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Budget Hard To Swallow? Maybe Some Whine Will Help

“Don’t we have able-bodied folks on Medicaid expansion who are not working and should be? Compare them to the 46-thousand disabled folks, and they’re not as deserving of funding as those who are unable to work.” – Sen. Sharon Hewitt

Senate Finance committee members got updated on the House-approved version of the budget Sunday, and were urged by Commissioner of Administration Jay Dardenne to halt the process where it stands.

“Are you asking the Senate to stop it?, Sen. Greg Tarver (D-Shreveport) asked, directly.

“I am,” Dardenne answered. “That is the best solution. The longer you spend talking about this now, the longer you’re waiting for a special session to fund priorities. I am saying to the Senate not to pass a budget. You can’t fix this.”

Committee chairman Eric LaFleur (D-Ville Platte) agreed.

“I will never vote for this budget,” LaFleur said. “I will not allow 46-thousand people to be thrown into the streets.”

He was referring to cuts necessitated by the House decision to fund TOPS at 80% while delivering the deepest budget cuts to health care. On the chopping block is the Long Term Care Special Income Level Funding Program. Eliminating that will disqualify 46-thousand nursing home patients and developmentally disabled from assistance in the fiscal year that begins July 1.

“We don’t have alternative programs that could assist these individuals,” explained Stephen Russo, legal counsel for the Louisiana Department of Health. “Nursing homes will have to discharge or evict residents. Of course, we have to get CMS okay to do this, and they can stop the clock, requiring the state to keep paying every provider until their decision is made.”

“How many of these 46-thousand people are capable of walking out of where they are?” LaFleur asked.

“These are the sickest of the sick, who require 24/7 nursing care,” LDH Medicaid Director Michelle Alletto replied.

“As I see it, the problem is the runaway growth of Medicaid costs,” Sen. Conrad Appel (R-Metairie) said. “Where is your plan to rein in that growth – to halt it? Or are we just going to let it keep growing, while we keep stripping money from higher ed?”

“As the finance guy for LDH, that’s definitely my great concern,” replied Health Dept. Undersecretary Jeff Reynolds. “But the feds, in many cases, tie our hands. Take the pharmacy program, for example. It grows three to four percent every year. CMS requires us to pay the average pharmaceutical cost, plus a dispensing fee. As drug prices go up, payments go up. There is no way we can implement any cost control on that.”

“Why don’t you take those 40-thousand people and find a cheaper way to do things for them?“ Appel persisted. “I’m not hearing anything from the administration about any plan to control the ticking time bomb of growing Medicaid costs. See if you can fix that before you start talking about raising revenue.”

“I find it hard to believe that everything in the budget is a higher priority than the things we’re now talking about being cut,” Sen. Sharon Hewitt (R-Slidell) said. “Don’t we have able-bodied folks on Medicaid expansion who are not working and should be? Compare them to the 46-thousand disabled folks, and they’re not as deserving of funding as those who are unable to work.”

“Medicaid expansion, by definition, affects the working poor,” Dardenne reminded Hewitt. “And if they are deemed eligible for whatever reason, they are entitled to coverage.”

“What you’re talking about are different programs, with different federal rules,” Reynolds added, answering Hewitt. “The 46-thousand take a higher percentage of state general fund, compared to the amount the feds pay. Even it we eliminated the entire Medicaid expansion population, it wouldn’t bring the dollar amount down to where it will balance the budget.”

While Appel and Hewitt were the only two Republicans on the committee whining about the administration’s failure to stave off this crisis, other GOP senators were choking on the idea of not passing a budget in this session.

“I don’t know how we don’t just have a budget,” Sen. Bodi White (R-Baton Rouge) said. “Everybody has been saying we need a budget to know where we are, and then fill in what we need. You’re telling us we don’t get a chance to say where we think the changes should be made? I want to have my name on a budget, in case we don’t pass more revenue. I don’t want to see those pink slips go out.”

“They’re going out anyway,” Dardenne said of the layoff notices that will be issued to public-private partner hospitals’ staff on May 1. “But you can take your time, and make your decisions.”

“Tell us what happens July 1, if we don’t have a budget,” Sen. Jim Fannin (R-Jonesboro requested.

“One argument is that everything shuts down, but I don’t have a definitive answer,” Dardenne replied.

“Shutdown is what I’ve heard,” Fannin agreed. “It’s never been tested, however, and I hope we don’t. But we’re sitting here debating about $648-million of a $28-billion budget. It doesn’t seem reasonable not to have a budget. I think it’s much more irresponsible to take the risk come July 1, if we don’t pass a budget this session. And I think there’s plenty of time to come into a special session once we end this one.”

“We think it’s more beneficial to alleviate the uncertainties as quickly as possible,” Dardenne insisted.

“Would the Governor let state government shut down?” Fannin asked.

“I guess we’ll just have to wait and see how it all turns out,” Dardenne answered, non-committally.

Fannin’s temper flared.

“I don’t think you’ve been handling the House properly through all of this. I think the way you pull folks on board is with sugar, and not vinegar.”

“I think this budget is full of vinegar,” Dardenne responded, then added ruefully, “There’s not a lot of sugar anywhere in it.”

“You keep talking about us shutting down early, but we’re only halfway through this session, and our bills are just now going over to the other side,” Hewitt said to Dardenne. “We still have a lot of important work to do this session. You’ve had all this time to prepare a budget. You have all the experts. Do you believe the budget you proposed was the best you could do, and that it put money in all the strategic places?”

“If there is no more, money, yes,” Dardenne replied. “But there really is no way to responsibly budget with this much less money. We need to replace what is going off the books.”

“You also keep talking about giving people hope. I don’t see how not passing a budget in this session gives people hope. Until we pass revenue, I don’t understand how this somehow is giving people hope. I believe we all need to know the correct starting number, and have an agreed-upon good starting place.”

“With this budget, it appears that ‘good’ starting place is to shut down medical schools, put 46-thousand people out on the streets, and underfund TOPS,” Finance chair LaFleur replied, disgustedly.

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