Louisiana’s Medicaid Crisis Sowing Resistance Among Constituents and Legislators

Deepening budget cuts being handled secretively by an administration plagued by arrogance and deception are combining to stir strengthening currents of resistance among constituents and legislators who were once allies of the Jindal administration.

So far, it’s all talk. But, there is more talk than there was and some of it has gone public. And, a possible showdown looms next week.

The cuts to the LSU Hospitals as a result of the Medicaid clawback engineered by congressional Republicans and Senator David Vitter have garnered the lion’s share of coverage since July. More cuts are coming next week when the LSU Board of Supervisors meets on Thursday morning.

On Thursday afternoon, the joint meeting of the House and Senate Health & Welfare Committees of the Louisiana Legislature will question LSU and Jindal administration officials on the latest cuts. The 34.5% cut amounts to taunting the Legislature. The law that shifted the hospitals to LSU’s control back in the 1990s requires legislative intervention if the cuts exceed 35%. By keeping the current cuts just under that limit, the Jindal administration is daring the Legislature to get involved. They have not done so yet, but pressure has been steadily mounting for them to do so in order to avoid disruptions on patient care and graduate medical education in the state.

Taking an ax to the budget to save the patient.

Independent pharmacists in Louisiana, whose members include some legislators, are in open rebellion against a Medicaid Pharmacy Emergency Rule promulgated by the Department of Health & Hospitals (DHH). The pharmacists, who are Louisiana small business owners, say the new rules are biased in favor of large national chains and will drive them out of business. DHH Secretary Bruce Greenstein is indifferent to their claims and has pushed ahead with the rule, angering the pharmacists and their allies on both sides of the aisle in both chambers of the Legislature.

While plenty of trouble abounds in the present, more is percolating in the future.

Governor Jindal, in full national Republican campaign mode earlier this summer, summarily announced that he would not allow Louisiana to take part in either the creation of a health insurance exchange here, nor in the Medicaid expansion segment of the Affordable Care Act, both of which go into effect in 2014. The Governor’s act of resistance might have played well with the Republican faithful in Iowa, New Hampshire and other 2016 Republican Primary states, but it sent shudders through the provider community in Louisiana that views reducing the number of people without health insurance in the state as a fiscal necessity.

Jindal joined about five other politically ambitious Republican governors in rejecting the Medicaid expansion option. However, in large cities in some of those states, health care leaders are seeking ways that they might be able to circumvent state obstruction and enable their residents to gain access to the Medicaid expansion in 2014, for which the federal government will pick up 100% of the cost.

Include New Orleans among the list of cities considering that option. The trick is that Louisiana’s DHH would have to consent to allowing the waiver request to be submitted. At which point in time Louisiana residents would learn if this is (at best) political posturing by the Governor, or if he truly is intent on denying several hundred thousand of the citizens he was elected to govern access to affordable insurance that will be available to most other Americans.