Sunday, July 1, 2012

The Shameful Truth behind Gov. Jindal's Rejection of Health Care Reforms

Bobby JindalBy Nomad
When it comes to Obamacare, Louisiana Governor Bobby Jindal's position is clear. He will have no part in it. However, his decision will come at a great cost to the welfare of the people of his state. Louisiana, more than most states, will benefit from affordable health care. 

The Quality of Care
Following the Supreme Court's decision, ruling that the Affordable Care Act was, after all, constitutional, all across the land one could hear the sound of the frying of the tiny shriveled brains of right wing conservatives. (It was no doubt made worse by those marvelous screw-ups from Fox and CNN.) 
Yet it was the reaction from Governor Bobby Jindal from Louisiana seemed the most insincere.
Immediately following the announcement of the court's decision, a flustered Jindal surely must have tweeted his fingers raw. He tweets:
Today’s decision is a blow to our freedoms.
He didn't even use all of his 144 characters to explain how our freedoms had precisely been blown. He left that to our imaginations. And later:
The Court should have protected our constitutional freedoms, but remember it was the President that forced this law on us.
As one blog writer noted, how the president forced the law on the American public was by passing it in Congress by majorities. That sly fox. 
However the most galling tweet of the day happened to be this one:
Americans oppose it because it will decrease the quality of care, raise taxes, cut Medicare, and break the bank. All of this is still true.
As we shall soon see, this tweet is, by far, the most obscene.

Later he brazenly announced his intention to (kind of) defy the first step in the health care reform. Here's how USA Today reported it
Louisiana Gov. Bobby Jindal is sticking with his refusal to set up a health insurance exchange as required by President Obama's health care law.

Jindal, mentioned as a possible running mate for Mitt Romney, said today he won't implement what he calls "Obamacare" even though the Supreme Court upheld the constitutionality of the law. He's counting on Romney to win in November.

"Elections have consequences," Jindal said on a conference call with Virginia Gov. Bob McDonnell set up by the Republican National Committee. "Elections matter. This one matters a lot."

The law requires states to set up exchanges by January 2014 that will help people buy health insurance from a range of companies. Jindal says he won't "set up an exchange." Louisiana, instead, is going to leave that task to the federal government.

Fourteen states and the District of Columbia have already set up health insurance exchanges.
From another source there's this precious quote:
“It really raises the question of what’s next, what’s allowable,” Jindal said. “Taxes on people who refuse to eat tofu or refuse to drive a Chevy Volt … this whole ruling I think is ridiculous. It’s a huge expansion of federal power.”
While Jindal’s defiance may seem a bold act to some on the far right, others might see it as a cynical attempt to grab Romney's attention. (Me! Me!) There's still a vice-presidential vacancy. Others might see it as merely childishly petulant or just plain silly. 

Even if Jindal refuses to participate, as the article notes, the federal government will simply take over that task of setting up the insurance exchanges for the state and pouting Jindal will have to be satisfied with the results.

However, with Louisiana having the fifth highest uninsured rate in the nation, leaving it to the federal government to do his job for him is more than an abdication of his responsibility. It is more than outward show of contempt for President Obama and the Courts. It was nothing short of a spit in the face of the poor, the elderly and the black community who will most benefit from the reforms.

Bobby Jindal and the Safety Nets
It's doesn't take a genius to understand how poverty and lack of health insurance and inferior health care are all intertwined. Prior to the health care reforms, the un- and underemployed could not afford the health insurance they needed. Part-time workers- even those who are working several jobs-, were not offered insurance from their employers. The only recourse for those people would be government subsidies; Medicaid and Medicare, for example.

As Mitt Romney has told us, we need not worry ourselves too greatly over the suffering of the uninsured poor, there are safety nets, after all. Unfortunately, Romney’s glistening world bears little resemblance to how things actually operate. 

When it comes to balancing the state budgets, those safety nets touted by Ronmey, are considered expendable by many governors. But as Jindal said, “elections have consequences” and for the poor of Louisiana, the consequences of the election of Jindal as their governor was a matter of life and death.

Between the wealthy and the poor of Louisiana, Governor Jindal has clearly shown where his allegiance lies when he recently released his proposed Fiscal Year 2012 Executive Budget.
Despite strong public opinion to the contrary, the governor stubbornly refuses to consider increasing revenues, either by increasing taxes or eliminating or suspending any of the 441 tax exemptions that are costing the state over $7 billion a year.

