Putting the brakes on managed care

Putting the brakes on managed care

The Medicaid health insurance coverage that 1.5 million low-income Louisianans rely on is imperiled after partisan maneuvering blocked the renewal of managed care contracts on Friday.

Number of the Day

8.5 - Percentage increase in the number of young adults, ages 25-34, in New Orleans, from 2010 to 2015, ranking the city 5th on a national ranking of “Millennial Magnet” cities. (Source: Urban Land Institute via Time)

The Medicaid health insurance coverage that 1.5 million low-income Louisianans rely on is imperiled after partisan maneuvering blocked the renewal of managed care contracts on Friday. The move was engineered by House Appropriations Committee Chairman Cameron Henry, who wants to see more cost-cutting, and was supported by nearly every House Republican on the joint House-Senate budget committee. While the contracts are likely to be approved in December, the incident foreshadows the central role that Medicaid will play in the 2018 budget debate, as conservatives have targeted the health program for reductions. The AP’s Melinda Deslatte has more:

“All we’re looking for here is time,” Henry said. “To say that you want to look at it a little bit longer doesn’t seem like an irresponsible thing to do.” Edwards administration officials said they don’t know what House members want to see changed in the contracts. Jen Steele, Louisiana’s Medicaid director, said the only way to cut contract costs is to change services, which she said happens outside the contracting process. Health department officials said refusal to extend the contracts would damage care for Medicaid patients, forcing Louisiana to return to a previous model of care they said would cost the state more money and offer fewer services. “I think we have to plan for the worst,” Steele said.

 

CHIP imperiled by deadlock

Funding for the Children’s Health Insurance Program (CHIP) expired Oct. 1, although Louisiana and other states have enough money on hand to keep children covered through February. The U.S. House of Representatives voted last week to extend the program for five years. But they took the money to pay for it from a program that funds preventive care, which is likely to be a non-starter in the Senate. The Advocate’s Bryn Stole reports from Washington on the effects on Louisiana:

(T)he deadlock has state officials, including those at the Louisiana Department of Health, drafting up notices for enrolled families about possible coverage losses. Andrew Tuozzolo, chief of staff at the state Department of Health, said about 6,300 children covered by the program in the state would be at risk of losing coverage altogether when the state’s federal CHIP funds run out in February. Others covered by the program likely would continue to receive coverage without a reauthorization — but only by shifting millions of dollars away from other state health programs, Tuozzolo said. The state would need to pick up an additional $31 million tab for 2018 and find more than $112 million more for each year afterward, Tuozzolo said.

 

Enrollment opens with fewer navigators
The period to sign up for health coverage through the federal marketplace exchanges opened on Nov. 1, and will last just 45 days – half as long as previous years – under changes ordered by President Donald Trump. The administration also has cut funding by 90 percent for “navigators” who help people understand their options and connect with a plan that suits their needs. Louisiana’s Insurance Commissioner, Jim Donelon, tells The Advocate’s Elizabeth Crisp that “it’s in everybody’s interest” to sign up for coverage. But that message may not be cutting through the din:

“So many people think the ACA has been repealed,” said Brian Burton, the state director of Navigators for a Healthy Louisiana, a group tasked with providing outreach, education and free enrollment assistance to marketplace consumers under the health care law. “There’s a lot of confusion around that right now.” Those who don’t sign up for coverage face penalties of $695 per adult and $347.50 per child or 2.5 percent of household income, whichever is higher. “Folks won’t realize that they will have to pay a penalty for not having insurance until they go to file their taxes,” Burton said.

 

The problem with tax “reform”
Former U.S. Treasury Secretary Lawrence Summers, writing in the Washington Post, says the tax overhaul proposed by the House would actually serve to retard economic growth while rewarding the wealthy – the exact opposite of what its sponsors are promising. To wit:

First, what is the rationale for passing tax cuts that increase the deficit by $1.5 trillion in this decade and potentially more in the future, instead of pursuing the kind of revenue-neutral reform adopted in 1986? There is no present need for fiscal stimulus. The national debt is already on an explosive path, even without taking into account large spending needs that are almost certain to arise in areas ranging from national security to infrastructure to addressing those left behind by globalization and technology. Borrowing to pay for tax cuts is a way to defer pain, not avoid it. Ultimately, the power of compound interest makes necessary tax increases or spending cuts that are even larger than those tax reductions. But in the meantime, debt-financed tax cuts would raise the trade deficit and reduce investment, thereby cheating the future.

 

Number of the Day
8.5 – Percentage increase in the number of young adults, ages 25-34, in New Orleans, from 2010 to 2015, ranking the city 5th on a national ranking of “Millennial Magnet” cities. (Source: Urban Land Institute via Time)