Action Center: Louisiana Medicaid Expansion

[Page updated July 21, 2014, 8:05pm]

Using the ‘public-private-partnerships’ of the LSU Charity hospitals to expand La. Medicaid

My apologies for not being able to attend in person the LCHE Louisiana Medicaid Expansion Strategy Session slated for Tuesday July 22nd. It has been great to participate alongside folks promoting expanded Medicaid and the Affordable Care Act. The leadership that all of you and others have exhibited seeking this reform has been magnificent. This cause is the right thing to do. Thank you for your efforts.

While it is clear that both the Jindal administration and a solid majority of the Louisiana State Legislature will continue to reject Medicaid expansion as proposed by President Obama, like it or not, expanded Medicaid in Louisiana is available now. We as a movement however need to be honest about its existence – and to stand with those needing the benefits of Medicaid expansion by encouraging their enrollment at the nearest LSU Charity Hospital system facility.

Much as the privatization and closures of the LSU Charity system hospitals have generated much controversy, these facilities remain the only comprehensive safety net healthcare available for the medically indigent of Louisiana. To be sure, many areas of the state are woefully underserved: The closures of LSU Charity hospitals in Baton Rouge, Lake Charles and Pineville have significantly impacted access to both primary care and specialty services. Further, the residents of sixteen parishes in central Louisiana will have to plan for travel up to 100 miles from their homes to access such healthcare without incurring medical debt. As for the populations around six other formerly publicly-run LSU Charity hospitals, anecdotal data indicates that at least access by the medically indigent has remained at previous LSU Charity levels; and in some cases, patient satisfaction has increased under the respective private and / or private non-profit hospital and clinic operations.

To be sure, the Jindal administration LSU Charity Hospital system privatization scheme leaves a lot to be desired. By all independent accounts, including reports by the Legislative Fiscal Office and Public Affairs Research Council of Louisiana, the privatizations have shown no savings over previously publicly-run hospitals. The recent proclamation by Jindal officials of a savings lacks in key areas, including consideration of the costs now borne by parish sheriffs for prisoner care once provided by the Charity hospital system, profoundly unmet mental healthcare gaps Charity system hospitals were often the only provider of, coverage of actual capital costs incurred regarding the changeover of facilities, supplies and technology from public to private, and especially the mass layoffs of state civil service employees – the latter increasingly seen as a culprit in the precipitous decline in Louisiana’s main retirement and healthcare fund for state workers, under the care of the now privatized Office of Group Benefits. Also looming is the prospect that the rejection of federal financial participation in the LSU Charity Hospital system privatizations by the federal Centers for Medicaid and Medicare Services (CMS) will become permanent. While the state is officially appealing this ruling, CMS insists these privatized hospital and clinic arrangements (impacting all but the Baton Rouge area deal) are in current violation of the federal Social Security Act – and potentially could cost our state budget from a minimum of $400 million to nearly $1 billion.

This result would not automatically mean that Medicaid expansion under the ACA would be welcomed by state government. Indeed, they might also use this development to jettison what remains of our safety net, by closing altogether even privatized Charity hospitals and clinics.

What remains before us however is an opportunity to showcase the real benefits of Medicaid expansion without having to overcome state gubernatorial or legislative opposition to the Affordable Care Act. Under Louisiana law, permanent residents with incomes up to 200% of the federal poverty line for family size are automatically declared “medically indigent” and are eligible to receive “free care” at the closest LSU Charity system hospital. Of the ten Charity system hospitals and hundreds of associated clinics, six have private operators that have fully assumed responsibilities for charity care at a rate twice that of Medicaid expansion under the ACA; two others in Baton Rouge and Lake Charles continue to honor state law in this regard even with the original LSU Charity hospitals closed. Only in central Louisiana remains a gaping hole – and this is being challenged by plaintiffs in Parker et al. v. Louisiana State Senate et al., with a Louisiana State Supreme Court ruling whether the legislative closure of the Huey P. Long Medical Center was constitutional expected later this year. Even so, these residents of CENLA can register for free care under state law at the next nearest privatized LSU Charity hospital to them, as well at the sole remaining public LSU Charity hospital, Lallie Kemp Regional Medical Center in Independence.

Let us spell out the benefits of Medicaid expansion in a way those of us needing such support can understand – by directly supporting needed access NOW with a mass registration campaign to enroll all eligible at the nearest privatized LSU Charity system hospital or clinic. The movement for Medicaid expansion will gain both more grassroots adherents and a wider audience in the very home regions of state legislators seemingly reticent about supporting a direct federal expansion.

Embarking upon such a campaign would not have to depend upon the legislature being in session. Indeed, we can re-energize the broadest base of Louisiana’s Medicaid expansion supporters within our own communities. The heightened level of public education brought forth about the benefits of Medicaid expansion – as well as the peril of reliance upon a system built upon uncertain federal funding – can reframe the debate in a way state legislators across Louisiana will ultimately not be able to ignore. Governor Jindal will likely continue to remain ideologically opposed to ‘Obamacare.’ But his relevance will greatly diminish with statewide legislative and gubernatorial elections being held in 2015. Under this proposal, we have the opportunity to both widen our public support and showcase all the aspirations of Medicaid expansion under the Affordable Care Act as well as the ACA’s wider benefits for people across all incomes. Through our continued actions, we can rekindle our movement for Medicaid expansion by encouraging enrollment to what effectively remains the only expanded Medicaid available statewide in Louisiana, via the ‘public-private-partnerships’ that make up the LSU Charity Hospital system. — K. Brad Ott

