Inside Report for Nov. 9, 2012

Health care changes prompt concerns

The Jindal administration’s plan to dismantle the LSU public hospital system, as people know it today, is prompting questions and a lot of concern in many quarters.

Members of the LSU Board of Supervisors, most of whom were tapped by Gov. Bobby Jindal, suddenly embarked on a plan that would transfer patient care and medical training that occurs in the hospitals to the private sector.

The stated reason: the current operations of the 10 public hospitals are unsustainable, particularly with a sudden decline in federal Medicaid funding support.

LSU’s share of the reduction is about $330 million for now, with more cuts on the horizon.

Details are few on how the goal would be accomplished even as LSU has announced plans to lay off about 1,500 employees, reduce intensive care, surgery, emergency and in-patient hospital beds, as well as eliminate some other services.

LSU and state health agencies are meeting behind closed doors to determine which private hospitals get arrangements that would use government funds to pay for patient care and medical education in the private facilities.

Legislators have squawked about the impact on Medicaid patients and uninsured constituents who rely on the public hospitals, the “safety nets” for health care in many areas. Access to care would be even more limited, they said.

Hospital executives weighed in, saying they have already seen the result of prior LSU hospital cuts in the form of increased emergency room activity, no reimbursement of care and “bad debts” climbing.

“I think everybody is concerned about the growing number of uninsured coming through their doors. Anecdotally we are hearing from our members that with reductions in services we are seeing an increase in uninsured coming into emergency rooms for services,” said Louisiana Hospital Association President John Matessino.

One thing is clear, Matessino said: LSU needs to make sure it keeps open the network of outpatient clinics it has across the state or the situation could get even worse.

Meanwhile, the state’s physician community is expressing deep concern about “the lack of detail and preparation” as LSU embarks on budget cuts that impact medical education training programs.

Dr. Andy Blalock, president of the Louisiana State Medical Society, warned that the “best and brightest” current and future medical students and physicians-in-training, or residents, would leave or not come at all amid the turmoil and uncertainty. The state’s future physician supply is at risk, he said.

Amid that uncertain health-care backdrop, looming large is 2014 when the Affordable Care Act — or “Obamacare” — kicks in.

The health-care revamp expands Medicaid coverage for low-income Americans while it reduces and redistributes disproportionate-share dollars that pay for uninsured care.

The federal government will initially pick up the cost of providing insurance to as many as 400,000 Louisiana residents. Jindal has opted Louisiana out of the Medicaid expansion.

The Louisiana Hospital Association, called LHA, hasn’t taken a formal position on the Medicaid expansion although its national counterpart supported the Affordable Care Act.

“We are in favor of getting as many people covered as we can,” said Matessino. “If we don’t expand Medicaid, it exacerbates the problem.”

Meanwhile, the Jindal administration contends it’s on the right track — being “aggressive and responsible” while doing something that is “truly transformational” for Louisiana health care. But the concerns remain.

Marsha Shuler covers health care policy for The Advocate Capitol news bureau. Her email address mshuler@theadvocate.com.