His strategy of no pain, no gain –
in other words, he cannot gain expansion of government without dishing out as
much pain as possible to frighten people and their representatives into tax
increases to fund a bigger state – calls for some roughly standstill spending
for some parts of government and bigger drops in others, with the notable
exception of a huge increase in health spending, most notably on Medicaid given
his decision to expand it.
That alone actually boosts the
budget much higher than the amended FY 2016 version
currently limping along by over $1.5 billion higher to reach over $26.5 billion
total. While a good chunk of that comes from increased federal funding that raises
the amount of national debt each Louisianan owes, forecast at $2.2 billion
more, some of it also comes from the state. A 2013
study, now understood to underestimate
actual costs to the state, including administrative
costs already consented to by the Edwards Administration not part of the
research, forecasts net change for FY 2017 caused by Medicaid expansion to cost
$41 million extra.
(Interestingly, the 2014 update
that noted the underestimation has disappeared from the Department of Health
and Hospitals website. DHH had scheduled a second update to appear at the
beginning of the year, but that now is a month-and-a-half tardy, leading to speculation
that the numbers come out distinctly unfavorably for the cause of expansion.)
Also, the higher numbers for DHH
appear to include the equivalent of nearly $350 million
in cuts previously sought by Edwards, cranking up its new total spending to
the $2.6 billion range – an over 10 percent increase in this one department
alone compared to the entire budget of last year. Counting the quarter of the
cut that comprises state money, if added back into this year’s budget means
roughly the state would spend the same on health care, so the entire increase
would come from federal funding. Of the $2.6 billion increase in just federal
funding, all but about $100 million comes in the form of Medicaid vendor
payments; that is, funding related to Medicaid expansion.
(NOTE: Shortly after the original posting of this column, DHH in testimony to the Legislature clarified that the budget presented included cuts about half of the size described in the paragraph above.)
(NOTE: Shortly after the original posting of this column, DHH in testimony to the Legislature clarified that the budget presented included cuts about half of the size described in the paragraph above.)
Compared to the rest of the budget
and to last year, spending on health care and other social service programs under
the Edwards plan rises from almost 40 percent to almost 47 percent, with proportions
for the areas of public safety, education, business and infrastructure, environment
and natural resources, and general government all headed lower. Keep in mind
the relative increase in human resources spending does not include the $131
million in state money health care cuts that would come mainly either from
reductions to the state-owned, nongovernment-managed charity hospitals or from
denying services to people with disabilities.
In other words, while other parts
of state government (excepting a few departments that can run largely or
entirely off their own fees charged) would get cut by Edwards, he focuses on
expanding Louisiana’s welfare state, quite possibly by beggaring its most
vulnerable citizens. In his mind, better to expand Medicaid rolls, that unlikely
would improve new enrollees’ health outcomes nor would change their use of
emergency rooms as their primary care outlets because of the surge in demand,
and thereby to secure their votes than to help people truly in need.
Nor does the budget do what we
might expect when an organization needs downsizing. It anticipates actually
increasing state employment by 140 full-time equivalent positions, with over
half going to DHH as part of the roughly 250 new hires to service Medicaid
expansion. (None of this includes higher education employees, as they
technically go off budget as a result of a previous law.)
In summation, in order to grow the
welfare state, Edwards proposes cutting most other parts of government, except
that he does not cut numbers of another reliable source of votes, state
employees, associated with these areas. It’s a joke budget, but Edwards never
intended for it to be serious because he wants to use it as political tool to
scare policy-makers into tax hikes to support the state in an expanded
condition – despite that in 2015 Louisiana ranked 18th
in per capita spending among the
states.
Legislators would best serve the state
by throwing away this mess and putting together their own version, facilitated
by wiping out all non-fee-specific statutory dedications in the current special
session and then budgeting on the basis of demonstrated need of programs that
would require little in the way of tax increases. They can crib a few good
ideas from the Edwards product, but they must reject its use as an ideological
tool in favor of utilizing it as a set of policy prescriptions designed first
and foremost to improve the state.
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