Monday, November 16, 2015

Monday, November 16, 2015

Waiting for a choice; Unlocking ‘dedications’ doesn’t save money; High deductibles are hurdle to care; and Love that chicken from Popeyes


Waiting for a choice
Fair play and the freedom to choose are core American values. Unfortunately, when it comes to long-term care for seniors and people with disabilities in Louisiana, the playing field is anything but fair. Nursing homes get unlimited funding – and even get paid by the state for empty beds – while funding for home and community-based care is capped. As a result, tens of thousands of families are being robbed of their freedom to choose the care that is best for their loved ones. In a letter to The Advocate, Warren Hebert explains what that means for families, and how reform could help:


Our 24-year-old daughter has Down syndrome and receives assistance of Direct Service Workers, or DSWs, through Louisiana’s New Opportunities Waiver. After 10 years on a waiting list, DSWs help make it possible for Brooke to live at home, hold a part-time job and be active in our community. DSW support frees my wife and me to work. This state program works well for us. But a 2014 state report indicated 54,000 disabled or aged Louisianans occupy waiting lists for home- and community-based services…and their families struggle to work, provide care, pay for medications and attend medical appointments. While they fight to avoid institutionalization, Louisiana’s Legislative Auditor indicates Louisiana pays over $15 million a year for empty nursing home beds.


The 54,000 had hope in a recent two-year planning project to bring Medicaid Long Term Supports and Services (MLTSS) to Louisiana. Such programs haven’t been perfect, but MLTSS saves money and enhances care in many states. MLTSS can rebalance care between institutions and people’s homes, and can shrink or eliminate the 54,000 person waiting lists. Planning efforts for MLTSS involved diligent work, tens of thousands of hours and millions of dollars spent by staff at the Department of Health and Hospitals, the Office of Aging and Adult Services and the Office of Citizens with Developmental Disabilities. Managed care companies invested thousands of hours and spent millions of dollars preparing to respond to the Requests for Proposals. Suddenly, overnight, MLTSS program plans were scrapped by the Jindal administration. So the 54,000, and their family caregivers, continue to wait on a list that grows longer each day. They grow ever closer to having to choose institutionalization.


Left unsaid in Mr. Hebert’s letter is that Louisiana’s nursing home operators expend significant political capital–and campaign contributions–to maintain this unequal system. It might just be a coincidence, but Gov. Jindal–a proponent of managed care for the past two decades–scrapped his plans for managed long-term care soon after the industry made $357,000 in contributions to his presidential PAC on a single day last April.


Unlocking ‘dedications’ doesn’t save money

The two major candidates for governor have mostly been coy about how they would address the yawning gap between the cost of maintaining basic state services and the revenue available to pay for them. Both John Bel Edwards and David Vitter have proposed “unlocking” up to $2 billion in dedicated spending so that cuts can be allocated more evenly across programs. But as The Advocate’s editorial board points out, that’s much easier said than done:


What is the go-to answer of the candidates? Loosen the locks on existing funds in the budget. Both candidates are old hands at the legislative process, and they understand that it’s not that easy….For those who’d like to see better priorities for state spending, as we do, we also have to recognize that just removing a dedication clause doesn’t mean that the money is free to be spent on highways or education or other purposes…


In the short term, Vitter and Edwards rightly point to the tax credits and exemptions that have drained the general fund, and require close examination during a time of budget scarcity. And the same is true of the statutory dedications. Edwards is right that “undedicating” is only the first step. “We can’t pretend that there is $2 billion in savings” to be found, he said. That’s because legislators and governors have set up the dedications for specific purposes. A homely parallel is cleaning out the garage. Unlocking the door is just one step and doesn’t take a thing out. Same with the political heavy lifting, going into the budget and actually telling constituents of institutions and programs, including businesses and many local governments, that their funding autopilot is now being kicked to the curb.


High deductibles are hurdle to care
The Affordable Care Act was designed to expand Americans’ access to health insurance, and on that count it is working. Millions gained insurance in 2014, many for the first time. But those who chose a high deductible plan are discovering that a low monthly premium comes with a cost, reports Robert Pear with the New York Times:


But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage. “The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”…Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game…


Health officials and insurance counselors cite several mitigating factors. All plans must cover preventive services like mammograms and colonoscopies without a deductible or co-payment. Some plans may help pay for some items, like generic drugs or visits to a primary care doctor, before patients have met the deductible. Under the Affordable Care Act, health plans must have an overall limit on out-of-pocket costs, to protect people with serious illness against financial ruin…Sara Rosenbaum, a professor of health law and policy at George Washington University who supports the health law, said the rising deductibles were part of a trend that she described as the “degradation of health insurance.”


Love that chicken from Popeyes
As many states have raised their minimum wage above the federal minimum–and as major chains like Wal-Mart and McDonald’s do the same–CNN Money caught up with Popeyes’ CEO Cheryl Bacheldor to get her take. While she isn’t in favor of an abrupt jump to $15 an hour, as some advocates have called for, when it comes to raising wages her attitude boils down to a shoulder shrug:


“Everybody in retail is dealing with an increase in minimum wage,” said Cheryl Bachelder, CEO of Popeyes Louisiana Kitchen (PLKI). “We will adjust to increased costs just like we have before. Life will go on. There’s been too much hubbub about it.”…to Bachelder, rising wage costs are no different than other increased expenses that are out of her control, such as the cost of chicken wings and other food commodities. “We are used to making adjustments over time. Going to $15 an hour overnight is not plausible,” she said, but added that many companies should be able to deal with wages around $10 without a problem. So far, it looks like Popeyes is doing just that. The company reported an 8% increase in profits for the third quarter on Wednesday — despite a 16% increase in costs related to employees…


Number of the Day


54,000 – Number of Louisiana seniors and people with disabilities on waiting lists for home- and community-based care (Source: The Advocate)