Health care cuts: “It’s going to be ugly”

The $750 million gap in next year’s state budget means there might only be enough money to fund two of the nine private “partnership” hospitals that receive special financing deals from the state to treat indigent patients. Gov. John Bel Edwards told a gathering of healthcare advocates on Tuesday morning that the budget budget will prioritize funding for the partnership hospitals in New Orleans and Shreveport, where LSU’s medical schools are located. Nola.com/The Times-Picayune’s Kevin Litten has the story:

Most of the other seven (hospitals) are in rural areas, but there are others in major urban centers — Our Lady of the Lake in Baton Rouge and Lafayette General are both safety net hospitals. Officials with those hospitals, as well as others in Alexandria, Bogalusa and Lake Charles, all testified during the special session about how funding cuts could devastate their partnerships with the state. Ending those contracts would mean layoffs of health care workers, CEOs of the hospitals testified, and driving the poor and uninsured into emergency rooms for care they’d otherwise receive in primary care clinics. It wasn’t immediately clear how the funding cuts would affect the health care workforce. But as DHH officials testified during a House Appropriations meeting Tuesday, the safety net hospital program is the largest single “optional” program the state funds under the Medicaid umbrella. There is also broad agreement that contracts with those hospitals have improved care: There is no more rationed care or long wait lists for services, and more residents are being treated in primary care clinics run by safety net hospitals than when the state ran much of its care out of emergency rooms.

Edwards also said he will work to open an emergency room in north Baton Rouge, where residents have lost access to services in recent years as a result of hospital and ER closures. As The Advocate’s Elizabeth Crisp reports, Edwards said the money coming to Louisiana as a result of Medicaid expansion could make an ER more economically viable in underserved areas. But testimony on Tuesday from the state Department of Health and Hospitals also emphasized the need for a broader restructuring of Louisiana’s health care system:

Almost $780 million — 38 percent of which is state  funding — was budgeted last year to compensate hospitals caring for people who can’t pay their medical bills. And there has been mounting concern that designating those hospitals to receive that funding is unfair to others who are required to treat the uninsured in their emergency rooms without the same reimbursement. “With expansion occurring July 1, that’s a trigger point for all of these public-private partnerships,” [DHH Undersecretary Jeff] Reynolds said. “When those deals were agreed to and negotiated, expansion was not on the table. So it is a case where, from my perspective, Jeff Reynolds, this is an opportunity to negotiate all of those deals.”

Medicaid expansion means happier, healthier patients

A new issue brief from the U.S. Department of Health and Human Services showcases another benefit of expanding Medicaid: improved access to treatment for mental health and substance abuse disorders. Expansion, the researchers explain, will not only provide more treatment for patients with behavioral and mental health disorders, but will also benefit state budgets by freeing up more state general fund dollars (previously used for caring for the uninsured) for other needs, making states better able to weather hard economic times:

While 16.4% of individuals 18-64 that were insured in non-expansion states received treatment for mental illness or a substance use disorder, among the uninsured in this age category, only 11.5% received treatment. This is despite the fact that the uninsured had higher rates of substance use disorder and mental illness. Lack of affordability was the most prevalent reason that individuals who are uninsured cited for not accessing treatment among those that thought they needed treatment in the last year and did not get it. … Adjusting for differences in state programs, researchers found that among low income individuals with a serious mental illness, the likelihood of mental health treatment was 30% greater for individuals enrolled in Medicaid … States that choose to expand Medicaid may achieve significant improvement in their behavioral health programs without incurring new costs. State funds that currently provide direct support for behavioral health treatment of people that are uninsured would become available to meet other needs, including those in the behavioral health area if states were to expand Medicaid and cover this segment of the uninsured population

Low wages, high rent squeeze low-income tenants

The lack of affordable housing for low-income residents in U.S. cities has made the threat of eviction an everyday reality for many low-wage workers. A new NPR story details how the stagnant wages of American workers fail to keep up with the cost of housing, pushing many working families into homelessness and even deeper poverty. NPR’s Pam Fessler has the details:

One in four low-income families pays more than 70 percent of its income on rent, leaving little money for other bills and almost no room for an unexpected expense. According to the Harvard Research Center’s State of the Nation’s Housing report in 2015, rising rents and stagnating wages nationwide have contributed to a record number of cost-burdened renters — a situation that is worsened by the shortage of affordable housing for low-income tenants. … “It really drives people deeper into a state of hardship,” says Matthew Desmond, a Harvard sociologist who spent more than a year following low-income renters and landlords in Milwaukee that he details in his new book, Evicted. Desmond says evictions are not just a result of poverty but a cause. It makes lives more unstable. People don’t just lose their homes in evictions, he says. “But you often lose your neighborhood and your school. Children often have to switch schools and miss long stretches,” he says.

Mandatory minimums move through Legislature

After hearing moving testimony from Lafayette senator Page Cortez and a family who lost their son to gun violence, a Senate Judiciary committee voted this week to pass a measure to the full Senate floor that would remove some judges’ discretion in certain criminal cases involving firearms. Mandatory minimums have become less popular in public opinion in recent years. But Julia O’Donoghue of Nola.com/The Times-Picayune reports that lawmakers believe some criminals should be subject to harsher rules and more jail time:

Under the bill, people convicted of certain types of sexual battery, burglary, carjacking, armed robbery, kidnapping, manslaughter and rape with a firearm would automatically face a minimum of a 10-year sentence. If the firearm was discharged during any of these incidents, the sentences for these crimes would automatically increase to a minimum of a 20 years. … Lawmakers who have typically supported reducing the prison population and dialing back mandatory minimums nevertheless supported this legislation when it came before the Senate judiciary committee Monday. “I’m generally not in favor of anything that is a mandatory minimum, but homicide is different,” said Sen. Dan Claitor, R-Baton Rouge, the head of the Judiciary C Committee that oversaw the legislation.

Number of the Day

29.5 – Percent of Louisiana’s uninsured population making less than 138 percent of the federal poverty line that reported having any mental health illness or substance abuse disorder from 2010-2014. This population will be able to receive behavioral health coverage through Medicaid beginning July 1, 2016. (Source: U.S. Department Health and Human Services)