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Legislative Roundup: Senate budget committee stalls Medicaid expansion

Last Modified: Monday, May 20, 2013 5:40 PM

BATON ROUGE (AP) — State senators rejected a proposal on Monday for Louisiana to offer government-subsidized health insurance to the working poor through the federal health overhaul law known as the Affordable Care Act.

The 7-3 vote by the Senate Finance Committee largely fell along party lines, with all but one Republican voting against tapping into the federal Medicaid dollars available for the health coverage.

Sen. Ronnie Johns, R-Sulphur, voted to defer the measure, saying he could not "vote for an idea or a concept."

"There's just too many uncertainties right now," he said.

During the hearing, Johns voiced concerns about the measure driving more than 170,000 residents out of private insurance into the Medicaid expansion market.

"That has a cost-shift effect," he said. "When you take that many people out of the private market you have to see health insurance rates rise in the private market. That's just a given."

Another issue, Johns said, is that guarantees from the federal government aren't set in stone. He spoke about the Federal Medical Assistance Percentage (FMAP) formula being changed after last year's session adjourned. The change resulted in the state's Medicaid funding being reduced by $879 million.

"There's nothing to prevent them from doing this in the future somewhere down the road on this legislation," Johns said.

Sen. Karen Carter Peterson's bill would have required the state health department to seek federal approval for a program using the Medicaid expansion dollars to provide private insurance coverage to adults making up to 138 percent of the poverty level — less than $32,000 for a family of four. The federal government would cover much of the cost.

A similar proposal is scheduled for a House vote Tuesday, but passage seems like a long-shot at best. Gov. Bobby Jindal and Republican Party leaders oppose the expansion, which was authorized under the health revamp championed by President Barack Obama.

Peterson, D-New Orleans, said the insurance expansion would improve health care for thousands of Louisiana citizens who work at low-wage jobs and can't afford the coverage on their own, while also providing an influx of dollars for health care providers.

"How in good conscience can we turn down 100 percent of anything that we know will tend to the needs of working class people?" said Peterson, leader of the Louisiana Democratic Party.

Rob Tasman, representing the Louisiana Conference of Catholic Bishops, said the bishops backed the proposal as consistent with church teachings that support the life and dignity of people and consider health care a basic right.

"Let's elevate the status of the poor today, the uninsured," Tasman said.

About one in five Louisiana residents are uninsured. Estimates are that as many as 400,000 uninsured people would be eligible for Medicaid under the insurance expansion.

Jindal says the increased insurance coverage would be too costly for Louisiana and could shift people from private insurance to government-funded health care. His health secretary, Kathy Kliebert, said Monday that the modified bill seeking to use the federal Medicaid money for private insurance doesn't change the administration's concerns.

"We do not see this as a worthwhile plan for the state of Louisiana," she told the Senate Finance Committee.

Kliebert, interim secretary of the Department of Health and Hospitals, said the private insurance model is unworkable because of federal restrictions governing the Medicaid funding. She said the Affordable Care Act doesn't offer enough flexibility to tailor an insurance program to Louisiana's needs.

In response to criticism that the Jindal administration hasn't offered an alternative, Kliebert pointed to the privatization of the LSU-run hospitals that provide safety net care to the uninsured. She said the efforts will improve access and health services.

Sen. Fred Mills, R-Breaux Bridge, noted that only three deals have been signed for the 10 hospitals — and that questions have been raised about whether the financing is available to support the arrangements.

Mills sought to delay action on Peterson's bill while awaiting further details about the ongoing efforts to privatize the LSU hospitals. He couldn't get enough votes for such a delay, however. He was the lone Republican senator to vote against shelving Peterson's bill.

The nonpartisan Legislative Fiscal Office estimates the Medicaid expansion could save Louisiana as much as $510 million over 10 years, with the state receiving up to $15 billion in federal funding. The Jindal administration disputes the fiscal office analysis.

• American Press reporter John Guidroz contributed to this report.

Proposals would limit cuts in Medicaid program

Proposals making it more difficult to cut the rates paid to hospitals and nursing homes for taking care of Medicaid patients are nearing final passage.

Support from lawmakers comes despite concerns the constitutional amendments would further limit budget areas available to cut when Louisiana has financial woes — and leave colleges more vulnerable to slashing.

The House-approved proposals received backing Monday from the Senate Finance Committee and move next to the Senate floor. They also would need support from voters.

One measure would let hospitals pool their money and use those dollars to draw down federal Medicaid matching money. In exchange, cuts to hospital payments would be limited.

The other proposal would set a floor on Medicaid patient reimbursements paid to nursing homes, pharmacies and institutions for the developmentally disabled.

Bid to give judges raises gets backing

A bid to give judges five years of annual pay raises easily received the backing Monday of the Senate's budget committee — after it was changed to require money for the salary hike to come from the annual judicial budget.

Supporters said the judges haven't had a raise since 2010. "It really is appropriate to do this," said Sen. Ed Murray, D-New Orleans.

The bill would give Supreme Court justices a 5.5 percent pay increase on July 1, with appeal court judges getting a 3.7 percent boost and district court judges receiving a 4 percent increase.

After that, every July from 2014 through 2017, all three sets of judges — along with city and parish court judges — would get a 2.1 percent annual bump in pay.

The raises would cost $2.5 million in the first year, then grow another $1.4 million in cost each year through the 2017-18 fiscal year.

The Finance Committee agreed without objection, sending the proposal (Senate Bill 188) to the full Senate for debate.

Also sent to the Senate floor with unanimous backing from the committee was a House-approved bill (House Bill 174) that would allow annual 4 percent pay raises for parish clerks of court for the next four years.

The raises would add about $300,000 in salary costs each year and would only be allowed if clerks complete an annual certification and maintain the certification.

Cutting back on consulting, professional services contracts

The House backed another attempt to force a 10 percent cut on state agencies' spending on consulting and professional services contracts.

Rep. Jerome "Dee" Richard, I-Thibodaux, has tried a similar bill for several years, only to see the idea killed in the Senate. The House voted unanimously for this year's version of the proposal (House Bill 73), which would require the reduction in the 2013-14 budget year that begins July 1.

Gov. Bobby Jindal's administration opposes the measure as limiting agency decision-making.

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