The passage of HCR 75 by
Speaker Chuck
Kleckley took the next step, steeped in subterfuge, of trying to shovel
money into Louisiana’s budget to satisfy short-term electoral whims of
legislators at the expense of needlessly costing Louisianans more in the long
run. This resolution allows the state to decide within the first three months
of next year whether to have general urban larger hospitals, which they and their
affiliated doctors receive the lion’s share of Medicaid funds, pony up money to
use as a match for Medicaid – hidden code to foist wasteful and
counterproductive expansion of the program through the Patient Protection and
Affordable Care Act.
The facts establishing that
expansion would have a negligible, if not negative, impact on the health care
of its clients while costing far more than at present are
well known. And the studies that demonstrate Louisiana would pay upwards of
$2 billion extra over the next decade through expansion in return for health
outcomes of those covered likely no better than under the current system where
health care is delivered to the indigent upon request regardless of their
ability to pay probably understate that unnecessary extra expense: data from
states that already have expanded show significantly
lower forecasts of extra costs than what actually has transpired.
But legislators want to give an
opportunity for their futures selves and a new governor to embark on this rash
and counterproductive course anyway, through a “sick tax” mechanism: hospitals,
if matching funds to qualify for expansion must be paid as they will be
beginning in 2017 (giving Louisiana a half-year of a needed match in the fiscal
year 2017 budget), kick in up to one percent of revenues to the state, which
then they will pass along to insurance ratepayers – including Louisiana
taxpayers because they fund insurance for state employees – and any
out-of-pocket payers for health care delivery. In short, it’s nothing more than
a hidden tax that doesn’t even pretend, unlike the sick tax passed under the
guidance of former Gov. Kathleen
Blanco then
quickly repealed, that hospitals won’t pass the costs along. Worse, if the
one percent of revenues doesn’t equal the match, which will be 10 percent from
2020 onwards and likely to be raised dues to federal budget deficits to the
horizon, taxpayers must cough up the remainder. Worst of all, federal spending that
Louisianans would have to pay for also would increase as a result of
acceptance.
The greed of hospital operators
combined with legislators selling out the people for electoral purposes to
foist this scheme onto the public. The original constitutional amendment
formulated in 2013 but passed in 2014 came under the guise of locking in
hospital Medicaid reimbursement rates – a bad idea in and of itself that
presented even less budget flexibility that is a main cause of the state’s
budgetary troubles today that helps drive this money grab – that also added
this feature that allowed a reimbursement formula to be set up, through passage
of this kind of resolution. In retrospect, it’s clear Kleckley and others
followed this path to avoid probable vetoes of Gov. Bobby
Jindal, who undoubtedly would have been canny enough to sniff out these surreptitious
maneuvers to grease the palms of hospitals with more business and legislators
with more money to play with. Unfortunately, the public fell for it as far as
the amendment went
(which in the text that voters saw did not even mention the potential
establishment of a reimbursement formula that could be shaped to Medicaid expansion).
Even as enough reliable
conservative legislators seemed to sleep through this resolution to allow its
two-thirds approval, hopefully they will be wide awake in the first quarter of
the next year, as HCR 75 also designates
essentially as the only time period in which this linking of formula to
expansion may exist. The hope among those unwisely wanting expansion is that
the new governor will work a deal with the Pres. Barack Obama
Administration not to have to accept legacy fee-for-service Medicaid, which the
state abandoned years ago in favor of a managed capitation system with premium
support. Supporters will point to states like Arkansas and Indiana, alleging that
a hybrid system can be created that removes the objectionable portions of
legacy Medicaid, these being part of the reason why it would waste money.
Yet that fictional assertion astute
policy-makers cannot afford to believe. Despite disingenuous publicity to the
contrary, the waivers Indiana received make
little positive substantive change to the program – something Arkansas
already has found out the hard way which led to its abandoning
expansion (although it may meet
resistance to that by the Obama Administration). While big-government,
redistributionist-minded Democrat state Rep. John Bel Edwards would jump in without
reservation, hopefully the other Republican candidates that are more likely to
triumph this fall, along with majorities on the Joint Legislative Committee on
the Budget, would see the stupidity of any such arrangement that did not
completely overhaul Medicaid into something like the state’s new program – which
the Obama Administration has shown no indication it would be willing to accept.
Thus the resolution would expire, and hopefully the idiocy wouldn’t be
repeated.
Let’s hope policy-makers come to
their senses and take their fingers off the trigger. Only by the public
lobbying them to understand that looting its wallets just to allow them to
avoid hard budgetary decisions until their terms run out while the people get
the shaft will wake up enough of them.
No comments:
Post a Comment