With just four days left in the special session, the Louisiana House of Representatives passed a budget that would cut $620 million from the state’s health care system. The $119 million state general fund reduction in the House budget would lead to the loss of $433 million in federal funds and $68 million from other (mostly local) funding sources.
The House budget recognizes and spends nearly $400 million in additional revenue raised by tax measures the House has approved during this special session. Even with the additional revenue, the House was unable to maintain full funding for health care because the Legislature actually needs to raise $648 million -not $400 million- to avoid having to make cuts to priority areas. There is simply no way that the House or the Senate can produce a budget that funds all of the critical priorities of the state unless they are willing to fill the full $648 million budget shortfall.
Complicating matters further, the House added language to the budget that protects certain Medicaid-funded programs and services, including home and community-based waiver services, public-private partnership hospitals and nursing homes. While these programs are vital, taking them off the table for cuts leaves Louisiana Department of Health (LDH) officials with a limited set of “optional” Medicaid programs to which they can apply the cuts.
The department’s list of cuts based on the House budget include: elimination of pediatric day health services for children with complex medical conditions, elimination of mental health services for adults, elimination drug and alcohol treatment for adults, and funding reductions for school-based health services. The House budget also assumes $175.8 million in total savings from a technical change in how the state determines Medicaid eligibility. The “savings” are based on the assumption that fewer people will qualify for Medicaid based on the change. According to experts the department, however, the assumption of how many people will lose coverage is not supported by data or evidence.
During the regular session, the House concurred with the Senate budget that fully funded the state’s health care needs, at the expense of other state priorities. Gov. John Bel Edwards vetoed that budget because it included “crippling budget cuts across state government, including irresponsible reductions to Higher Education, Children and Family Services, Veterans Affairs, Corrections, law enforcement and TOPS.”
With the budget veto, the House had to craft a new budget for the special session. But in doing so, House members returned to their old ways – placing the brunt of any budget shortfall on health care services.
The Senate could again choose to fully fund health care services. But without additional revenues, it would have to come at the expense of other priorities. If legislators truly have the best interests of the state and their constituents in mind, they will raise the additional revenue necessary to avoid painful tradeoffs between health care, higher education, public safety and other priorities.
– by Jeanie Donovan