Letter: Now’s the time for reform

The Louisiana Budget Project recently joined more than 100 organizations and individuals in urging Gov. Bobby Jindal to accept billions in federal health-care dollars that can be used to provide coverage to as many as 400,000 low-income Louisiana adults. Medicaid expansion will create a healthier, more-productive workforce, ensure that health-care providers get paid for their services and help create steady, well-paid jobs in the health-care industry.

Unfortunately, the administration remains opposed to this opportunity. Gov. Jindal calls Medicaid “outdated” and Health and Hospitals Secretary Bruce Greenstein claims (‘Letter urges participation”) that federal law does not provide enough ‘flexibility” or opportunity for “a reform situation” in the states.

What Greenstein is too modest to mention is that Louisiana already is in the midst of a “reform situation.” The Jindal administration last year launched the Bayou Health initiative, which transitioned Medicaid from a fee-for-service model to one where most enrollees have their health care overseen by private managed-care plans. Thanks to Bayou Health, most Medicaid recipients now sign up with one of five insurance plans that receive a set payment from the state in exchange for coordinating and improving patient care while controlling costs.

Bayou Health is just getting started, but it has great potential to improve health outcomes, while allowing the state to better manage the cost of the program. This transition to managed care took place under current Medicaid rules, which offer states ample flexibility and opportunities for reform — hardly the “outdated” program Gov. Jindal describes.

Should Louisiana accept Medicaid expansion — and the $15.8 billion in federal support over 10 years that comes with it — the state would essentially be expanding its own Bayou Health initiative.

This expansion would give uninsured Louisianans greater access to primary care services, and would result in budget savings to the state due to better care coordination, a focus on prevention and improved management of chronic diseases. Failure to take advantage of this opportunity would mean leaving this population in the fragmented, inefficient safety net that exists today.

Greenstein claims that states need more “flexibility” to redesign their Medicaid programs. But current law already gives states the flexibility to design new Medicaid benefits packages that more closely mirror a typical commercial health plan, and to impose cost-sharing requirements on enrollees based on their income. These are some of the same policies that Gov. Jindal recently advocated for in the Washington Post.

No system is perfect, and there will always be room for further reforms. But now is the time to take the first, critical step by taking advantage of a historic opportunity to improve the health of our citizens and lift Louisiana’s economy.

Steve Spires, policy analyst,

Louisiana Budget Project

Baton Rouge