Louisiana’s annual state budget is more than $29 billion when all financing sources are considered. So how hard can it be, citizens often ask, to set priorities and find a few hundred million dollars in savings during financial downturns? A lot harder than it seems, as the AP’s Melinda Deslatte explains in her weekly column. That’s because most of the money is already spoken for before the budget debate even begins.

Louisiana state government must maneuver through a labyrinth of federal regulations, state constitutional restrictions, retirement obligations, court judgments and self-inflicted complications that limit how the state can make cuts and often dictate where it must spend. A governor and lawmakers can’t simply pull down a list of programs and services Louisiana provides and determine, without constraints, what the state should and shouldn’t be doing. That nuance often gets overlooked in favor of political talking points.

Team Gleason opposes Medicaid caps

Several dozen health advocacy organizations – including the foundation started by former New Orleans Saints standout Steve Gleason – have signed a letter to congressional leaders opposing the effort to replace the current Medicaid program with federal block grants or per capita caps to states. Such an approach, the letter notes, would mean big cuts to safety-net health care services for people with disabilities, and financial calamity for states that depend on federal health care dollars.

Medicaid is already a lean program, with spending per beneficiary considerably lower than private insurance and growth in spending per beneficiary slower than private insurance (and expected to continue to grow more slowly in coming years). Therefore, the caps would increasingly force states to cut services and eligibility for everyone who relies on Medicaid. Simultaneously, numerous federal protections, in place for 30 years, and in some cases more than 50 years, could evaporate under a block grant or per capita cap, because states would likely receive federal monies with relatively few requirements. Block grants and per capita caps are nothing more than cuts to Medicaid, reducing the dollars flowing to the states, rationing access to needed care, and threatening job opportunities and growth.

Trump and HBCUs

The president of Dillard University writes that President Donald Trump’s decision to invite leaders of America’s Historically Black Colleges and Universities (HBCUs) to an Oval Office photo-op has brought unprecedented attention to the accomplishments of these schools and their graduates. Seeking to seize the moment, Walter Kimbrough writes a guest column for Nola.com/The Times-Picayune:

We are under-resourced, yet overproduce. With the advent of Brown vs. Board of Education in 1954, black students explored a wider range of options for higher education. Incidentally, the key actors who pushed for those reforms were also HBCU graduates. At that time, more than 90 percent of black students attended HBCUs especially since Southern universities were still segregated. Today, about 9 percent of black students attend HBCUs, yet HBCUs produce about 20 percent of black undergraduate degrees. The past two years has seen a wealth of studies providing strong evidence for the HBCU value proposition. This includes research by Gallup indicating that black students who completed black colleges versus predominantly white ones have a well-being edge. The study found HBCU grads to be stronger in purpose and financial well-being, and that “Black graduates of HBCUs are more likely than black graduates of other colleges to strongly agree they had the support and experiential learning opportunities in college” which lead to well-being.

Obamacare sticking points

It’s a big week for health policy in Washington, as congressional Republicans are expected to unveil their proposal for repealing the federal Affordable Care Act. So far, debate on the bill has taken place behind closed doors, and it’s far from clear whether Republicans have consensus on what should replace the landmark law that has resulted in more than 20 million Americans gaining health coverage. Margot Sanger-Katz, writing for the New York Times’ Upshot blog, has a rundown of the potential last-minute sticking points. Chief among them: What to do about Medicaid?

House leaders would like to restructure the program to drastically slow its long-term costs. They want to cut back the amount the federal government pays states that cover poor adults without disabilities, and they want to change the overall structure so that it awards states a flat fee each year for people who sign up, instead of the current system in which the federal government pays a share of every Medicaid patient’s bills. The budget hawks in the Republican caucus don’t like this plan because it essentially leaves much of Obamacare’s costly Medicaid expansion in place. But more moderate Republicans, especially those who come from states that expanded their program under the health law, dislike the proposal because it would cut back funds to their states.

Number of the Day

7.8 – Percentage of Louisiana public high school students who scored 3 or higher on an Advanced Placement exam. That’s up from 2.5 percent in 2006 but still far below the national average of 22 percent. (Source: The Advocate)