Political Horizons for Nov. 4, 2012

Health care and politics

Mark Ballard.
Mark Ballard.

Dr. Fred Cerise says the layoffs and cuts in service at LSU hospitals are unnecessary and could have been easily avoided if the state’s leaders were more concerned about Louisiana’s welfare than national politics.

“If the state wanted to do it and, if the state was interested in preserving access through the public hospital system, there is a vehicle to get there,” said Cerise. The former head of LSU Hospitals was reassigned in August after not playing well with the Jindal administration and Jindal-chosen members of the LSU Board of Supervisors.

Because of a provision initially pushed by U.S. House Republicans during the negotiation of legislation to fund the nation’s transportation projects, Congress included an amendment that reduced the amount the federal government would pay towards the state’s Medicaid bill.

To cover the reduction in revenue, Cerise was ordered by interim LSU President William Jenkins to come up with four scenarios that sliced and diced spending on the charity hospitals in a way that would lower costs, but keep the facilities operational.

In August, Cerise was replaced by Dr. Frank Opelka, who went on to recommend deeper cuts and ordered hospital officials to explore ways to transfer medical care and education to private hospitals. “As soon as they got me out of the picture, they went aggressive with cuts,” Cerise said.

In an Oct. 4 press release, the LSU system said the Opelka plan “protects and strengthens Louisiana’s graduate medical education,” which has “struggled in the constraints of an arcane public hospital model of care.”

Cerise said in an interview last week that his best recommendation — the fifth option — would have saved the public hospitals from the pain of layoffs and cuts in service that presently are being imposed. But that fifth option would have required Gov. Bobby Jindal to accept a part of President Barack Obama’s signature health care overhaul, which the governor steadfastly criticizes.

In very general terms, Cerise says LSU could have used one-time money this fiscal year to stave off cuts until next year. At that point, the federal monies could kick in.

About half of LSU’s patient population is uninsured, Cerise said, meaning that they are covered under a program in which the federal government pays roughly 60 percent of the costs incurred by those who can’t pay their bills.

The Affordable Care Act, called “Obamacare” by many, has a provision to expand Medicaid, the health insurance plan for the poor that is jointly funded by state and federal governments. The expansion would open Medicaid rolls to some people who earn too much to qualify for government coverage, but too little to buy their own insurance on the private market.

Under the “Medicaid expansion” provisions, the federal government would pick up 100 percent of the costs for three years, then slowly drop its participation over the next three years down to 90 percent thereafter.

Louisiana could provide health insurance for several hundred-thousand people by shifting them from a program that requires the state’s taxpayers to pony up 40 percent of the costs into a program that, at its most — after 2020 — would cost the state 10 percent, Cerise said.

But Jindal was one of a handful of Republican governors who criticized Medicaid expansion as too expensive for the states.

Cerise pointed to a sheaf of studies that says otherwise, including calculations by the Congressional Budget Office, the Urban Institute, and the Center on Budget and Policy.

The Center for Health Policy at the University of Nebraska Medical Center published a report in August that found that state government would have to pay more than $1 billion for uncompensated care if it refused to join the Medicaid expansion. “The spending by the federal government on Medicaid expansion would generate at least $700 million in new economic activity every year in Nebraska, which could finance over 10,000 jobs each year through 2020,” the report states.

Mitt Romney, the Republican candidate, says he would do away with most of Obamacare, if elected president Tuesday. As Jindal no doubt repeated as he campaigned for Romney this weekend in New Hampshire, Iowa and Wisconsin: “Elections matter. This one matters a lot.”

Mark Ballard is editor of the Capitol news bureau. His email address is mballard@theadvocate.com.