Tag Archives: uninsured

Legislators Leveraging Hospitals to Pressure Governors to Expand Medicaid

Mid City ERNew Orleans       In Florida, there is a well-publicized breech between the Republican Governor and the Republican-controlled legislature over their budget shortfalls and the need to bridge the gaps by expanding Medicaid.  The governor, Rick Scott, has gone to wild extremes of suing the federal government to try to force a change in the already settled matters of disproportionate share funding and blaming the federal government rather than adding Florida to the list of Affordable Care Act states.   Scott believes the hospitals, desperate for more funding and some in danger of closing, are lined up against him.

Interestingly in Louisiana much the same Republican-on-Republican division has also quietly broken out over disagreements over budget gaps and health care needs.  The legislative session is almost over, but rifts are huge.  Governor Bobby Jindal is so dedicated to his ambition to fail as a Republican presidential candidate in hopes some other Republican will win and give him a job, that he has chained himself to the hospital door to prevent the expansion on Medicaid for the 400,000 uninsured in the state.  Interestingly, the Jindal “no-tax” pledge of the state’s health to Grover Norquist has created devastating economic consequences in Louisiana especially with the cataclysmic dip in oil prices.

Public education is more popular in Louisiana than poor people or their health care, and the evisceration of the higher education funding under Jindal has also reached crisis proportions.  In a slick political move in the funding chess game, House leaders, who are obviously disproportionately Republican decided to fund higher education – against the Governor’s budget recommendations – in the next year leaving the state’s health care system at least $200 million short.   And, this starves a health care system that is invariably ranked near the worst in the country, and also threatens dubious agreements that Governor Jindal concocted with private companies to take over Louisiana’s public facilities.  Another $33 million in state is also needed to leverage federal funds to finish building the new hospital facility in downtown New Orleans that was designed to replace the Charity Hospital, shuttered after Katrina.

Tellingly the Advocate reported that “…Capitol insiders said they believe House leaders left health care alone on a limb to create pressure for the Legislature to expand Medicaid…a proposal that Jindal and the Republican controlled Legislature have rejected so far.”  The same report, referencing again unnamed “Capital insiders” added that they “…also suggested that House leaders left health care unfunded to cause hospital and other health care lobbyists to rev up their considerable sway to pressure anti-tax lawmakers to approve more tax measures.”

Regardless of what the Supreme Court decides about subsidies under Obamacare and any number of other issues, it seems the only thing stopping expansion of Medicaid, even among hardcore “hospital door” politicians trying to block health care for the poor, is political stalling and logrolling as Republicans try to position their “never Obamacare” positions with the desperate needs of their own health care systems and their longtime supporters and friends in their state hospital facilities with their deep community support and large payrolls.  Last minute, Hail Mary, lawsuits and meaningless pledges to DC power players are not going to be enough to protect the ideologues from their own citizens and their needs.  It seems the clock is ticking in our favor, if people can live long enough to make it.


This song goes out to a faithful reader who made the suggestion of posting this great video on the next blog about health care.  Thanks Mike.

Pokey LaFarge’s  Close the Door – Live 


Venal Politics of Ambition, Ideology, and Contributions Crippling Louisiana Healthcare

New Orleans  What often goes unsaid when the right pontificates and proselytizes about the wondrous benefits of privatization or public-private so-called “partnerships,” is the how much this is all simply a rationalization for personal ambition and the need to raise huge campaign contributions to fuel that fire.

We see this now, painfully and almost daily, in Louisiana while watching the gyrations of Governor Bobby Jindal to cripple the healthcare and educational institutions in the state that go back literally to the days of Huey Long.  His naked ambition as a wildly long shot aspirant for higher office means that he has to raise huge money to campaign and it is easy to tell his desperate strategy is two-fold, by first appealing to the rich ideologues pulling the Republican tail these days and secondly, asset-stripping by leading a giveaway of the state’s long established public hospital system to unnamed private hospital corporations for huge expected later contributions.

On his way out of town for another fundraising and headline hoping trip, Jindal announced his budget proposal.  Of course more cuts for higher education which has endured 5 straight years of reductions, which will force tuition increases.  Jindal wants to avoid having to own the responsibility by having his people claim that tuition increases will be at the decisions of the individual boards and chancellors.  Yeah, right!   In health care Louisiana once led the country in establishing public hospital care, but now Jindal is dismantling the system wholesale.  Of the ten remaining public hospitals within the LSU system, five have already been forced into public-private partnerships.  Two others have guns to their heads.  The hospital in Monroe in the northern part of the state was only put in the budget for the first three months of the new fiscal year.  Seems like that would be a hard message to miss if the hospital administrator was hoping for better bargaining chips in negotiating with private hospital companies, but the budget bullet puts pressure for little more than a cave-in with the governor to thank.

The billion dollar new hospital finally being built in New Orleans where we have been a healthcare desert since Katrina now worries that all of the numbers were wrong on their projections for operating budgets for the facility, since they had calculated them on the assumption that healthcare would be expanding through the Affordable Care Act (ACA).  It had never occurred to these state, city and federal healthcare planners that a far right ideologue in the governor’s chair would deliberately deny a free expansion of healthcare for uninsured citizens in our poor city and region.  Of course Jindal a captive of the Koch types, preferring to be consistent rather than right, literally answers the question of reconsidering his decision in the wake of other Republican governors recanting by laughing.  It’s the kind of response you would probably expect from someone who has also now devastated the prospects of mental health assistance in the state that might have benefited him personally.

Where did this notion come from that public assets and institutions are simply commodities that can be traded away at the whim of individual politicians?  The pretense of public service has to include restraint when embarking on destroying institutions that are hundreds of years standing and critical to citizens, especially those without alternatives.  The road to privatization has long been paved by campaign contributions from the benefiting parties, and certainly none of us are naive in thinking that big time politics is other than big time business.  A governor or politician of any persuasion in this time where money plays such an outsize role can only expect thanks from citizens for continuing to provide first class public services, but contributions flow freely when public assets are transferred to private parties in the name of whatever.

Meanwhile in this crony capitalism of Louisiana’s healthcare assets, the State of Louisiana will still pay for the privately managed outfits to provide service to the citizens creating a future spiral of state cutbacks to these outfits for declining care for the citizens, until they walk away as well, but that is long after Jindal’s term has expired.  How do they live with themselves?