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“Cleaning Up Another Republican Mess”: Louisiana Ready To Make Big Gains Through Medicaid Expansion

Few states need Medicaid expansion more than Louisiana, which made it all the more difficult to justify former Gov. Bobby Jindal’s (R) refusal to consider the policy. By all appearances, the Republican made a plainly political decision without regard for the state’s needs: Jindal wanted to be president (yes, of the United States), so he took a firm stand against “Obamacare.”

Louisiana’s current governor, Democrat John Bel Edwards, ran on a platform of Medicaid expansion through the Affordable Care Act, won his election fairly easily, and immediately adopted the policy. The Times-Picayune in New Orleans reported yesterday that the governor went directly to the legislature to explain why this was the smart move for Louisiana.

Medicaid expansion is estimated to save Louisiana $677 million over the next five years and more than $1 billion over the next decade, Department of Health and Hospitals officials told Senate Health and Welfare Committee members Monday (April 18).

The cost estimates came after Gov. John Bel Edwards testified before the committee about his decision to expand Medicaid eligibility to about 375,000 people between July 1 and June 30, 2017. DHH officials will make an effort in the coming weeks to educate legislators about the benefits of Medicaid expansion and what they said was misinformation given to the Legislature to justify not expanding Medicaid under former Gov. Bobby Jindal.

“I believe the folks in the prior administration who said we couldn’t afford Medicaid expansion, they took the worst case scenario on every variable,” Edwards told lawmakers in the GOP-led legislature. “If you look at what we’re doing in light of experience in other states … we know we’re going to save money.”

And he knows this because it’s true.

I can appreciate why this may seem a little counter-intuitive. Ordinarily, when state policymakers recommend expanding benefits to struggling families, critics will respond, “We’d like to help, but we can’t afford it and we’re not willing to raise taxes.”

But Medicaid expansion is one of those policies in which states get to do both: participating states receive federal funds to implement the program, while expanding coverage for low-income families who would otherwise go uninsured. At the same time, hospitals’ finances are strengthened as medical facilities see fewer patients who can’t pay their bills.

Since implementation of the Affordable Care Act began, how many states have found Medicaid expansion hurt state budgets? None. Republicans will be quick to argue that someday, maybe, in the future, the fiscal challenges will become more acute, but given pre-ACA reimbursement rates, there’s no reason to believe they’re correct.

It’s exactly why every governor with access to a calculator – including plenty of red-state Republicans – have found the arithmetic undeniable.

As for Louisiana in particular, as we talked about last week, the state really is having an “elections have consequences” moment right now. Gov. Edwards, the region’s only Democratic governor, hasn’t been in office long, but he’s already making strides to clean up the Republican mess he inherited.

 

By: Steve Benen, The Maddow Blog, April 19, 2016

April 20, 2016 Posted by | Bobby Jindal, John Bel Edwards, Louisiana, Medicaid Expansion | , , , , , | 1 Comment

“A Steady Drumbeat”: Republican Governors Buck Party Tenets To Seek Expanded Medicaid

Republican governors are pressing forward to expand Medicaid even after being stymied by lawmakers in their own party.

As the Obama administration vows to help develop plans that will pass muster with conservatives, the governors of Utah and Wyoming said they still want the health care program for the poor broadened. Georgia Gov. Nathan Deal, who declined to act in 2013, may seek a federal waiver to make insurance available to more residents. Louisiana’s Republican legislature also opened a legal door.

Their views challenge party orthodoxy, even if some governors are crafting their own proposals and denying that what they’re doing is expanding Medicaid. Twenty states have refused the expansion under President Barack Obama’s 2009 health care overhaul because of cost and ideological opposition. The resistance is easing as states see a chance to recoup tax dollars and help hospitals get paid for charity care.

“This is about your citizens’ financial and health security, and it’s also about the economic health of your states,” Sylvia Mathews Burwell, U.S. secretary of health and human services, said Saturday at a National Governors Association meeting in West Virginia. “We want to help you design a system.”

This month, Alaska became the 30th state to expand, including 10 with Republican governors, according to the nonprofit Kaiser Family Foundation, a health-research group in Menlo Park, California. Gov. Bill Walker, a first-term independent, used his authority under state law to accept the expansion unless the legislature returns by September 1 and votes it down.

“I did it unilaterally because it was the right thing to do,” Walker said in an interview.

Governors in Tennessee, Utah, and Wyoming lack the ability to act alone, and their Republican-led legislatures declined to adopt expansion this year.

Even so, Utah’s Gary Herbert plans to meet with legislative leaders this week and said he hopes to call a special session in September to pass what he’s calling an alternative to Medicaid expansion.

Herbert’s program also would require a waiver from Medicaid officials for elements designed to appeal to Republicans, such as having applicants get job training.

“I’m optimistic,” Herbert said in an interview. “I think our approach is better than traditional government-assistance Medicaid.”

In Georgia, lawmakers last year blocked the governor from expanding Medicaid without their approval. A provision tucked into this year’s budget, though, allows the state to pursue a waiver.

Wyoming Gov. Matthew Mead called his expansion effort “a colossal failure.” Still, he hopes to bring it back in February’s budget session or in 2017.

“It’s going to take probably some time and continued work by all of us to eventually get to that point,” Mead said.

