Health care crisis brewing

If you live in the heart of Louisiana’s capital city, you will soon need to learn how to decide whether a health problem requires a trip to the emergency room or whether an urgent care visit will suffice. That, at least, was the gist of the Department of Health & Hospitals’ advice to residents who will be left without access at the end of the month when Baton Rouge General shutters its Mid-City ER. Ted Griggs with the Advocate has the story:

“What happens next? That’s the big question,” (Health and Hospitals Secretary Kathy) Kliebert said Tuesday during a community meeting at Star Hill Baptist Church. Roughly 150 people were present.The short answer is a lot of education and outreach efforts. Kliebert said the state Department of Health and Hospitals will need help from everybody, including the state Department of Education and the East Baton Rouge Parish school system, to get out the word on where and how to access health care….Many patients used the ER as their source of primary care. This kind of improper ER use is an entrenched, national problem, Kliebert said, and it will take years to alter patient behavior, but the change is necessary.

The most obvious solution is to expand coverage using available federal funding, as former DHH Secretary David Hood pointed out. But Gov. Bobby Jindal’s administration has refused to expand Medicaid. Worse, they are going in the wrong direction, moving to yank primary care and mental health coverage from more than 57,000 people in the New Orleans metro area who receive care under a Medicaid waiver. This move will force some neighborhood clinics to close, which will increase the use of local emergency rooms.

But don’t expect support for charity hospitals either. As the Associated Press reports, the governor’s budget proposes freezing funding for the nine charity hospitals that the administration privatized. State support for the new teaching hospital set to open in New Orleans is particularly sparse, which could put medical education at risk. Being uninsured in Louisiana is only going to get harder.

Governor’s budget draws anger, confusion

The business lobby’s anger at Gov. Bobby Jindal’s proposed budget is already on full display, with corporate leaders calling it a “multi-million dollar tax hike on business,” according to the Associated Press. The Louisiana Association of Business and Industry, National Federation of Independent Business, and Louisiana Oil and Gas Association came out against plans to curtail the inventory tax credit.

Others are scratching their heads, with the Advocate’s editorial board questioning the governor’s seemingly ideologically-driven move to go after the inventory tax credit–which many agree is an awkward solution to a complicated problems–instead of tackling other programs like film tax credits and Enterprize Zones that the administration’s has publicly acknowledged in past are are rife with problems.

Jindal’s suggested solution to the budget quagmire is less than comprehensive, and some of its particulars appear to defy common sense. Curiously, the governor didn’t propose cutting or eliminating…an enterprise zone credit and movie tax credits..It’s a feat of contortion that asks Louisiana’s core industries to shoulder a greater local tax burden while Hollywood filmmakers and their celebrity friends live lavishly on the state’s dime. Conservative values, this is not.

On the same pages, columnist Lanny Keller suggests an appropriate response to the budget for those who care about higher education: panic.

Would that LSU’s constituencies, or those of any other state institution, could believe that the governor and lawmakers have their interests at heart. Instead, the political leadership under Jindal has jettisoned more than 20 years of economic development policy, including that of Republican Mike Foster and Democrat Kathleen Blanco, focused on nationally competitive universities. The new priorities are tax cuts mostly for businesses and the wealthy taxpayers, in what is indisputably among the lowest-taxed states in the nation.

It will take a decade, even if the governor and Legislature decided tomorrow to raise more money for higher education, to repair today’s “flagship” university and its essential peers in other systems…Panic doesn’t help anything? Maybe not, but it could be a rational response to the situation as it stands today.

Will Supreme Court revisit internet sales taxes?

Deciphering the U.S. Supreme Court is no easy task, but a concurring opinion in an otherwise unremarkable tax case may signal a bit of hope for state governments who are currently prohibited from collecting sales tax on internet purchases due to a 1992 Supreme Court case regarding mail-order catalogs–a growing problem for funding schools and roads as more and more commerce moves online. The New York Times’ Adam Liptak reports:

Anthony M. Kennedy [said] that the Supreme Court went badly astray in a 1992 decision that said states may not collect taxes from companies without some local physical presence. Justice Kennedy invited a fresh challenge to that decision, Quill Corporation v. North Dakota.

“It is unwise to delay any longer a reconsideration of the court’s holding in Quill,” Justice Kennedy wrote. “A case questionable even when decided, Quill now harms states to a degree far greater than could have been anticipated earlier…When the court decided Quill, mail-order sales in the United States totaled $180 billion,” he wrote, adding that “by 2008, e-commerce sales alone totaled $3.16 trillion per year in the United States.”

Number of the Day

57,000 – Number of people in the New Orleans metro area who would lose access to primary care and mental health services if the Jindal administration’s health care budget is approved (Source: Nola.com)