Healthcare showdown

Posted on June 26, 2017

With nary a week of deliberation, the U.S. Senate continues to plow forward toward a likely Thursday vote on a “healthcare” bill that would upend one-sixth of the country’s economy, wreak havoc on health-care providers, take away coverage from millions of Americans and raise insurance premiums and co-pays for millions of others. Noam Levey of the Los Angeles Times has an excellent overview:

“These reductions are going to wreak havoc,” warned Tom Priselac, chief executive of Cedars Sinai Health System in Los Angeles, one of the country’s leading medical centers. “It will be a tragic step backward not just for the people most affected, but for the country as a whole.” … The cascading effects of such a retrenchment will reach far beyond those who lose coverage, according to doctors, hospital leaders, insurance executives, patient advocates and state officials across the country. To date, not a single leading patient group or physician organization has supported the GOP repeal bills. Governors and state legislators, facing huge reductions in federal Medicaid funding, may soon have to decide whether to reduce services, limit who can enroll in the healthcare safety net or make cuts to other state programs, such as education or transportation.

The New York Times reports that the bill appears to be losing momentum in the Senate, where Majority Leader Mitch McConnell can only afford to lose two Republican votes. Louisiana Sen. Bill Cassidy remains a holdout, while Sen. John Kennedy continues to study the proposal.

Senate leaders have been trying to lock down Republican votes by funneling money to red states, engineering a special deal for Alaska and arguing that they could insure more people at a lower cost than the House, which passed a repeal bill last month. But as more analysis of the bill reached state officials, especially in places that expanded Medicaid access under the Affordable Care Act, misgivings grew. Senator Bill Cassidy, a Louisiana Republican and doctor who is considered a critical vote, said he remained undecided. Louisiana, with its high levels of poverty, recently expanded Medicaid. “There are things in this bill which adversely affect my state, that are peculiar to my state,” Mr. Cassidy said on CBS’s “Face the Nation.”

Elsewhere in the Times, Jordan Rau reports that the bill could force states to cut back on nursing home care – a move that would hit many middle-class families that rely on such care when retirement funds run out.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage. “The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.” States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.


Health care showdown – Louisiana edition

As Louisiana’s senators grapple with the healthcare bill, they’re getting some clear advice from home-state newspapers, who worry about how it would affect families that rely on Medicaid. Writing for Times-Picayune, physician Scott Martin notes that Medicaid expansion has made a big difference for patients who previously had to wait until a medical emergency before they could get care.

I have seen how Medicaid expansion worked for Louisiana.  Very well.  The current congressional proposals are outright assaults on this success story and will send health care for hundreds of thousands in Louisiana back to the stone age.  The state’s budget will be suffocated, leading to severe cuts in crucial services, with the most vulnerable left out in the cold.  The ERs will begin to ripen yet again, inefficiency will return to the norm, the preventable will stop being prevented.  We are going to regress. Times-Picayune’s editorial board calls the bill “very bad news for Louisiana.”

Louisiana has struggled to balance its budget for most of the past decade, and health care and higher education already have taken hits. If Congress pushes billions more in costs to the state, the most likely outcome is that tens of thousands of Louisiana residents would lose health coverage. They would have to go without preventive care and most likely wind up in emergency rooms, which would put a greater financial burden on hospitals. TImes-Picayune columnist Tim Morris writes that the Senate bill is moving much too quickly through the process and urges lawmakers to take their time.

The urgency has nothing to do with making anyone healthier or better off. It is politically driven to get a GOP victory on the books for Congress and President Donald Trump before the 4th of July break and, maybe, to keep the window from closing on other priorities like tax reform and an infrastructure package. But the group that used to be called “the world’s greatest deliberative body” needs to actually deliberate on this one.

The inimitable Jim Beam agrees that “Medicaid expansion is working.”

Medicaid expansion has given millions of Americans the first real health care they have ever enjoyed in their lives. There has to be a better way than ending it now, or later.


Will the governor use his veto power?

The 2017 legislative sessions will likely be remembered for the battles between Gov. John Bel Edwards and a group of House Republicans intent on blocking his agenda. While the governor ended up getting most of what he wanted in the budget (and virtually nothing on taxes), the question now centers on whether Edwards will use his control of the state construction budget to veto projects sought by his political opponents. The Advocate’s Tyler Bridges delves into the question, and learned that a group of Democrats met privately with Edwards near session’s end to ask for more projects in their districts.

The key meeting to resolve this issue occurred early on the morning of the final day of the legislative session, in the Capitol’s first-floor office of state Rep. Walt Leger III, D-New Orleans, and the speaker pro tem. Besides Leger, two other Democratic lawmakers attended: Rep. Gene Reynolds, of Minden, who chairs the party’s House caucus, and Rep. Joe Bouie, of New Orleans, who chairs the Legislative Black Caucus. Representing the Edwards administration were Block; Jay Dardenne, who oversees state spending for the governor; and Mark Moses, who oversees the construction spending. The six men reviewed a wish list of House Democrats. After they were done, said Leger and Reynolds, the administration officials had agreed to add several projects to HB2 and move others already in the bill to a higher priority position to get funding. “We definitely got some additional projects,” Leger said. “That meeting will help us be more productive next year.”


Edwards shifts strategy on taxes

Gov. John Bel Edwards signaled his frustration with the Legislature as the second special session wrapped up, indicating that he wants House leaders to come together around a plan to solve the $1.2 billion fiscal cliff before calling them back into session. As the AP’s Melinda Deslatte reports, the idea is already getting pushback from House GOP leader Lance Harris.

“That would be like me coming out with a marketing program in my company to increase sales and it didn’t work, and so then I say, ‘Well, vendors, it didn’t work. It’s your turn to come up with a plan and I’m going to sit on the sidelines,'” Harris said. Edwards said he’ll seek to work with House and Senate leaders to build support for a tax plan that could steady Louisiana’s finances — and pass the Legislature.


Number of the Day
68 – Percentage of all jobs in Louisiana that pay below $20 an hour. (Source: United Way via Jim Beam)


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