The House-Senate budget negotiations, which must conclude by 6 p.m. Thursday, boil down to this: House leaders are insisting on $154 million in additional cuts on top of reductions agreed to by the Senate. The cuts would hit public colleges, the corrections department, hospitals and the Department of Children and Family Services. They would also prevent state workers from getting their first across-the-board pay raise since 2006.  The Advocate’s Tyler Bridges and Elizabeth Crisp have the latest House amendments.

The cuts proposed come on top of 2 percent cuts across many agencies to which the Senate agreed, after the Republican-controlled House rejected most proposals for tax increases in the coming year. The Senate had sought to spare higher education, social services, prisons and veterans affairs from the across-the-board budget slashing. “Our members won’t find it acceptable,” state Sen. Eric LaFleur, D-Ville Platte, said in an interview Tuesday night of the House’s negotiation starting point. “We still think those things are high priority items.”

The governor’s office has described the House cuts as a “non-starter,” and a failure by House leaders to give ground would likely result in a special session in June to resolve the stalemate.

Medicaid in small-town America

The Medicaid program serves people in every community in America. But it is especially important in small towns and rural areas, where health care providers are sometimes scarce and the need for health care is great. A new report from Georgetown University Center for Children and Families finds that Medicaid is more prevalent in rural areas than in urban enclaves, which is especially true for children.

Demographic factors have an impact on this relationship: rural areas tend to have lower household incomes, lower rates of workforce participation, and higher rates of disability— all factors associated with Medicaid eligibility. In addition, the role of Medicaid has increased in the past few years both in small towns and rural areas and in metropolitan areas, given the implementation of the Affordable Care Act (ACA) and more aggressive efforts to enroll children in Medicaid and the Children’s Health Insurance Program (CHIP). Research shows that Medicaid provides families with access to necessary health services. In addition to the health benefits of Medicaid, it also protects the entire family against medical debt, bankruptcy and improves economic insecurity. Because Medicaid plays such a large role in small towns and rural areas, any changes to the program are more likely to affect the children and families living in small towns and rural communities.

Meanwhile, Matt Broaddus and Edwin Park of the Center on Budget and Policy Priorities report that the GOP’s healthcare bill would effectively end the Medicaid expansion that has seen more than 420,000 Louisiana adults gain coverage since last July.

States that want to continue enrolling low-income adults in expanded Medicaid coverage after 2019 thus would have to pay 2.8 to 5 times more from their own funds for each new enrollee, relative to current law.  This higher cost would also apply to current enrollees who leave Medicaid for a month or more when their income rises but later seek to reenroll when they fall on hard times. Most adult Medicaid enrollees see their incomes fluctuate and thus use the program for relatively short spells, so the higher state costs would apply to most of a state’s expansion program within just two or three years.  Moreover, while under the ACA, states must redetermine eligibility for expansion adults annually, the AHCA would require them to do so every six months starting in October 2017, which would accelerate the declines in enrollment.

Race and the social safety net

A new study from the Urban Institute finds a sharp disparity between states in the availability of welfare benefits, with income supports generally more generous in states with higher percentages of white residents. Tracy Jan of The Washington Post reports:

A poor family in Vermont, where 94 percent of residents are white and only 1 percent are black, is 20 times as likely to receive welfare as compared with if that same family lived in Louisiana, where 61 percent are white and nearly a third of residents are black, according to a previous analysis by the Center on Budget and Policy Priorities. Vermont has the most generous welfare benefits of all 50 states, with 78 out of every 100 families in poverty receiving cash assistance. In comparison, Louisiana, the least generous state, gives welfare cash assistance to only four out of every 100 poor families. The disparity does not end there. Vermont offers a maximum monthly benefit of $640 to a family of three, and allows families earning up to $1,053 to qualify for cash assistance. Louisiana only offers a maximum cash benefit of just $240 a month, and families must make less than $360 a month to qualify. In other words, a family must be the poorest of the poor to qualify for cash assistance in Louisiana, and even then, they would only receive less than half of what Americans living in Vermont would get.

Low economic rankings persist

Another day, another study showing that Louisiana’s economy is struggling compared to other states and the rest of the country. The latest comes from WalletHub, which ranks Louisiana second from the bottom among the 50 states and the District of Columbia. The study ranked states on a broad range of economic indicators, including GDP growth, unemployment and the average educational attainment of recent immigrants. Katherine Sayre at NOLA.com/Times-Picayune has more.

Louisiana ranked only better than West Virginia in the study; the bottom five also included Mississippi, Arkansas and Oklahoma. WalletHub used data from the U.S. Census Bureau, the bureaus of Labor Statistics and Economic Analysis, United Health Foundation, American Legislative Exchange Council, CoreLogic, the U.S. Patent and Trademark Office and the National Science Foundation, among others. Louisiana did shine in one category: the state tied with Texas and Washington for most exports per capita.

One bright spot: Louisiana is tied with Texas and Washington for the most exports per capita.

Number of the Day

53– percent of rural Louisiana children who were covered by Medicaid and CHIP in 2015 (Source: Georgetown Center for Children and Families)