Tennessee Gov. Bill Haslam, a Republican, said he doesn’t know whether he’ll try next year after failing in February.

While Louisiana Gov. Bobby Jindal, a Republican presidential candidate, has been an adamant opponent, his state still could move, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

Jindal leaves office at year’s end, and Republicans running to replace him have all expressed support for expansion in some form, she said. The legislature has passed a provision requiring hospitals to pay the state’s share of expansion.

“I don’t think we are going to see a super-large number of states moving forward,” Alker said. “But it is a steady drumbeat.”

 

By: Mark Niquette and Margaret Newkirk, The National Memo, July 29, 2015

August 1, 2015 Posted by | Affordable Care Act, Medicaid Expansion, Republican Governors | , , , , , , , , | 1 Comment

“Back Street Abortions?”: New Law Could Force All Of Louisiana’s Abortion Clinics To Close

Women in Louisiana could lose all access to abortion services if the state succeeds in enacting a secretive overhaul of its clinic regulations. The requirements are so stringent that every one of the five clinics currently operating in Louisiana would have to close, according to a lawyer advising the clinics. The new regulatory framework would also impose a de facto 30-day waiting period for many women—an exceptional requirement.

“What it amounts to is a back door abortion ban,” said Ellie Schilling, a New Orleans attorney. “The way the [Department of Health and Hospitals] went about passing these regulations was in a secretive and undemocratic way. The public definitely doesn’t know what’s going on.”

DHH enacted the overhaul just before Thanksgiving, when it passed the rules as an emergency measure, effective immediately—exempting them from the normal comment period. None of the clinics were given notice; one heard about the declaration of emergency from  anti-abortion protestors.

It isn’t clear what emergency the agency was responding to. There has been virtually no reporting on the new rules, and DHH did not respond to questions submitted Monday. The Declaration of Emergency states that the agency proposed the licensing standards in order to comply with two acts passed by the Louisiana legislature in 2013, but a complete overhaul goes well beyond their demands. DHH formally declared its intentions to make the emergency rules permanent in December.

According to Schilling, the law gives the agency the ability to shut down every existing clinic in Louisiana immediately, by imposing new space requirements that none of the existing clinics meets. Providers would lose some of their rights to appeal noncompliance citations, while new and complex documentation and staffing requirements create more opportunities for DHH to cite clinics for deficiencies. “Deficiencies are used to create this impression of clinics being repeat offenders, and that’s a basis for revoking their license,” explained Schilling.

The regulatory overhaul would also give the state tools to prevent new clinics from getting a license. Proposed facilities—like a $4.2 million Planned Parenthood health center on South Claiborne Avenue in New Orleans—would have to prove to DHH that their services are needed; it’s unclear what criteria the agency would use to determine need. “It certainly seems that one intention is to prohibit Planned Parenthood from entering the market,” Schilling said. (Planned Parenthood clinics in Louisiana do not currently offer abortion services. “We are evaluating all our options” in light of the regulations, a spokesperson said.)

The new rules place a significant, unjustified burden on women by requiring that they undergo blood tests at least a month before an abortion procedure. That means that unless a patient happens to have gone to the doctor previously and had those tests done by chance, she will face a mandatory 30-day waiting period.

“I’ve never seen anything like this. It’s pretty outrageous,” said Elizabeth Nash, state issues manager at the Guttmacher Institute.

Louisiana already has a 20-week cutoff, and so the waiting period could dramatically shorten the window in which women are legally allowed to have abortions. There is no medical rationale for conducting those particular tests so far in advance; they are routinely conducted by providers prior to an abortion, and legislation passed in 2003 that tightened the laws governing Louisiana’s abortion providers stipulated that they had to be done within 30 days of the procedure. To the contrary, forcing women to delay the procedures increases their expense, and raise the risk of complications.

Dozens of other states have passed waiting periods or regulations, known as Targeted Regulation of Abortion Providers, or TRAP laws, which single out abortion providers with burdensome rules. But Nash said that a de facto 30 day waiting period combined with requiring clinics to prove need for their services makes Louisiana’s law striking. “It’s a great way to eliminate access,” said Nash.

All that’s stopping the state from completing the overhaul, Schilling said, is going through the motions of a public hearing. One is scheduled for Wednesday morning in Baton Rouge, but bad weather threatens to cancel it. It isn’t clear if the state would hold another hearing, as it was already scheduled at the very end of the comment period.  Legal challenges would surely follow, but as Nash warned, rolling back clinic regulations in the courts is challenging.

“As it is right now, you have to go to the major cities to have procedure done. If these clinics close, where will the patients go? Then what are we back to? Back street abortions?” said Missy Cuevas, who is fighting a legal battle with the state after her New Orleans clinic lost its license a little over a year ago. With more than two decades of work in women’s health, Cueva has seen the burden on Louisiana women grow as regulators clamp down. Five to ten women still call every day looking for services, even though she’s been closed for so long.

“If we make it any more difficult, where are the patients going to go—Houston? Atlanta? My patients can’t afford to go to Baton Rouge from New Orleans, much less to Houston or Atlanta. It’s going to force women to go back to what they used to do before, and women will die.”

 

By: Zoe Carpenter, The Nation, January 27, 2014

February 3, 2014 Posted by | Abortion, Women's Health | , , , , , , , | Leave a comment

   

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