization of institutional solutions, its fiscal incentives steering some who can enjoy a higher quality of life at reduced cost to the state outside of institutions into them. Genuine reform would take money away from the institutionalization option and transfer it to community-based solutions. Worse, it can actually allow more building; that is, to increase institutional capacity which already is way above the national norm.

(Fantastically, McPherson is arguing his bill actually would give such homes an incentive to diversify into “home and community-based care” by converting unused beds into more apartment-like accommodations with nearby medical aid. This most decidedly is not home and community-based care – that occurs when a patient does not live at an institution, such as having health care workers come into a person’s home or the consumer accessing such care in an outpatient setting. McPherson has a record of saying and doing anything to keep the nursing home gravy train rolling, however.)

Only HB 697 constitutes real reform but with a very small footprint. This bill permits in-home personal care attendants with some extra training to give medicines to some elderly and developmentally disabled people. On the margins it will increase efficiency.

Blanco has talked big about this issue, the most expensive general fund item in the budget, but her actions this session show she has done little to wage admittedly a tough struggle against established special interests, and for the taxpayer and the health care consumer.

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