Health care services for the poor, K-12 public school education and safety-net services for abused and neglected children are among the state services that would take big hits next year in a spending plan approved by the House budget committee in a party-line vote on Monday. Lawmakers were already forced to contend with a budget that was $440 million short of what’s needed to maintain its current level of services. The House Appropriations Committee added more than $300 million in additional cuts – the vast majority of which fall on the state Department of Health.  Julia O’Donoghue with The Times-Picayune/Nola.com has the story:

(Gov. John Bel) Edwards had already proposed an across-the-board spending cut to state agencies unless the Legislature agreed to raise more revenue, but the Appropriations Committee voted reduce funding even more for some agencies. Those cuts would especially hit the Health Department ($235 million less),  Corrections Department ($11 million less), public safety services ($18.5 million), Department of Child and Family Services ($19.5 million) and the Education Department (at least $18 million).

Deepening the health spending cut was Rep. Franklin Foil, who proposed an additional reduction to the Louisiana Department of Health and shifted the funds to restore full funding for TOPS:

To fully fund TOPS, the committee voted to take $82 million from the Health Department. Edwards had maintained TOPS funding at its current year level, covering 70 percent of tuition for all recipients attending a public university, unless more revenue was raised. The Appropriations Committee budget would bump it to covering 100 percent of tuition, though it’s not clear what health services would be cut to make this happen.

The budget committee used to operate in a bipartisan fashion, but has broken down along party lines in recent years. As the AP’s Melinda Deslatte reports, the minority Democrats are not happy:

Rep. Gary Carter, a New Orleans Democrat, said [Rep. Franklin] Foil was proposing to cut health programs for  vulnerable people to pay for a college program in which 40 percent of recipients come from households earning $100,000 or more a year. “There has to be a balance,” said Rep. Patricia Smith, a Baton Rouge Democrat. “We are a poor state.”

The budget bill heads next to the full House, which will take it up on Thursday. It then goes to the Senate.

Profits over patients

In a comprehensive three-part series, The Advocate’s Rebekah Allen explores Louisiana’s questionable approach to providing long-term health care services, which is heavily biased toward institutionalization compared to other states. Many of those interviewed by Allen described a system in which the powerful nursing home lobby has used campaign donations to influence lawmakers and buy political favors. The results are policies that keep reimbursements for nursing homes high, while keeping funding for home and community-based services low, despite an overwhelming preference for the latter among patients in need of long-term care.

Most of the nation is moving toward a model that steers more elderly and disabled people into long-term care in their own homes — an option that saves the state money, and happily, is preferred by most customers. The result, in most states, is an ever-increasing number of people served by home- and community-based Medicaid providers and a decreasing reliance on nursing homes. But Louisiana is going in the other direction. Here, home- and community-based providers are barely hanging on because the state has made difficult efforts to help more people transition out of nursing homes. The list of elderly and physically disabled Louisianians waiting for home- and community-based services numbers about 32,000.

The AHCA fight wears on

One of the most popular provisions of the Affordable Care Act is (ACA) its protections for people with pre-existing conditions, so it comes as no surprise that weakening those protections in the American Health Care Act (AHCA) is rubbing some House Republicans the wrong way. Even those who have campaigned on repeal of the ACA are having second thoughts about supporting this particular version of a replacement.  David Weigel and Paige Winfield Cunningham with The Washington Post report:

In 2010, Rep. Billy Long (R-Mo.) campaigned for a safe Republican seat in Congress by pledging to fight “government-run health care.” Every two years, he won easy victories while telling voters he was “fighting to repeal Obamacare.” On Monday, Long came out against the American Health Care Act with a few kind words about the law it was designed to replace.  “I have always stated that one of the few good things about Obamacare is that people with preexisting conditions would be covered,” Long said in a statement. “The MacArthur amendment strips away any guarantee that preexisting conditions would be covered and affordable.”

Still, Vice President Mike Pence and House Speaker Paul Ryan are pushing hard to get moderates in their party to support the bill with the hopes of bringing it to a floor vote this week. In the meantime, President Donald Trump complicated the process by saying in an interview that he wanted the AHCA to include stronger protections for people with preexisting conditions. Politico’s Kyle Cheney, Rachael Bade, and Josh Dawsey:

And the task was made even harder by an unforced error from Trump. The president told Bloomberg News in an interview Monday morning that the bill might change to provide more protections to people with preexisting conditions. “It’s not in its final form right now,” he said. Trump’s comments frustrated the House whip effort, as some members interpreted them to mean the president was reopening negotiations.

Child care and economic productivity

The average costs of child care in Louisiana is $5,600 per year, making it unaffordable for many working families. This has a substantial impact on economic productivity and employment rates for parents of young children, according to a new study by the Louisiana Policy Institute for Children in partnership with LSU’s Public Policy Research Lab. Cuts to the state’s child care assistance program have only compounded the problem, leaving many families without a child care subsidy, despite being income-eligible for the program. Andrea Gallo with The Advocate has the story:

More than 16 percent of Louisiana parents asked about their child care arrangements reported quitting their jobs because of problems finding care for their young children, while 18.5 percent of parents scaled back from working full-time to part-time at one point, according a survey presented Monday that was billed as the first-of-its-kind. The state has also cut its child care assistance program by nearly 70 percent since 2008, [Melanie] Bronfin said. She wants legislators to fully fund the program with 3,000 slots and to preserve, if not expand, Louisiana School Readiness tax credits.

Number of the Day

$1 billion –  Preliminary estimate of the amount of federal funding Louisiana could lose as result of the $235 million reduction in state funding for the Department of Health. (Source: The Times Picayune/Nola.com)