Thursday, August 28, 2014

Thursday, August 28, 2014

Rejecting coverage expansion has consequences; Legislature’s chief economist blames tax base for budget woes; A new jail not the only answer for Orleans Parish Prison problem; $391 million in disaster loans forgiven for Louisiana

Rejecting coverage expansion has consequences
Somewhat lost in Wednesday’s hullaballoo over the closing of an emergency room in the heart of Baton Rouge – abruptly reversed hours later when Gov. Bobby Jindal’s administration “found” $18 million to keep it open – are the policy decisions that led up to this unfortunate bit of brinksmanship. This was a crisis that was entirely of the administration’s making.

First up was the decision to close Earl K. Long Medical Center, which served a largely poor and uninsured population from its location on Airline Highway for generations until closing last year. While the taxpayer dollars that supported EKL were transferred to Our Lady of the Lake Regional Medical Center, the patients who relied on that safety net care did not follow suit. “The Lake,” as it’s known around Baton Rouge, sits a considerable distance from most of the low-income neighborhoods served by EKL. So if you happen to live in one of those neighborhoods and have a medical emergency, you are probably more likely to go to Baton Rouge General Medical Center in Mid-City, which is considerably closer.

That’s exactly what happened at the General, which saw a 30 percent uptick in uninsured patients, and a 60 percent increase in psychiatric consults. Those are exactly the type of patients who once sought care at Earl K. Long.

But anyone who romanticizes “the Earl” probably didn’t set foot in that facility during its final few years. The hospital was in terrible physical condition, the result of decades of neglect and failure by the Legislature to make capital improvements. Baton Rouge General, meanwhile, was the only area hospital rated a “top performer” by a national commission. So the movement of patients and services from Airline Highway to Mid-City was a good thing from the patients’ perspective. If only there was a way to make sure the hospital gets paid for that care, instead of losing an estimated $20 million a year.

Of course, there is a way for the General – and every other hospital that treats the uninsured – to get paid. Had the administration moved forward with Medicaid expansion, many – if not most – of these uninsured patients would have been covered by private insurance. That means the hospital and its doctors would have been paid for their services. But the Legislature, at the administration’s urging, rejected this coverage expansion. And the consequences of that decision are now being felt.


Legislature’s chief economist blames tax base for budget woes
Chief economist Greg Albrecht of Legislative Fiscal Office visited the Baton Rouge Rotary Club Wednesday, where he blamed the state’s continuous budget woes on a tax base that has been badly eroded since 2005, due largely to the repeal of the Stelly Plan. The plan – which was approved by a vote of the people – raised income taxes and repealed the sales tax on groceries, pharmaceuticals, and residential utilities.

“We are facing the third year of essentially zero sales tax growth,” Albrecht said, and the revenues needed to fill the yawning $1.2 billion predicted shortfall in the state budget this coming year will require another round of raiding “ad hoc” funds from sources that are not sustainable and were never intended to be in the general fund. “I get asked all the time, ‘Why can’t we live with the budget we had in 2005?’ My answer is simple: We can. Just give me the tax base we had in 2005.”


A new jail not the only answer for Orleans Parish Prison problem
The Lens reports that public defenders in New Orleans complain of long wait times to see their clients, a lack of privacy when they do, and poor conditions in general at the Orleans Parish Prison. But, Orleans Chief Public Defender Derwyn Bunton and law professor Norman Lefstein see another issue at play.

“The jail issues compound what Lefstein describes as ‘the nation’s most bizarre funding system,’ which leads to inconsistent budgets and understaffing. ‘Louisiana has the only user-paid criminal justice system in the nation,’ Bunton said. ‘Statewide, we rely on fines and fees for two-thirds of our budget.’ As a result, Bunton said, ‘We need criminals. And we need them to lose. Because they only pay if they’re guilty.’


$391 million in disaster loans forgiven for Louisiana
More than 95 percent of “disaster loans” provided to Louisiana communities in the wake of Hurricane Katrina – worth $391 million – have been forgiven by the federal government, reports. This represents a hard-fought victory for Louisiana Mississippi. When Congress authorized raising the cap on disaster loans to communities, it also inserted a provision that would bar loan forgiveness. In 2007 and 2013, legislation backed by the entire Louisiana and Mississippi delegations allowed the loans to be written off.

Number of the Day
– Percentage increase in psychiatric consults for uninsured patients at Baton Rouge General Medical Center since the 2013 closure of Earl K. Long Medical Center. (Source: The Advocate)