With the closing of the city’s charity hospital in
the area a few years ago and transfer of most of the services it provided
previously to a hospital in southern Baton Rouge, a health care hole opened up
in north Baton Rouge. Most patients had their bills paid by Medicaid, with many
living in that area. When those services moved several miles south, clients
found transportation to these more challenging. This becomes magnified when
people need emergency services.
That situation became more exacerbated when the next closest full-service hospital, Baton Rouge General Medical Center Mid City, closed its emergency room. It had hemorrhaged money because increasingly its patient load comprised Medicaid patients, who disproportionately use emergency services even though most of their ailments do not require that kind of intervention. Medicaid reimbursements fell far short of actual operating costs, which threatened to drag under the entire hospital.
To address primary care needs, the state sponsored the new provider, Our Lady of the Lake Regional Medical Center, in its opening clinics in the area. But this could not address critical care services, and so a coalition has sought to open an emergency room in the area. Recently, the Edwards Administration signed on to the effort, with Department of Health Secretary Rebekah Gee proclaiming that her “marching orders are to make sure we have an emergency room in north Baton Rouge.”
OLOL has remained noncommittal to this point, expressing willingness to meld in an ER to an existing clinic in the area, but hesitantly for apparently financial and logistical reasons. It also remains an open question about whether the area needs one, as officials from various hospitals, including OLOL, point out that more severe and specialized cases never went to north Baton Rouge facilities anyway and other facilities in other parts of the parish seem to be providing enough ER services adequately. OLOL also notes that the clinic strategy seems to have produced some shift in utilization patterns away from ERs.
In other words, economics mean no private provider will set up an ER in the area, much less an entire hospital – unless the state coughs up some kind of subsidy, in a replay of a local version of this debate that has happened in New Orleans. There, available federal tax dollars, political pressure, and carrying out ideological imperatives combined to prompt Democrat Mayor Mitch Landrieu to open an unneeded hospital in New Orleans East, which now loses $4 million a year, eaten by New Orleanians.
Don’t put it past Edwards and Gee to want to export this model to state taxpayers just because part of his electoral coalition demands it. They want it not just for the marginal additional health care services it could provide compared to what exists citywide but also as they envision it as an economic development engine. Of course, they never will admit that true economic development comes from reducing the size of government and its appetite for the people’s money while making less harmful the redistribution of wealth that saps initiative, thus enhancing the investment environment that will produce growth in that struggling part of Baton Rouge.
That Edwards implemented Medicaid expansion will make the situation only worse. States that have done so have found higher levels of ER usage because new clients understand going forward they pay nothing for even the slightest malady and the new demand influx on primary care providers overloads the system, thus sending patients to ERs. Losses will continue to grow.
Yet by Gee’s rhetoric it appears that Edwards will have an ER in north Baton Rouge, regardless of how bad the deal for the state. It seems just a matter of working out the right price with which to gouge taxpayers. But legislators would have to fund it, and if and when this comes up they need to reject it unless there exists truly unmet and substantial emergency medicine needs in Baton Rouge.
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