As rumors swirl that Bobby Jindal will be named the country’s health secretary, President-elect Donald Trump says he supports a core provision of Obamacare that prevents insurance companies from denying coverage to people with pre-existing conditions: diseases like diabetes, asthma, cancer, and many more. The problem: if this is retained but the requirement that everyone buy insurance (and the subsidies that make coverage affordable for middle class families) go away, costs will skyrocket and only the sick will purchase plans. Pre-ACA, some states experimented with solutions, with little success. Margot Sanger-Katz explains in the New York Times’ Upshot blog:

Before Obamacare, several states tried policies like this, and required insurance companies to sell insurance to everyone at the same price, regardless of health histories. The results were nearly the same everywhere: Prices went way up; enrollment went way down; and insurance companies fled the markets. Some states hobbled along with small, expensive markets. Some experienced total market collapse and repealed the policies. Prices in those markets typically became so high that they were really a good deal only for people who knew they’d use a lot of health care services. And the sicker the insurance pool got, the more the companies would charge for their health plans.

Also at risk is the provision that extends Medicaid coverage to low-income adults at favorable federal match rates, which has been a political football ever since the Supreme Court made its enactment optional. Gov. John Bel Edwards says he isn’t concerned about repeal because of the difficulty in scrapping a program that’s providing real benefits to millions of people. WGNO’s Stephanie Oswald has more:

“So it’s gonna be very difficult I think to repeal the Affordable Care Act, including the Medicaid expansion, without providing a suitable substitute,” said Edwards. “We’re going to work with the administration, obviously, because our job is to make sure we’re taking care of the people of Louisiana as best we can — that’s why we expanded Medicaid in the first place,” he continued. The governor, who signed an executive order to expand Medicaid in Louisiana on his first full day in office (January 12, 2016), says that about 350,000 people in Louisiana have health care insurance thanks to this effort, many for the first time.

 

The Trump agenda

Much prognosticating is afoot as Donald Trump prepares to assume the presidency. Columnists and policy analysts across the ideological spectrum are trying to decipher what the incoming Trump administration will prioritize, while also providing some advice. The Washington Post opinion writer Catherine Rampell believes Trump should focus on family friendly policies that have broad bipartisan support:

Poll after poll after poll after poll finds that Americans overwhelmingly favor paid parental leave. A Public Religion Research Institute survey from last fall found that 82 percent of Americans believe companies should grant full-time employees paid leave for the birth or adoption of a child. This includes 89 percent of Democrats and an astonishing 75 percent of Republicans. For comparison, another recent PRRI poll found that only 29 percent of Republicans want to “identify and deport” immigrants living in the United States illegally. Yet Trump has declared mass deportation to be among his first orders of business when he gets to the White House, while he has said nothing recently about paid family leave.

Dean Baker, co-director of the The Center for Economic and Policy Research, writes in The Huffington Post that investment in infrastructure would be a shot in the arm for the economy:

The infrastructure story is straightforward. Roads and bridges in many parts of the country are badly in need of repair. This is both an economic waste, as people needlessly get caught in traffic, and a health hazard when bad roads increase the risk of accidents. Ideally, infrastructure spending would also go to repair schools and improve water systems so that we don’t have more Flints with people drinking lead in their water. It would be great if some of this funding also went to mass transit and clean energy to reduce greenhouse gas emissions, but that might be expecting too much from a Trump administration. The infrastructure spending would also create jobs. Public construction has traditionally been a source of relatively good paying jobs for men without college degrees.

Despite the promised infrastructure investments, The Financial Times’ Martin Wolf struggles to see any positives for working class people:

Mr Trump promises a burst of infrastructure spending, regressive tax cuts, protectionism, cuts in federal spending and radical deregulation. A big rise in infrastructure spending would indeed help construction workers. But little else in these plans would help the working class. Overall, his plans might indeed generate a brief economic surge. But the longer-term consequences are likely to be grim, not least for his angry, but fooled, supporters. Next time, they might be even angrier. Where that might lead is terrifying.

And while repeal of the ACA may prove to be difficult, that’s not the only major health care policy change the Trump transition team is proposing. Jonathan Cohn and Jeffrey Young report in The Huffington Post that the president-elect is warming to House Speaker Paul Ryan’s plans, meaning Medicare and Medicaid are also on the chopping block:

What would this mean for beneficiaries? A great deal would depend on details Ryan has yet to provide, particularly when it comes to the value of that voucher ― and how quickly it would increase every year ― compared to the cost of the insurance. But the whole point of the system is to ratchet down the value of the vouchers over time. That would reduce spending on Medicare, which Ryan always says is a goal, and some seniors would likely end up saving money, because they could easily switch to cheaper plans. The question would be what happens to everybody else. Without adequate regulation of benefits and other safeguards tailored to the special needs of an older, frequently impaired population of seniors, the consequence of moving to premium support could be higher costs for individual seniors who have serious health problems ― with low-income seniors feeling it most intensely.

 

Oil and gas bankruptcies complicate audit process

The recent oil bust is a major reason for Louisiana’s recession. Coupled with shortsighted tax cuts and poor fiscal planning by previous administrations, the state faces a historic revenue crisis. However, the state should be receiving a bit more from the industry. With oil and gas bankruptcies on the rise, government auditors are getting bogged down. Mike Stagg has the story for Acadiana Business:

While programs were being cut because of revenue shortfalls, the Jindal administration was leaving oil and gas revenue on the table. New DNR (Department of Natural Resources) Secretary (Thomas) Harris says he came into office viewing OMR as a “place with some low-hanging fruit, where the performance of the department could be improved.” OMR’s (Office of Mineral Resources, David) Boulet says he is dedicated to improving the performance of his office but the need to audit bankrupt royalty payers while working short-handed complicates that task.

Tax credits improve child care

The Louisiana Policy Institute for Children has a new report out this week looking at the ways families, child care workers and their employers have benefited from a unique set of tax credits designed to help Louisiana’s youngest citizens get a good start in life. The Advocate’s Will Sentell has the details about school readiness tax credits, which have helped 14,500 low-income families access high-quality care for their infants and toddlers.

The percentage of children getting subsidies enrolled in higher quality child care centers has doubled, the report says,  and child care staff enrolled in professional development courses rose from about 1,200 to 5,800. The study was released as lawmakers and others begin grappling with how to tackle Louisiana’s latest budget crisis, including another daunting shortfall for the financial year that begins July 1. The financial mess has put tax credits under heightened scrutiny in the scramble to save dollars.

Number of the Day

82 – Percentage of Americans who believe companies should grant full-time employees paid leave for the birth or adoption of a child. (Source: Public Religion Research Institute via The Washington Post)