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Health Care Roller Coaster 

Last week was a roller-coaster ride for anyone concerned about health care services in Louisiana. As Congress moved closer to passage of the RESTORE Act, it appeared the final version of the bill would cost Louisiana at least $1.1 billion in Medicaid funds. That will lead to deep, painful cuts in public health care services. Also last week, the U.S. Supreme Court narrowly upheld the Affordable Care Act, known to critics as Obamacare. The nation's first attempt to implement a comprehensive health care policy has only begun to take effect, but already it's clear that the new law will have a huge impact on health care financing and service delivery.

  In the face of so much uncertainty, there is one bit of good news: A new state law authored by Sen. David Heitmeier (D-Algiers) will help bring up to $100 million in additional federal funds to Louisiana for badly needed adolescent mental health services. Senate Bill 371 tracks several other measures that have come to be known as the "Heitmeier Plan" — named for the Algiers lawmaker, a practicing optometrist who has emerged as the Legislature's leading authority on health care financing. Heitmeier admits he borrowed the concept from Texas, which pioneered a method of combining local and state funds to leverage millions more from Medicaid, the federal health care provider for the nation's poor.

  Since 2009, Heitmeier has found ways to leverage increasing amounts of Medicaid funds without raising taxes or cutting local services — to the point that the current state budget will see more than $700 million in additional funds. That has helped stabilize local hospitals such as Ochsner, East Jefferson and West Jefferson hospitals in the wake of Hurricane Katrina, and rural hospitals and ambulance providers across the state. "This year's bill, if its provisions are approved by federal regulators, could provide another $100 million for adolescent mental health services, which are sorely needed in the New Orleans area," Heitmeier told Gambit.

  Mental health care is considered "optional" under Medicaid, which means some states provide it and some don't. Louisiana has been one of those that don't, mostly because of budget squeezes. When the state brought in Magellan Health Services to manage its burgeoning Medicaid program, the private contractor was asked to make the program more efficient and to provide additional services. Heitmeier's bill allows the latter to happen for adolescent mental health care on a fee-for-services ("pay as you go") basis. Considering the hits that adolescent health care has taken under Gov. Bobby Jindal — such as the closure of New Orleans Adolescent Hospital in 2009 — the extra money for such services is a boon.

  On other health care fronts, it's too early to accurately project the total fiscal impact of the Affordable Care Act on Louisiana's future budgets. Among other things, a lot depends on whether future governors and legislators continue to decline to participate in the law's health care exchanges. At a minimum, the federal government will begin providing health care coverage to at least 400,000 Louisiana citizens — possibly as many as 600,000 — who currently have none. These newly covered Louisianans are too poor to afford private insurance but not quite poor enough to qualify for Medicaid. The feds will initially cover all the additional costs, but gradually the state will have to pick up 10 percent.

  Meanwhile, Louisiana continues to trail most states in health care outcomes. Our state ranks 16th in the nation in public health care spending but 48th in outcomes, according to rankings published by the United Health Foundation. In the face of massive cuts that will follow adoption of the RESTORE Act, Louisiana will have to cut a total of $1.1 billion in Medicaid spending in the next two fiscal years — starting with the year that began this week. Those cuts are essentially the price tag that Congress has imposed on Louisiana for sending billions of dollars in BP oil spill fines to restore our coastline.

  While south Louisiana celebrates the anticipated arrival of long-sought coastal restoration funds, health care providers across the state bemoan the cuts that are just around the corner. Among them: cuts to programs for women with breast cancer and cervical cancer; elimination of Medicaid's hospice program and adult denture program; cuts to LSU system hospitals and rural hospitals; and at least a 10 percent cut in payments to Medicaid providers (read: doctors).

  Unfortunately, the journey to better public health care is often a case of two steps forward, one step back. And the road is never straight, or smooth.

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