Journalists’ knowledge about public policy typically is like farm land
during the Dust Bowl era – acres in coverage area but not even an inch deep. So
it comes as no surprise when a gaggle of them showed up to hear state Rep. Stephen Ortego
pitch an alternative, government-centric plan for provision of indigent and
uninsured health care to that outlined in Gov. Bobby
Jindal’s recently-submitted budget that they seemed unable to probe deeper
to uncover the practical and theoretical problems with it that make it a poor
substitute.
Ortego addressed the Baton Rouge Press Club, claiming the budget
assumptions are untenable. Jindal’s plan, already implemented with negotiations
among providers, is to contract out management of eight of the 10 state-owned
charity hospitals to nongovernment providers, who make lease payments. They
submit to the state for regular Medicaid reimbursement those people covered
under it. The state, using its own money (about a third under the current
formulaic calculation) and a federal government match (the remaining two-thirds
or so), reimburses at a set rate. But since the rate is low, in order not to
discourage providers from servicing this clientele, money up to a cap provided
by the higher Medicare rate additionally can be provided through a different
program known as the Upper Payment Limit where a similar matching strategy
occurs. The lease payments will be used as the state match. The Jindal
Administration calculates that this arrangement will save money as opposed to
the current system which shovels the UPL money directly to charity hospitals without
the benefit of a managed care approach that avoids reliance upon the open-ended
fee-for-service model.
Instead, Ortego’s idea would be to fold the ten institutions into
existing hospital service districts, which would run them independently. This
would expand their present duties of coordinating regional psychiatric care.
They may also acquire a portion of tax revenue streams, such as from the
proposed increased tobacco tax. This could be integrating into providing money
to the state, which by law must provide at least 40 percent of the match, to
get UPL funds.