Legislators worry hospitals will close
Anxious legislators got no assurances Thursday that LSU hospitals in their areas would not be closed as the Jindal administration deals with a big drop in federal funds for Louisiana’s health insurance program for the poor and disabled.
The state’s health chief also told a House legislative briefing that more reductions would be on the way if a hoped-for surplus does not materialize when the books on the last fiscal year close.
About half of the 105-member House attended the meeting where state Department of Health and Hospitals Secretary Bruce Greenstein and interim LSU System President Williams Jenkins were grilled over Jindal’s plan for an unexpected reduction in the federal government’s contribution, leaving a nearly $860 million hole in the $7.7 billion Medicaid budget.
Medicaid is a joint state and federal program that provides health care to 1.2 million of Louisiana’s low-income and disabled residents.
Last week, the Jindal administration announced $522.5 million in spending reductions to partially compensate for the drop in federal dollars. Jindal’s plan included yanking more than $320 million in funds to cover uninsured care from the LSU hospital system. The money represents half of the hospital systems’ disproportionate share dollars.
The rest of the balancing plan counts on a $93 million surplus from the fiscal year that ended June 30. The surplus money would then be used to attract enough additional federal dollars to close the remaining hole in the budget.
State Rep. Cameron Henry, R-Metairie, asked Greenstein to provide legislators with an advance look at where cuts would occur if there’s no surplus.
“They will fall primarily in the LSU hospital system,” Greenstein replied. Later, he added that more dollars would be taken from uninsured care.
Some legislators said Jindal and his lieutenants failed to do enough to waylay the cuts that came about because of congressional action and asked whether any attempt was being made at the national level to cushion them. Greenstein said nothing is being done and so the cuts would proceed.
Earlier threats of cuts of much less magnitude had prompted some LSU officials to warn about closure of some facilities in the LSU System’s 10 hospitals. Legislators recalled those warnings and asked about the much-larger cuts being proposed now.
Jenkins and LSU Board Vice Chairman Bobby Yarborough did not rule out hospital closures. “We are looking at all options and it depends on how successful we are on some of the options” under consideration, Yarborough said.
“We cannot close hospitals on our own. Accordingly, if we proceed, the Legislature must be there with us,” Jenkins said.
While legislative approval would be required to close a hospital, House Speaker Chuck Kleckley said “that doesn’t mean you can’t cut the funding where there’s no option but to close it.”
Kleckley said LSU’s Moss Regional in Lake Charles handles 80,000 to 100,000 out-patient visits. “The capacity is not there otherwise” in the area to handle that volume, said Kleckley, R-Lake Charles.
Jenkins said all the out-patient clinics in the LSU system are reimbursed through the hospitals. “Hospital closures excludes a large number of hospital visits. That’s an important part of this mix,” he said.
The LSU hospitals also serve to help train medical “residents” — the state’s future physicians. “It’s a moral, ethical and legal commitment to finish their training,” Jenkins said.
About 70 percent of Louisiana’s physicians are trained through the hospitals, Jenkins said.
“We have to look at new models. We have to look at partnerships with private entities to get this done,” Jenkins said.
State Rep. John Bel Edwards, D-Amite, said the uninsured-care dollars left in the LSU System is less than that provided to run LSU hospitals in New Orleans and Shreveport. “I’m trying to find out factually speaking what is the realm of possibility of leaving these hospitals open and operational and what is not possible,” Edwards said.
Greenstein said LSU still has 70 percent of its budget for funding the system, even with the $300 million-plus cut.
“There’s no way you can cut $300 million from the LSU system and you can tell me there is not going to be any care impacted,” state Rep. Patricia Smith, D-Baton Rouge, said.
Republican and Democratic legislators questioned the absence of Fred Cerise, the LSU System vice president for health care and medical education. The legislators requested his appearance at the next meeting on the subject because of his “factual knowledge” of the hospitals and the medical education situation.
Yarborough said Cerise could attend and answer questions but he said, “This is a board- and presidential-led endeavor.”
“I want to be clear that when he speaks he is not speaking with any kind of decision-making authority. That will be the board and the president of the LSU System,” Yarborough said later.