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The Vitter and Jindal war on Medicaid is undermining Louisiana’s health care future

War-Of-2012-1At the October 4th joint meeting of the House & Senate Health and Welfare Committees in Baton Rouge, Senator Ben Nevers of Bogalusa asked representatives of LSU, “Who decides who lives and who dies?”

LSU System health care chief Frank Opelka told Senator Nevers and others in the committee room that patient access to care will decrease as a result of the cuts. (To learn more about the services once delivered by this system, you can download the most recent LSU Health Annual Report by clicking here.)

Those questions and answers were made necessary by Senator David Vitter’s decision to allow a Medicaid clawback provision to remain in the federal Transportation bill that passed Congress in July. The clawback was also included because Governor Bobby Jindal was too busy campaigning for some Republican candidate in June to be bothered to intervene with his former House colleague Speaker John Boehner.

The resulting 11% cut in the state’s Medicaid program has produced deep cuts in the state’s safety net hospital network and threatens to unravel the system of training for doctors, create new public safety threats due to behavioral health cuts, and inundate community hospitals with patients who do not have the ability to pay for the care they need. Jindal and Vitter’s presidential candidate of choice would make a 30% cut in Medicaid if elected.

Because the cuts are being executed in a manner designed to achieve an ideological objective — the dismantling of the state’s public hospital system — the impact of the cuts will be more dramatic and more devastating that they would otherwise be.

The Damage Being Done

Senator Nevers and other Washington Parish residents have an active interest in the cuts. Bogalusa Medical Center is part of the LSU Hospital system and it is the only hospital in the parish. According to the Bogalusa News, 146 hospital employees (25% of total staff) will lose their jobs as a result of the latest cuts.

The 18-bed psychiatric unit at the hospital will be closed. Combine that with the closure of Southeast Louisiana Hospital in Mandeville and there are no — zero — public psychiatric hospital beds available on the Northshore. In the New Orleans metro area south of Lake Pontchartrain, the Orleans Parish Prison is the largest public provider of psychiatric care in the region.

In Houma, the cuts at Leonard J. Chabert Medical Center have been described as “apocalyptic.” Jindal’s hand-picked LSU Board of Supervisors slashed 245 jobs at the hospital. In coming months, the residency program there will be transferred and closed; inpatient and outpatient orthopedic services will be eliminated; women’s services will be closed; and inpatient beds will be cut from 48 to 24.

In Lafayette, University Medical Center (UMC) had 80% of its inpatient beds closed, 173 jobs eliminated, and 2/3 of its operating rooms closed.

LSU officials mentioned discussions with Lafayette General Medical Center about taking over some patient services from UMC. But, Representative Stephen Ortego of Carencro said that LSU officials had misled legislators while under oath. The Independent in Lafayette, asked Rep. Ortego whether LSU Health Care Services was slashing UMC’s capacity without the probability of a deal with LGMC to take over. Ortego replied “that’s exactly what I’m saying.”

The cuts at Earl K. Long Regional Medical Center in Baton Rouge worry constituents as well as other health care providers in the region. The question in the Capitol region, as elsewhere, is where will patients who were getting care at EKL go? The hospital had 4,884 inpatient admissions and 46,720 emergency room patients in the most recent fiscal year.

That pattern repeats itself across the part of the LSU system directly controlled by the LSU Board of Supervisors (the LSU Health Sciences Center in Shreveport operates the LSU hospital there and those in Monroe and Pineville).

House Democratic Caucus leader John Bel Edwards of Amite, whose district is home to LSU’s Lallie Kemp Medical Center in Independence, slammed LSU officials for making cuts without provisions in place for either the care of patients or ensuring the continuity of graduate medical education (the training of doctors). “You are demolishing what you have before you have something to transition to,” Rep. Edwards said.

The Damage Will Not Be Confined to LSU

The danger cause by the cuts is clear to the Louisiana Hospital Association (LHA) and to the leaders of the Louisiana State Medical Society. John Mattesino, head of the LHA told Gannett that his members can’t handle a large influx of uninsured patients currently served by LSU. He added that Governor Jindal’s refusal to participate in the Medicaid Expansion component of the Affordable Care Act further clouds the future of community hospitals.

Jeff Williams, CEO of the Louisiana State Medical Society (LSMS), told Gannett that “this is a scary time for all of us” in the medical profession

The two major concerns of hospitals and physicians are access to health care for those now depending on the state’s hospital system and the graduate medical education program that has relied primarily on the LSU hospitals for training.

Williams said the wall of secrecy that LSU (at the direction of Governor Jindal) has erected around what it’s doing undermines confidence in whatever process is actually underway. A poll of its members conducted by the LSMS found that 70% of its members believe LSU’s actions will worsen graduate medical education in the state. If graduate medical education is affected, it will worsen the current health professional shortage that exists in much of the state.

Opelka told legislative committee members last week that Louisiana could lose some of its graduate residency programs to other states if the current maneuvers do not meet the approval of the graduate medical education accrediting agency.

To summarize: the current cuts in Medicaid funding are reducing access to care for people dependent on the LSU Hospital network for care; the shift of uninsured patients away from LSU Hospitals to community hospitals threatens the economic viability of those community hospitals; the system by which Louisiana prepares doctors for our state has been destabilized and is in jeopardy; the Jindal administration has made these cuts with no provisions in place to provide for the care of those Louisiana citizens who don’t have health insurance.

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Originally published: Oct 13, 2012