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Medicaid Mess

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On the same day New Orleans celebrated Saints quarterback Drew Brees' new five-year, $100 million contract, state officials released news of another mega-figure — one that demands the attention of all Louisianans: $859 million. That's the amount being slashed from the state's Medicaid program under a new federal law. In response, Gov. Bobby Jindal's administration initially ordered $523 million in cuts, mostly to health care services for Louisiana's poorest and most vulnerable citizens. Given Jindal's track record, that's no surprise. But the cuts also hit middle class and wealthier taxpayers — in the wallet.

  The reasons for the cuts are complicated, but they stem from a compromise written into the 2010 Affordable Care Act. The federal share of the joint state-federal Medicaid insurance program, which provides health care for the poor, is based on per capita incomes in each state. Louisiana's delegation successfully argued that per capita incomes here after Hurricanes Katrina and Rita were artificially inflated by relief funds. The higher federal match written into the 2010 legislation brought a windfall to Louisiana — but now Congress has lowered the federal match.

  The cutbacks come at a most inopportune time. State revenues continue to falter or even decline, and Team Jindal has decided that roughly two-thirds of the initial cuts should fall on public hospitals managed by the LSU System. Those hospitals treat most of Louisiana's Medicaid population and train new doctors — many of whom would normally stay in Louisiana and treat private patients.

  The consequences will be far-reaching, long-lasting and painful. Sadly, the governor's idea of budgetary "reform" amounts to starving key providers of critical services — such as public hospitals (and, on another front, public colleges and universities) — to force them to change and to bolster his political cred as a fiscal hawk. Never mind that citizens in his state will, quite literally, die as a result of his decisions. Jindal recently rejected the opportunity to expand Medicaid coverage under the Affordable Care Act, which is set to begin in 2014, because it fits the GOP's anti-Obama meme. Louisiana will have to cut health care for its poorest citizens like never before.

  But Jindal doesn't seem to care. He's too busy traveling the country campaigning for GOP presidential candidate Mitt Romney — and preening for the party's right wing in the hope of being tapped as Romney's running mate.

  Back in Louisiana, state Health and Hospitals Secretary Bruce Greenstein told a special legislative committee meeting last week that the massive cuts would be "a difficult time, but ... not a crisis." Really? During the recent legislative session, in response to conservative lawmakers' push to cut the state health care budget by a mere $230 million, Greenstein warned that such cuts would be detrimental to "everyone's quality of life." Greenstein's words rang so hollow last week that even some Republican lawmakers balked. "I get the politics of it, but please don't sit there and try to convince me that these are different scenarios," said Rep. John Schroder, R-Covington. "The first scenario was painless compared to what we're talking about now."

  Among the near-certain cuts: the closure of Southeast Louisiana Hospital in Mandeville. That facility is one of only three in-patient psychiatric facilities in the state after Jindal shuttered the New Orleans Adolescent Hospital (NOAH) in 2009 and Greenwell Springs Mental Hospital in Baton Rouge earlier this year. Mandeville patients will be moved to facilities in Pineville in central Louisiana, and possibly the state hospital in Jackson.

  Mental health advocate Cecile Tebo, the former head of the New Orleans Police Department's Crisis Unit, describes the cuts as "medical discrimination." She told Gambit that for Louisiana's mentally ill, "this is the equivalent of closing all the big cancer centers in the state." Tebo also pointed out that there are only two possible outcomes: mentally ill people wandering the streets or presenting themselves at the state's already overtaxed emergency rooms. Care at the ER, by the way, is the most expensive form of medical treatment, which means the cuts will actually force some increased health care spending. Who will bear that cost? Private hospitals and taxpayers, especially middle-class and better-off taxpayers who form the core of Jindal's base.

  Closing sorely needed mental hospitals, slashing care for the state's most vulnerable citizens and leaving taxpayers holding the bag: that is Bobby Jindal's health care legacy. No wonder he spends so little time in Louisiana.


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