Louisiana readies for expansion

With Medicaid expansion starting on July 1, the medical community that will serve the 375,000 newly eligible Louisianans is anxious about expected growing pains. Louisiana’s health-care delivery system for the poor was already in flux as public-private partnerships replaced the old charity hospital model. Now  hospitals and managed-care plans are grappling with how to get the newly insured to seek non-emergency care through primary care providers. Finding medical providers that are willing to accept current payment levels is another concern. Elizabeth Crisp with The Advocate has more:

On top of the public-private partnerships, the state struggles to pay other providers who cover Medicaid patients at a level that they will accept. The result: Many patients are turned away because doctors and other providers don’t accept Medicaid. Many have wondered whether adding more to the system that already has struggled to get providers on board will be helpful or hurtful. The goal is to get more people seeking treatment through primary care providers in medical offices and clinics, rather than hospitals. The Edwards administration has insisted that increased provider rates will come. “We don’t have a plan and a timetable (but) it’s as soon as possible,” Edwards said. “It’s something we’re talking about. We’re going to do it at the very first possible time. We’ll do it our first opportunity.”

Our roads are terrible

Louisiana’s interstates are some of the worst in the nation, according to a new report by TRIP, a national transportation research group. Twenty-six percent of the state’s interstate highway miles are in poor or mediocre condition, placing Louisiana as the fourth worst in the country. Louisiana saw a 43 percent increase in vehicle miles traveled from 2000 to 2014 – the largest increase in the country, and ranks in the top 10 for interstate fatalities.  Nola.com/The Times-Picayune’s Wilborn P. Nobles III reports on TRIP’s findings:.

The deterioration of the state’s expressways comes as the travel on the Interstates increase two times faster than new lane capacity being added to them, the report said. Researchers said 32 percent of Louisiana’s urban Interstates experience congestion during peak travel times. The first three months of 2016 travel on the Interstate Highway System are already five percent higher than the first three months of 2015, the report said. Researchers also wrote that last year’s vehicle miles of travel on the Interstates were four percent higher than in 2014. The U.S. Department of Transportation estimates $189 billion is the price tag for the current backlog of needed improvements to Interstates. The current investment in national transportation, however, is less than two-thirds, or 61 percent, of the amount needed to keep them in good condition.

Has “tax-cut” fever subsided?
Massive tax cuts in Louisiana and Kansas have not resulted in the job growth and economic booms promised by state leaders, which may be why leaders in other states have paused their own tax-cut dreams.  In fact, both Kansas and Louisiana have experienced consistent budget shortfalls since enacting extreme tax cuts forcing both to subsequently cut state budgets and raise taxes. However, state fiscal experts are sceptical that the subsidence in “tax-cut fever” is permanent. Writing for Governing, Alan Greenblatt:.

Slicing and even eliminating income taxes remains very much a goal among many Republican lawmakers. If this leads to shortfalls and spending cuts, that may not be entirely a bad thing, suggests Chris Edwards, an economist at the libertarian-leaning Cato Institute. “Some small-government-minded governors may want to cut revenues substantially, to force legislators to cut spending substantially,” he says. For many conservative Republicans, the current pause in tax reduction may thus be just that — a brief hiatus before conditions allow more cuts to come. “We are definitely starting to see a break in the tax-cut fever, but it’s a remarkably stubborn virus,” says Nick Johnson, vice president for state fiscal policy at the progressive Center on Budget and Policy Priorities. “We still expect 2017 to be a banner year for big tax-cut proposals.”

Basic income experiments abound
There has been a lot of talk recently about fighting poverty by guaranteeing citizens a “basic income” with no strings attached. As Dylan Matthews of Vox explains, Finland is launching an experiment to see what happens if the government gives everyone a set amount of cash each year, instead of trying to reduce poverty through various targeted programs. And now a Silicon Valley investment firm, Y Combinator, is jumping into the act.  

YC announced that it will begin with a short-term project in Oakland (Calif). “In our pilot, the income will be unconditional; we’re going to give it to participants for the duration of the study, no matter what,” the company stated. “People will be able to volunteer, work, not work, move to another country — anything. We hope basic income promotes freedom, and we want to see how people experience that freedom.” … Y Combinator — a startup incubator that counts Dropbox, Airbnb, and Reddit among its alumni — seems mostly interested in basic income as a response to technological unemployment. In the future, the reasoning goes, enough work will be automated that demand for all but the highest skilled labor will collapse, leaving a small group of programmers and capitalists with all the coconuts and most people with nothing.

Number of the day
33 – The number of states where infant care now costs more than a year’s tuition at a public 4-year university. (Source: Economic Policy Institute)