Gov. Bobby Jindal in July 2010. (Photo by Gerald Herbert, The Associated Press archive)
"The outcome of the election largely will determine what Jindal will or can do with health care in general and the Medicaid expansion especially."
Their responses are in, or not, and our state legislators have spoken: They will leave solving the current health care crisis to the governor rather than take responsibility for it themselves. A solid majority of the House, 66, and a super majority of the Senate, 30, did not sign the petition for a special session to deal with the sudden loss of federal Medicaid dollars and the governor's plan to close a mental health hospital and to gut public hospitals, turning some into glorified out-patient clinics.
Most of the non-signers were Republicans, but a fair number were Democrats. By their inaction, some are saying they support Gov. Bobby Jindal's plan for this massive, historic and rapid change in public health care. Others have misgivings but do not know what else to do. Their overriding fear would be to spend $80,000 a day in special session and to not come up with a better solution. That would only serve to shift the growing public anger over the hospital cuts and layoffs from Jindal to themselves.
They have a point. If the main obstacle to the special session was the lack of a consensus plan, the main obstacle to a consensus plan was the governor's flat opposition to raising taxes or repealing exemptions. (While he cannot veto the temporary suspension of a tax exemption, most suspensions would still require a two-thirds vote.) For the governor to limit legislators' options so much gives them all the more reason to let him deal with the problem himself.
So, his administration and LSU health care officials move ahead, in fire-drill fashion, to try to arrange partnerships with community and private hospitals or to explore the possible sale or lease of some of the stronger state hospitals, particularly in north Louisiana. The downsizing of public hospitals creates a further budget hole in the graduate medical education program for training new doctors, as the LSU Board of Supervisors seemed surprised to learn last week.
The governor and many legislators have long recognized that the state network of public hospitals is unsustainable within the federal Medicaid system. The long-term plan, which Congress abruptly shortened, was to move gradually toward more public-private partnerships, like the one still being developed in Baton Rouge. But that has taken three years and millions of dollars of new construction, by the state and Our Lady of the Lake. The time and money are not available to do the same in other south Louisiana cities.
There is much interest and willingness on the part of private and community hospitals to help, but the big missing piece is adequate funding to take over the care of the uninsured, who make too much money to be on Medicaid and not enough to afford private insurance. Federal payments to hospitals that care for a disproportionate share of low-income patients is being reduced under the Affordable Care Act, which would cover many of the uninsured through the expansion of Medicaid.
But that is another option Gov. Jindal has taken off the table by declaring the state would not participate in the Medicaid expansion. Critics, even some supporters, say he's dead wrong on this, especially with the feds picking up the whole tab for three years, after which the state's share gradually rises to 10 percent.
It galls supporters of the special session even more that one man would block what they see as a big part of the solution to the current health care crisis. Yet Jindal's role in setting the future course of public health care in this state is small compared to that of the prime mover, the next president of the United States.
With the Medicaid expansion not taking place until 2014, the governor's opposition is a political statement, like with other Republican governors, in the national debate over health care. That was supposed to be a major issue in the presidential election, but it hasn't been.
Nevertheless, the outcome of the election largely will determine what Jindal will or can do with health care in general and the Medicaid expansion especially. If Mitt Romney wins, the new president might decide to keep the Medicaid expansion but to give the states more flexibility to run their systems, which Jindal wants. If Barack Obama wins, this governor, doing the math, might not have much choice. That's one more reason the Legislature is leaving it up to him.
John Maginnis is an independent journalist covering Louisiana politics. He can be contacted at www.LaPolitics.com.
Source: http://www.nola.com/opinions/index.ssf/2012/10/legislators_leave_health_care.html
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