New B.R. indigent care policy needs expansion statewide

Gov. Bobby Jindal is making the right move, but now he needs to make the big move when it comes to realigning the way the state provides health care to the indigent.

The Jindal Administration made formal its commitment to discard the charity hospital model in Baton Rouge by making permanent the ongoing move of functions of the state’s Earl K. Long Medical Center to the private Our Lady of the Lake Regional Medical Center. By 2014 the state’s run-down facility would cease any provision, and all but prisoner care and obstetrics would be done by OLOL or from state-leased facilities from it. The state would pay for some of the new construction and operating costs.

This will save the state perhaps $400 million in costs to build a new facility due to the decrepit nature of the present facility. Still to be worked out is the disposition of some of EKL’s satellite clinics which to receive federal funding for treating Medicaid patients must be affiliated with a hospital and the treatment of prisoners and obstetrics, but surely the state can make arrangements with other providers for these. Besides OLOL essentially taking over treatment of the indigent, it will become the major source of medical education for the area.

Thus, in short order the state will exit the charity hospital business in the Capitol Region. Given changing federal policy and other budgetary constraints, it also may do so in every region of the state except around Shreveport and New Orleans, and has the opportunity to reduce significantly its involvement in those two places by maintaining only their medical education functions. In short, the charity hospital model that has typified state policy regarding indigent care will cease to exist about eight decades after it came about – if Jindal makes that commitment.

One obstacle is Baton Rouge legislators who like the idea of having a large state facility in their districts, so they can tout to voters the jobs and direct care provided to constituents as part of their legislative service. When one hears complaints of “How in the world can we write a blank check to the Lake and we are having all these [health care] budget problems?” from the likes of state Sen. Sharon Weston Broome, it translates as, “How can you privatize state assets so we have less direct control over and can claim less electoral credit from them,” and thereby Jindal must keep the pressure on and back other legislators who see the deal favorably to make sure it goes through.

But the other obstacle is Jindal himself, who seems wedded to the charity hospital model in New Orleans. Also there hundreds of millions must be spent to have available a workable state facility, but political considerations appear to make Jindal unwilling to farm out indigent care unlike his course in Baton Rouge. Presently, the state is fighting for money to build a large new facility when if its activities were restricted to medical education it could do with a smaller one, perhaps using a refurbished Avery C. Alexander building that now sits gutted for much less in expense. A bold and cost-effective move would be for Jindal to scrap plans for the new campus and instead renovate the old, leaving only enough beds for medical education and allowing the overbuilt non-government hospital sector to serve the area’s indigent.

The idea of a charity system, where any state resident could walk in a get free care, might have made sense in a different era of medicine, technology, and without any federal policy covering indigent health care. In recent years, Louisiana’s government-owned hospitals have spent more money with worse outcomes for indigent care than their non-government counterparts. Jindal will burnish his credentials as a transformative governor achieving smaller, more efficient and effective government were he to use this decision as another step towards shedding the charity system.