By Robert Mann
At first glance, two ill-conceived constitutional amendments on the November ballot might not appear to harm Louisiana college students. Their passage, however, would be further proof that the wellbeing of Louisiana’s young people remains among our lowest priorities.
It’s a complicated issue, explained well in a voter’s guide published by the nonpartisan Public Affairs Research Council of Louisiana (PAR), but the basic situation is this: the state imposes a fee on nursing homes, intermediate care facilities for the developmentally disabled and community pharmacies. That money goes into the Louisiana Medical Assistance Trust Fund and is used as a state match to draw down federal dollars, much of which goes to compensate the nursing homes and other facilities who provide services to the poor and others who qualify for Medicaid.
Good so far.
Amendment one, however, would give the trust fund, in PAR’s words, “the more protected status of a constitutionally established fund, which could be altered only by another constitutional amendment. It could not be raided for other spending purposes in the annual budget process or during mid-year budget cuts.”
Worse, the amendment would lock in current reimbursements paid by the state to providers. Payments could go up, but would never drop below a “floor” established by the amendment.
In other words, this is a sweetheart deal carved out by legislators for the very powerful and politically connected nursing homes.
It gets worse.
Amendment two would create a similar arrangement for the state’s hospitals, allowing a new fee that would go into a Hospital Stabilization Fund and then be used to draw down federal money. Similar to amendment one, this amendment would create a floor for reimbursement rates.
“The amendment would eliminate the government’s ability to make targeted cuts to hospital providers,” PAR notes. The amendment, as PAR further observes, would permit a decrease in hospital rates “only to address a state budget deficit and only if two-thirds of the Legislature agrees during a session or two-thirds of the joint budget committee agrees out of session. Even then, the rate reduction could not be more than the average reduction experienced by other types of providers in the Medicaid program.”
In other words, a very inflexible state budget, already overloaded with constitutionally protected funds, would become even less flexible.
Nursing homes, hospitals and other facilities will be guaranteed their funding, even if fees are insufficient to match the payments they receive. If hard budget times hit us again – and they will, eventually – the nursing homes and hospitals will be paid first.
The only way to mitigate the mess created by these amendments would be a two-thirds vote of a Legislature already controlled by the nursing homes and hospitals. In the case of amendment one, it could only be changed by a vote of the people.
In the meantime, you know what will be cut during the hard times? Other health care providers, like doctors and home-care providers, colleges, state police and other critical services. That’s because they don’t have special budget protections, like that which these amendments would give to hospitals and nursing homes.
No one is suggesting that nursing homes and hospitals don’t deserve adequate funding. It’s just that programs for our youngest citizens are almost always the ones that get shortchanged.