Louisiana sets off healthcare 'smart' bomb

Louisiana Gov. Bobby Jindal warned his GOP colleagues at a national convention earlier this year that it can no longer afford to be the party of stupid people. Meanwhile, he's planted a smart bomb in his home state's system of healthcare delivery.

Jindal, like virtually every other Republican governor, has a visceral dislike of the Affordable Care Act. So Louisiana is not going to expand its Medicaid program. That's going to preclude about 350,000 residents from getting healthcare coverage. That's not nearly as many Medicaid-eligible residents as there are in Georgia, Florida and Texas. But in grindingly poor Louisiana, it represents a far larger proportion of its total population--about 9 percent in all--nearly double the ratios of those other states.

The overall rate of uninsured in Louisiana is even more troubling. According to the Trust for America's Health, it rose from 16 percent of all residents in 2009, 17th highest in the nation, to 20.4 percent, third-highest, in 2011. A combination of the loss of job-based health insurance coverage due to the Great Recession--and Louisiana already had among the lowest rates of covered workers before it hit--and funding cuts to the Medicaid program, account for the startling rise.

Meanwhile, the Louisiana State University Health System is in the midst of being privatized--another Jindal-driven initiative. The LSU hospital network provides the vast bulk of care to the state's low-income and uninsured residents. State officials claim that it will net about $100 million a year in lease payments from the private operators.

The only thing certain about the privatization efforts is that many LSU hospital employees have been laid off--nearly 4,000 to date, a stunning 25 percent of the system's workforce. One hospital campus has also been closed.

Whether the private entities will provide better care or the same level of charity care remains to be seen. The LSU system could not rouse itself to reopen the landmark Charity Hospital in New Orleans after it was closed by Hurricane Katrina nearly a decade ago, so it can't be argued that private operators will do worse. But given the opacity surrounding the privatization contracts and the fact Jindal didn't hesitate firing LSU Health's two top officials just days after they voiced legitimate concerns regarding the plan, it can't be said they are expected to do better.

Indeed, the LSU Health website hardly inspires confidence: There are three prominent links on its website's home page alone pertaining to layoffs. An accompanying missive from interim system CEO Michael Kaiser, M.D., is a masterpiece of corporate-speak save for two instances: When he acknowledged that the privatization effort is driving away seasoned providers and admitted the transition is "hard to watch."

Compounding all these decisions is the poor state of health of Louisianans in general. The state has the highest rate of obesity in the entire nation among adults--nearly 35 percent--and the fourth-highest among children. Diabetes and hypertension rates are the third and fourth-highest in the nation. A huge swath of the state's population will need close-in care for decades to come.

Yet Jindal is also hostile to the kind of initiatives that might keep costs in this area under control. The state recently announced it will not participate in a federal demonstration project to beef up home healthcare to chronically ill Medicaid enrollees. Despite the fact that there's data indicating that this kind of care dramatically reduces hospitalizations and cuts costs, Jindal's healthcare people grumbled that the Centers for Medicare & Medicaid Services wouldn't grant them the flexibility they needed to proceed. The fact that this project is part of the ACA has a lot to do with the decision as well, the New Orleans Times-Picayune recently observed.

So, in summary, Jindal believes the best stewardship possible of a state full of constituents in precarious health and poverty is by denying access to health coverage to one out 11 of them, turning over its safety net to private operators in an opaque and blunt fashion while letting thousands of employees go, and rejecting a chance to cut costs and improve care for its existing Medicaid population due to political dogma.

As has been the case in many of the Red States, the Louisiana Hospital Association has been pretty much silent. If it does not speak up soon, it will only get quieter--many members will be forced to close their doors.

As for Jindal, he's certainly not stupid--at only 42, he's come too far in too rapid a time to be labeled as such. But when it comes to healthcare policy and the state's hospitals, he is certainly reckless. And as the case with some smart bombs, it could take years before the havoc it wreaks becomes painfully clear. - Ron (@FierceHealth)

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