Medicaid turnabout coming

January 27, 2016
Longtime Vandebilt coach passes away
January 27, 2016
January 27, 2016
Longtime Vandebilt coach passes away
January 27, 2016

Gov. John Bel Edwards’ decision to accept the federal government’s Medicaid expansion – a reversal of his predecessor’s dogged refusal – will result in 350,000 more people in Louisiana being eligible for assistance with their medical bills.

His executive order overrides legislative reluctance to come on board with the offering, opposed largely by Republicans because of expectations of additional costs to Louisiana now, and even further down the road.

But health care providers, who must deal routinely with a large population of patients who until now had no way to pay for procedures and check-ups, while not entirely sold on the concept as a group, have hopes that the expansion will help them better meet their missions. For true progress to be made however, many say that Louisiana’s Medicaid system needs review and change for all components to work smoothly.

“We anticipate less bad debt and less uncompensated care due to the expansion of Medicaid,” said Phyllis Peoples, the CEO of Terrebonne General Medical Center, who added that while the expansion is a good thing for local families, it does not necessarily eliminate the problems hospitals experience due to inability of some to pay through insurance or their personal resources. The cost of rendering care will continue to exceed the current reimbursement level.”

According to TGMC estimates, 24 percent of Terrebonne’s population – amounting to 24,732 people – are already eligible for Medicaid. The expansion is estimated to bring inclusion to around 7,000 adults not yet covered, between 21 and 64 years of age.

Peoples said 11 percent of TGMC’s patient load is covered by Medicaid. When those patients are billed, the hospital may get only 10 cents for each dollar it charges from the Medicaid plan.

The Medicaid expansion, made possible through the federal Affordable Care Act – colloquially known as “Obamacare” – will pay for 100 percent of federal financing of those made newly eligible through 2016. The percentages drop each year through 2019, with a ceiling of 90 percent in 2020 and beyond.

“It could be a help for those families who cannot get insurance,” said Greg Stock, CEO of Thibodaux Regional Medical Center, noting that the current oilfield downturn is likely placing more Bayou Region residents than ever in need of help. “Coverage is one thing, but how much you are paid by Medicaid is another. Medicaid reimbursement does not provide the cost to provide care and for the last two years there have been un-level playing fields in Medicaid reimbursement.”

Some hospitals, Stock said, are paid more than others through privatization programs for Medicaid put in place by Gov. Bobby Jindal’s administration.

Stock and some other hospital administrators say the current setup has eliminated transparency, and that there is no independent way to audit varying reimbursement rates.

“It is done in secrecy and no one knows what those actual payments are,” Stock said. “That is the big question out there.”

Medicaid is being managed in Louisiana through Amerigroup, AmeriHealth, United Healthcare, Aetna and Louisiana Healthcare Connections.

Under Medicaid each state negotiates its own plan with the federal government, subject to certain minimum standards, of what the program will pay for how much of a given service it will pay for.

TRMC plans on opening a new wellness center soon that is geared toward keeping people out of hospitals and emergency rooms by attacking health issues before problems occur through proper management and prevention. How such programs will fare under Louisiana Medicaid remains to be seen.

Across the board, however, health care providers clearly see the expansion as a bright spot for patients.

David Gaines, a spokesman for the Ochsner Health System, which operates Leonard J. Chabert Medical Center, said his firm “welcomes the opportunity to extend high quality health care to more people across our network of 28 owned, managed and affiliated hospitals and more than 60 health centers.

“We look forward to working with the (Edwards) administration and Department of Health and Hospitals on the structure of the proposed Medicaid expansion so that we can ensure appropriate access to healthcare for all Louisianans,” Gaines said.

Now that Edwards has opened the door, Ochsner’s position is more positive than when its CEO was asked by a reporter, in the presence of Jindal at an LCMC news conference in 2013, if the governor’s rejection of Medicaid expansion stood in the way of Chabert’s ability to provide care to more people.

The CEO, Warner Thomas, yielded the question to Jindal, who ticked off his talking points explaining his objections.

A longtime proponent of Medicaid expansion, who criticized Jindal for refusing it, is Dr. Gary Wiltz, director of the Teche Action Clinic, which provides health care to largely impoverished people including those described as the “working poor.” Appointed to head up Edwards’ medical transition team, Wiltz has expressed unbridled support for the governor’s decision and resulting executive order.

“It can only help the state,” he said.

The big task for the administration now, Wiltz said, is to get as many eligible people signed up as possible within the next six months, if the state is to fully benefit.

As more people take advantage of available medical care, particularly before a medical crisis happens, and give themselves a “medical home” such as a family doctor, the changes will be of greatest help to the state’s ability to help provide health care, Wiltz said.

The challenge, he said, is maximizing signups, making sure people “get a card.”

“We need to deal with the measures causing us to rank 49th and 50th in the nation in health care,” Wiltz said. “We need to address smoking and tobacco use and abuse, using the tobacco tax as a disincentive for people to smoke, and make it competitive with the neighboring states.”

Louisiana’s tax on alcohol, Wiltz said, has not been adjusted in decades.

Medicaid expansion, he said, can be integrated into new alternatives that attack causes of ill health.

Increased involvement of parish governments, Wiltz said, will go a long way toward making people healthier and thereby driving down care costs. The doctor said he has confidence in the direction Louisiana health care will take in coming years.

“I am very optimistic and hopeful,” Wiltz said. “We have a caring resident in the governor’s mansion now and all the people who chose to stay in his administration want to make the state better. It can be a really good four years, and maybe another four years after that.” •

The clinic’s CEO, Dr. Gary Wiltz, is on Gov. John Bel Edwards’ medical transition team and says the administration’s acceptance of Medicaid expansion will help many more Louisianans receive proper medical care.