HB 532 would lay the groundwork to recreate a “sick tax” levied on
those admitted into hospitals that indirectly would be passed on to consumers. But
it also would eliminate flexibility in reimbursement rates paid by the state to
hospitals by locking them and guaranteeing adjustment upwards by inflation
rate, removing completely the idea of payment on the basis of market
conditions. HB 533 would extend this to other providers where payment is made
for nursing homes, pharmacies, intermediate care facilities, medical
transporters, and managed care organizations with Medicaid contracts. Exceptions
to the automatic adjustments could be made in times of budget deficit as long
as all other providers are cut similarly.
Were these constitutional amendments offered by House Speaker Chuck Kleckley
to pass, this could commit the state to paying excess taxpayer dollars to fund
these special interests, if the market rate went below the rate being paid.
Worse, it leaves out one set of providers that is different from all of these: those
for home- and community-based waiver services. This means in times of budgetary
stress only these rates could be cut, or they could be cut at least as much as
the other shielded providers’. In essence, this also would decouple the rates
being paid from market considerations, as these rates now would be held hostage
to external factors created by the inability to cut other rates or would have
to be cut in concert with the others regardless of the market conditions
affecting them.
Worst of all, this could open up the state to lawsuits that only cuts
elsewhere in the budget or raising taxes could prevent. Louisiana public policy
in the area of waiver provision, which has the state pay providers that allow
the developmentally disabled or the infirm to live in the community or at home
instead of being institutionalized, is guided by the federal Olmstead
and state Barthelemy court decisions.
This means the state must provide adequately for those who qualify to live in
the least restrictive setting given their needs; it has no option.
If put in the position of cutting provider rates artificially low because
of the lack of flexibility created by these amendments, this could contract
enough supply as to begin forcing individuals into nursing homes (which in most
cases cost the state more), in direct violation of the law. The only way then
to prevent suits to make the state follow the law is for it to find the
revenues to keep these providers’ rates at a level to provide adequate supply,
and if it can’t be from cuts elsewhere, it comes from tax increases – directly,
as because these providers don’t have nongovernment revenues the “sick tax”
dodge can’t be used.
In other words, by giving all other providers the special privilege of
locked-in rates that never go down – a recipe that encourages inefficiency in
performance by them and in use of the public’s money – the state sets itself up
for wasteful allocation subsidized by taxpayers who may have to give more than
is necessary as a result. Unfortunately, to this point legislators seem blind
to the consequences of approval of these, meaning the last resort would be the
people defeating these amendments.
1 comment:
Saw your post to Bob Mann's excellent article of the total lack of transparence in the Jindal administration.
Two observations:
1] You just cannot set out a cogent defense of what is going on with Jindal and transparency for the public. It's impossible. I see you have pretty much quit trying.
2] You calling Bob Mann a "hack" is beyond the veil, never-never land. 'Nuf said.
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