Louisiana’s 2017-18 budget is currently balanced. But Republican state lawmakers don’t believe the state’s revenue projections will hold up, and have asked Commissioner of Administration Jay Dardenne to provide a list of $60 million in potential mid-year cuts. In the administration’s proposal, safety-net hospitals and public colleges would be chopped, while the opening of a new juvenile prison in Avoyelles Parish would be postponed for a second year. Melinda Deslatte at the Associated Press has the story.

When revenues come up short of the income forecast, agencies must slash spending, a situation that has repeatedly occurred over the past nine years. Some Republicans believe that will happen again, but the governor and a majority of lawmakers refused to reduce spending in anticipation of that possibility. Dardenne stressed the cuts aren’t currently being made and the state won’t know until later in the year if any reductions are required. Barry Dusse, director of the governor’s Office of Planning and Budget, sent a follow-up letter to lawmakers Monday stressing the point. “The plan is subject to change from one month to the next. It will not be finalized unless and until a deficit occurs,” Dusse wrote.

Kids squeezed by cuts

The Advocate’s editorial board weighed in on a recent report from the Legislative Auditor that showed kids in Louisiana’s foster care system weren’t getting the care needed during Gov. Bobby Jindal’s administration. The board reminds readers that tax and budget policies have a real impact on Louisianans – in this case, on some of the most vulnerable children in our state.

As budgets elsewhere shrunk to fuel the Jindal priority of “smaller government,” even smaller children removed from abusive or neglectful homes were not properly supervised, according to a new audit of the performance of the state’s Department of Children and Family Services. … We know how state spending was squeezed by Jindal’s budget policies, and we know the dollar value of the costs of the tax breaks funded. What we cannot know, but common sense suggests, is that those policies have come with a high cost on the streets of Louisiana for vulnerable children, and for our state’s commitment to a more productive society in the long term.

Preparing for prison reform

Secretary of the Department of Public Safety and Corrections, Jimmy LeBlanc, is making Gov. John Bel Edwards’ prison reform a reality. A grant for employee overtime pay is covering staff as they review 16,000 inmate sentences. Retroactive changes for low-level, nonviolent offenders, goes into effect November, 1. Nearly 45 percent of the state’s prisoners have a chance to have their sentences shortened to reduce Louisiana’s highest-in-the-country incarceration rates. Nola.com/The Times-Picayune’s Julia O’Donoghue has the details:

In the end, LeBlanc estimates about 1,500 to 2,000 of that cohort will actually get out in the weeks following Nov. 1. Others will probably have to wait. Some inmates may not have completed all the rehabilitation work required to get out at an earlier date. The bulk of Louisiana’s states inmates are actually not housed in state prisons at all. About 55 percent of them — 19,500 inmates — are kept in local parish jails by sheriffs that get paid by the prison system to house them. It’s not clear how many inmates who will get earlier releases — including those who will leave in November — will come from local jails or state prisons at this point. However, local jails tend to house lower-level offenders that are less of a public safety risk. Those in state prisons are more likely to be serving longer prison sentences for violent offenses, most of which weren’t changed recently.

Many ways to universal coverage

The thus-far failed attempts to dismantle the Affordable Care Act has renewed conversations about whether America should adopt a “European-style” health-care system – an idea that remains anathema to virtually all Republicans. But while U.S. conservatives typically equate European medicine with socialized, single-payer systems, The Economist explains that European countries differ greatly in how they achieve universal health coverage. The biggest difference between the European and U.S. systems is consistency. While the United States employs a mix of “socialized” (Medicare, Medicaid) approaches with private coverage, European countries usually employ a single national strategy. Either way, universal coverage doesn’t have to mean “government-run:”

Finally, in the Netherlands and Switzerland, health insurance is handled almost entirely by private insurance companies, and doctors and hospitals are generally private. Coverage is universal because citizens are legally obliged to buy it, which ensures that healthy people stay in the system, holding insurers’ costs down. The government keeps premiums affordable by pumping in generous subsidies, and bars insurers from rejecting those with pre-existing conditions. It also regulates providers in order to control expenses. If this last variant sounds familiar to Americans, that is because it is essentially the same as Obamacare. One salient difference is that because the Netherlands and Switzerland provide more subsidies, premiums are much lower. They also enforce the mandate more strictly. As a result, they manage to insure over 99% of their citizens, whereas America insures only about 90%.

Moving from mandatory to voluntary payment reform

This week, the Trump administration proposed rollbacks of a major payment reform initiative of President Barack Obama’s administration called “bundled payments” that was expected to ramp up in 2018. With bundled payments, hospitals and doctors are paid fixed amounts for certain surgeries and procedures with the goal of reducing costs in Medicare and improving coordination of care for patients. Under the new proposal, some bundled payment models would be scaled back, and others would be cancelled, but the shift toward more value-based care will continue to move forward. Vox’s Sarah Kliff explains:

Experts say that the Trump administration is not backing off from value-based payments entirely; that train has, in some ways, already left the station. The ACO program, for example, continues to grow. A bipartisan Medicare reform law passed in 2015 called MACRA (Medicare Access and CHIP Reauthorization Act) built on these programs.  “MACRA is rocket fuel for this transition, and we’re seeing more adoption of ACOs,” says Roades. “We’re still seeing big interest from providers.” In other words: The Trump administration is not turning the ship around on changing the way Medicare pays for health care. But the ship is moving a little bit slower now, and depending more on doctors volunteering to make these changes themselves — rather than the government requiring it.

Number of the Day

$54 million- Amount the state saved by refinancing $377 million in Gasoline and Fuels Tax Revenue Bond debt, which can be used for highway and bridge projects. (Source: The Advocate)