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Jindal continues reform agenda through budget woes

One underappreciated facet of the Gov. Bobby Jindal Administration has been its ability to make lemonade out of lemons and advance a reform agenda simultaneously. This trait surfaced again in Louisiana’s Department of Health and Hospitals forced cuts because of mid-year budget deficits.

With roughly 40 percent of general fund money going into health care, the $248 million total general fund cut was going to make a significant impact on its operations as well as produce the single largest area of fiscal relief for the state Yet when the dust settled, particularly in the area of care of the indigent elderly and developmentally disabled, the Administration made exactly the best moves to induce increased efficiency into the system.

Most prominently, it has accelerated plans to close state-run development centers – in other words, publicly-owned nursing homes for the developmentally (meaning mentally and/or physically) disabled. Their operating expenses are much higher than comparable facilities in the private sector, and some of their clients could be cared for adequately in home- and community-based settings. Also, the state again has scaled back payments to the politically-powerful nursing home industry which for decades has benefitted from extra largesse that has bred wastefulness and inefficiency. This may encourage more transfers from institutional settings into alternatives at cost savings to taxpayers. Yet at the same time, the Administration preserved funding for the very home- and community-based programs that will be expected to take up the slack from the impact of these other changes.

What distinguishes these changes from those of the greater crisis of a year ago is back then alterations to produce savings largely were procedural, while this time they are more reallocation. This is a key and (given political forces) more difficult step in policy evolution but absolutely necessary if savings are to be realized. Some efficiency gains get realized through changing the way tasks are performed, but the real savings come from pulling money from less efficient uses and putting it into activities that produce the same or better outcomes for fewer dollars.

One would hope that these kinds of things would have been done absent any budget crisis on the principle that smaller government is morally better but regardless Jindal has done them in the current forced situation, instead of takings alternatives such as budget gimmickry, not introducing prioritizing into cuts, or, worst of all, raising taxes. Like other actions such as state human resources pay and personnel reform they are unglamorous whose benefits are hard to see but whose self-interested political opponents are vocal in their criticism, yet they bring large and undeniable benefits to the state as a whole. Jindal may be criticized for infrequent pursuit of the large and symbolic, but he must be commended for his ability to insert a conservative approach in the nuts-and-bolts of governing when faced with harsher fiscal times.

1 comment:

Margaret said...

I felt it necessary to comment on this post and advise the writer that DHH did not protect services for the elderly as the press release of 12/31/09 stated. On Jan 21, by Emergency Rule, reimbursement reductions were ordered for several Medicaid providers, including the Long Term Personal Care Program.

While not a waiver program, this program serves a vast majority of elderly and disabled individuals who rely on the services of a personal care agency for basic daily needs. The 5% cut ordered to take effect 01/22/2010 is the third cut to provider reimburesment in 11 months and will surely cause some providers to layoff staff thereby jeopardizing the delivery of care.

Without the services of personal care providers such as myself, individuals will be forced to seek institutional care in nursing homes long before they really need that level of care.