The Advocate’s editorial page hails Congress’ six-year reauthorization of the Children’s Health Insurance Program (CHIP), which had expired at the end of September and hung in the balance for months while GOP leaders focused on higher priorities such as cutting taxes on corporations. The renewal means more than 120,000 Louisiana children don’t face the loss of health benefits in the weeks ahead, and shows that some government programs still have broad bipartisan support.

Perhaps it was politically more saleable than traditional Medicaid, as the U.S. government provides a generous reimbursement for state spending, and even middle-class families can benefit: Families of four can make up to just over $53,000 a year and still qualify for free care for children up to 19. If that family makes up to just under $63,000, it can get coverage for a nominal premium. In a national landscape where too much is short-term and transitory, the durable political consensus for LaChip and its counterpart programs in other states has seemed something of an anomaly.

But the Nola.com/The Times-Picayune editorial board notes that the budget deal did not include new funding for federally qualified community health centers, which have blossomed in New Orleans in the years since Hurricane Katrina and serve more than 57,000 patients in that city.

For Louisiana, $62 million is at risk. “Without funding reauthorization, Community Health Center CEOs across Louisiana may have to consider staff reductions, cutting service hours, and canceling a number of planned expansions and capital improvement projects,” a spokesman for the primary care association said. Already, clinics are finding it difficult to recruit staff because of the uncertainty. … The expectation is that Congress eventually will vote to continue the program. Like the Children’s Health Insurance Program, community health centers have broad bipartisan support. They are seen as an effective and efficient way to provide care, and they lower overall health care costs.

Edwards explains work requirements

Gov. John Bel Edwards’ administration has not revealed any details of its plan to require some Medicaid recipients to get jobs as a condition of maintaining health coverage. The specifics are being worked out with the help of the outside consultants who helped develop a work requirement in Kentucky that was recently approved. But while health care advocates in Louisiana were surprised by Edwards’ turnaround on the issue, the governor told Nola.com/The Times-Picayune reporter Julia O’Donoghue that it has been in the works for months:

“We’ve been, for quite some time, moving in that direction,” Edwards said in an interview Friday. “It’s not anything we’ve just been thinking about over the past couple of weeks.” … The governor said the number of Medicaid recipients that any new work requirements would apply to in Louisiana will likely be a much smaller pool than people realize. The governor said about 75 percent of the able-bodied people in Medicaid, who primarily got insurance through Medicaid expansion, have jobs or would otherwise meet a work requirement already. … But those able-bodied Medicaid recipients who don’t have jobs — and aren’t enrolled in school or full-time caretakers — ought to be “nudged” toward getting a job, Edwards said Friday.

Edwards’ former colleagues in the Legislature, meanwhile, are planning to revive his 2016 proposal to charge co-pays for Medicaid recipients who visit a doctor, pharmacy or hospital. That plan died a quick death in the Legislature, and the chairman of the Senate’s Health and Welfare Committee explains to The Advocate’s Mark Ballard why most health care providers hate the idea.

(State Sen. Fred) Mills calls copays a “backdoor way” of reducing the rates paid to doctors, hospitals and pharmacists — an assessment with which many health care providers agree. “They’re calling it ‘copay,’ but what they’re doing is making Medicaid pay less,” said Dr. Keith DeSonier, an ears, nose and throat specialist from Lake Charles who treats Medicaid patients. Medicaid already charges less for medical services than the rates contracted by private insurers, DeSonier said. In Louisiana, the rates paid for treating Medicaid-covered patients already are so low that the federal government has warned state officials not to lower them further. A copay would allow officials to subtract the amount the Medicaid participant presumably would pay out of pocket. And if the physician couldn’t collect, then he or she would be paid even less for the service they provided.

The latest on the fiscal cliff
Multiple deadlines have come and gone, yet House leaders have still not presented a detailed plan for how they propose to solve the “fiscal cliff” – the $1 billion plunge in state revenues caused by expiring taxes that would force deep cuts to health care and education if nothing is done. But while conservatives haven’t presented a plan – aside from a new website to track government spending – there are strong hints emerging about what may and may not have the votes to pass. The Advocate’s Mark Ballard:

Still, more than 70 percent of Democrats, according to the poll and leadership, along with a good many Republicans, according to the perceptions of a dozen interviewed GOP House members, indicate agreement is possible for many of the governor’s proposals, such as making permanent the temporary reductions to credits, deductions and rebates on taxes paid to other states, corporate income tax exclusions, and the value of a few economic development incentives. Also, there seems to be support for increasing and making permanent the sales taxes paid by businesses and industries for the gas and electricity they use.

Unfortunately, lawmakers still oppose the tax changes that would the most to put Louisiana’s fiscal house in order: restoring the income-tax brackets that voters approved in 2002 as part of the Stelly Plan tax swap, and modernizing the state sales tax. Ballard:

Compressing individual income tax brackets would raise close to $300 million, but it is off the table. And few legislators are on board with charging sales taxes on currently untaxed services, such as insurance and cable television, which removes another $200 million.

As the AP’s Melinda Deslatte reports, the continued deadlock has made folks around the Capitol grumpier than usual.

A palpable sense of irritation from both sides ran throughout last week’s budget hearing, as Louisiana’s elected leaders seem unable — or unwilling — to negotiate an end to the constant cycles of financial uncertainty for the state. Tension and mistrust coursed through the question-and-answer exchanges, as accusations were lodged about the spreading of misinformation and the intractability of people claiming they want to stabilize Louisiana’s budget and move on to larger policy debates.

Number of the Day
42 – Percentage of state revenues that came from mineral revenues in 1981-82, the peak year for the oil industry in Louisiana. In 2016-17, mineral revenue accounted for 4.3 percent of the state tax base. (Source: Division of Administration)