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ORGANIZATIONS PREDOMINATELY FOCUSED ON LOUISIANA MEDICAID EXPANSION (Advocates for Louisiana Public Healthcare works with all):

Campaign for Healthcare for Everyone Louisiana

Louisiana Medicaid Expansion

Louisiana Center for Health Equity

Louisiana Progress Action

Louisiana Consumer Health Coalition

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Louisiana House and Senate by DHH/LSU Charity Hospital administrative regions. These links feature downloadable PDF sheets that also make the argument to simultaneously support Louisiana’s Charity Hospital public safety net and expanding Louisiana Medicaid to federal ACA standards. Thanks to Linda of Save SELH for the PDF conversions:

Map of DHH/LSU Charity Hospital administrative regions

Region 1: Jefferson, Orleans, Plaquemines and St. Bernard parishes

Region 2: Ascension, East Baton Rouge, East Feliciana, Iberville, Pointe Coupee, West Baton Rouge and West Feliciana parishes

Region 3: Assumption, Lafourche, St. Charles, St. James, St. John, St. Mary and Terrebonne parishes

Region 4: Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin and Vermillion parishes

Region 5: Allen, Beauregard, Calcasieu, Cameron and Jefferson Davis parishes

Region 6: Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon and Winn parishes

Region 7: Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River and Webster parishes

Region 8: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union and West Carroll parishes

Region 9: Livingston, St. Tammany, St. Helena, Tangipohoa and Washington parishes

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Links to additional Defend Louisiana Public Healthcare commentaries for Expanding Louisiana Medicaid (Most recent listed first):

May 27, 2013: ANALYSIS: The 2013 Louisiana Legislautre might support Medicaid expansion )but only if they can decide the fate of Louisiana’s Charity hospitals)

May 22, 2013: There is little time to lament the loss of the La. Medicaid expansion vote (we still have our Charity Hospital system to save from Jindal)

May 20, 2013: How we treat people in need is a moral issue

May 6, 2013: Contact your state legislators: Defend Louisiana Public Healthcare and Expand Medicaid

May 6, 2013: Defense of Louisiana Public Healthcare at the half way point at the Louisiana Legislative session

April 29, 2013: ENOUGH IS ENOUGH: Join us Tuesday April 30, 2013, 11:00am, Louisiana State Capitol Steps for the one rally you should make the effort to attend

April 24, 2013: Expanding Medicaid and NOAH: Will the legislature be aligned with the people or Governor Jindal?

March 5, 2013: Thwart Governor Jindal’s abandonment of Louisiana’s poor and uninsured!

March 5, 2013: Forward Louisiana Medicaid expansion tour

February 21, 2013: Louisiana Medicaid expansion efforts are EXPANDING!

September 23, 2012: The Louisiana Medicaid Misery Tour

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UPDATE on the 2014 Regular Louisiana Legislative Session coming soon

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RECAP of outcome of Medicaid expansion legislation in the 2013 Regular Session:

HB 233 during House Floor debate Tuesday May 21st  failed by a vote of 59-37.

SB 125 was involuntarily deferred by a vote of 7-3. The Louisiana Senate Committee on Finance considered the measure because of the fiscal note attached to the measure according to The Advocate, after narrowly passing out of the Senate Health and Welfare committee. Confirmed “yes” votes of Senators Mills, Murray and Tarver.

LEGISLATIVE INSTRUMENTS AND LINKS FAVORING MEDICAID EXPANSION:

Contact lists of Louisiana legislators by DHH/LSU Charity Hospital administrative regions.

2013 Regular Louisiana state legislative session instruments, authors, status (as of 5.20.2013)

Instrument Author Current Status Considered
HB110 NORTON Involuntarily deferred in House Health and Welfare Considered 4/24/13 more…
MEDICAID:  Requires that La. Medicaid eligibility standards conform to those established by the Affordable Care Act (OR DECREASE GF EX See Note)
HB233 P.SMITH House voted 59-37 against
5/21/2013 more…
MEDICAID:  Provides that eligibility standards for the La. Medicaid program shall conform to those established by the Affordable Care Act and requires reporting of program outcomes (OR DECREASE GF EX See Note)
HB449 BURRELL Pending House Health and Welfare Sched. for 4/24/13 more…
MEDICAID:  Provides for a time-limited expansion of Medicaid eligibility standards in La. to conform such standards to those provided in the Affordable Care Act until Dec. 31, 2016 (OR DECREASE GF EX See Note)
HCR4 NORTON Voluntarily deferred more…
MEDICAID:  Directs the secretary of DHH to expand eligibility standards for the La. Medicaid program to conform to those established in the Affordable Care Act (OR DECREASE GF EX See Note)
HCR8 EDWARDS Voluntarily deferred more…
HEALTH CARE:  Amends administrative rules to provide that La. Medicaid eligibility standards conform to those established in the Affordable Care Act (OR DECREASE GF EX See Note)
SB125 PETERSON Involuntarily deferred by a 7-3 vote more…
MEDICAID:  Provides for the Louisiana Health Care Independence Program and requires reporting of the program outcomes. (gov sig) (OR DECREASE GF EX See Note)

[Page up-to-date as of May 1, 2014]

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