Implementation details may yet provide health care hope

In terms of financial overhaul of state health care costs in Louisiana, Gov. Kathleen Blanco has done little to achieve this. What then of her efforts to tackle the regulatory and administrative side of things?

One new law reorganized the provision of services, particularly in the intake of clients, to promote efficiency. However, the law also had a more ominous impact, to define into law the idea that the state should force people close to bankruptcy before they are allowed access to taxpayer-funded health care. In other words, somebody defined as “poor” gets all kinds of free care that only the rich could afford on their own, while everybody else gets much less assistance, if any, from the state, putting a huge burden on their resources. Generally, this means that before the state pays much to a family struck by catastrophic health costs that no private insurance in the world can cover costs adequately it mandates the wiping out of any but the most rudimentary amounts that can be set aside for living and retirement purposes.

The proposed law that encourages nursing homes to get into reimbursed residential care does not in any way shift the balance from institutional to home care, heavily tilted in Louisiana in favor of nursing homes (82 percent of long-term care dollars going to them as opposed to the national average of 67 percent). The only substantive favorable change here came with the funding of 100 additional home-based care slots (which represents about 1 percent of the total backlog of eligible people waiting for those slots – many of whom will die or be forced into much more expensive nursing home care paid by taxpayers long before their names come up to actually get these much less expensive services).

Another proposed law at least will help those with less-complicated health needs. However, an opportunity exists to enable this law to provide much greater services to clients and much greater savings for depending upon the rules developed by the Department of Health and Hospitals that address what "non-complex" medical tasks in-home workers can do and set up training parameters and a registry for in-home workers.

For example, the tasks associated with caring for a mobile (either by self or by electric wheelchair) ventilator-dependent person are not tremendously demanding except in extreme emergency situations. Indeed, such skills are taught to the patients and family members as a matter of course. Currently, the state allows payment (and insurance companies follow) only for licensed practical nurses or even more-qualified personnel to care for these individuals. But if personal care assistants trained in this area were allowed to be reimbursed, savings to families, insurance companies, and taxpayers could be substantial, and more skilled nursing personnel could be deployed to cases where their particular skills are more in demand.

Naturally, the state would have to set rigorous requirements, perhaps create a menu of different competencies that it can test and certify people in. As long as there is creative thinking and no relaxation of standards, it is this aspect of Blanco’s health care reform plans that holds the greatest, even if it is in an absolute sense small, potential for genuine improvement of the system for all concerned.