Thus, it is no surprise that the governor has chosen to cut programs vital to the state’s future and engage in questionable privatization schemes in order to reconcile the $1.6 billion deficit for this year (now $1.5 billion, based on the Revenue Estimating Conference’s latest estimates that arrived too late to be incorporated into the Governor’s budget). The new budget slashes over $1 billion from programs such as social services, health care, higher education, and public safety and proposes using more than $474 million in one-time revenue, which just kicks the problem into next year.
Business Report Executive Editor JR Ball states the matter directly:
It's also wonderful that Louisiana, under Jindal, has moved hundreds of millions of dollars from the state treasury to personal bank accounts and corporate balance sheets thanks to an unprecedented level of tax cuts over the past five years. Even better for the average reader of this publication, nearly every one of these cuts has almost exclusively benefited the wealthiest of this state's residents and business owners.
Louisiana Budget Project Director Eddie Ashworth, supported Ball’s thoughts. 
“A lot of what you hear from the administration today is just simply not true…Our fiscal problem is not due to state government spending beyond its means and it is not because we are spending too much.”
He explained that following the twin disasters of Hurricanes Katrina and Rita, Louisiana was awash in temporary federal recovery money. As those funds gradually dissolved, the spending remained the same as before the disaster. 

Meanwhile, the demand for state services continued to rise.
“Medicaid enrolment gone up 13%,” Ashworth said. “Medicaid for children has gone up 16%. Food stamp recipients have gone up 20 %. Enrolment in community and technical colleges has gone up 37% at same time that spending has been flat.”This is not merely a coincidence. Natural regional catastrophes were followed by national economic ones.
The legislators and the governor have made the problem worse by not drawing revenue from all available sources. The tax cuts for corporations, for example, were untouchable. For example:
Much of the state’s budget shortfall stems from what Ashworth called “the largest tax cuts in state history” in 2007 and 2008, when the state was flush with federal recovery money and before the recession.
That loss in tax revenue, combined with the effects of the recession, precipitated the current crisis, he said.
Compounding the problem is the fact that Louisiana currently offers over 440 separate tax exemptions, which amount to $7.1 billion in lost revenue.

If a looming $1.6 billion revenue shortfall is only dealt with by cutting the budget, Ashworth said, the result will be devastating for families in Louisiana.
Basically the situation in Louisiana is a demonstration of Tea Party politics in action. The very same approach is what the Republicans are calling for in Washington. Budget cuts while keeping the tax cuts for the super wealthy, even at the cost of the middle class and poor.

Death by a Thousand Cuts

According to experts, the policy of cutting Medicare, besides being devastating to the poor, is shortsighted in the larger view as well. Cutting these services has a knock-on effect. As the organization Louisiana Progress explained:
Hospitals in Louisiana employ more than 99,350 people and contribute $4.4 billion annually in payroll, according to an analysis by the Louisiana Hospital Association (LHA) released Sept. 22. But cuts in Medicaid payment could lead to the loss of approximately 6,764 jobs and $258 million in earnings statewide, according to the report, “Hospitals and the Louisiana Economy, 2011.”

James A. Richardson, alumni professor of economics at Louisiana State University, conducted an economic impact analysis for the LHA to measure the economic activity generated by hospitals in the state. According to the report, the healthcare sector in Louisiana employed approximately 269,200 people, or 16.2 percent of the state’s workforce. Hospitals contributed 99,351 jobs and $4.4 billion in pay. Overall, hospitals generated more than $27.1 billion annually in economic activity.

“People often do not realize that hospitals are huge contributors to our economy, even during economic recession,” John Matessino, LHA president and CEO, said in a statement. “Every dollar spent by a hospital supports 95 cents of additional business activity, and each hospital job supports approximately 1.4 additional jobs.”

Cuts in Medicaid would negatively impact economic activity in the state, according to the analysis. About 19 percent of net revenues in the state are Medicaid-related, the report found; Medicaid-related expenditures resulted in 47,483 jobs and $1.8 billion in personal earnings.
All in all, Governor Jindal’s stubborn refusal to increase taxes on the wealthy has come at the direct cost to the poor of his state, particularly in terms of health care. And the supposed job-creating benefits of lowered taxes for the rich have not resulted in noticeable decrease in unemployment. Additionally, by cutting these health care services, with the closing of hospitals, unemployment has, in fact, become worse.

In Governor Jindal’s budget for 2012, he proposed cutting health care in the state by $140 million from the previous year budget. That was approximately $410 million in cuts for the last two years. Since 2008, he has reduced the number of health care workers by 3.781 positions, despite the increased need for health care services. He also reduced funding to Medical Vendor Payments, which includes financing for charity hospitals. You may think that it couldn’t get any more discouraging but you’d be wrong. In fact, that’s just the beginning. Quoting Mathis again:
In addition, the Governor seeks to privatize a significant portion of Louisiana’s Medicaid program.
Under a controversial new plan called Coordinated Care Networks (CCN), DHH would outsource management of medical care to private insurance companies for approximately 800,000 Medicaid recipients, including pregnant women and children. Other cuts apply to nursing homes, a $22.7 million reduction for the Office of Public Health, and a $39 million reduction to behavioral health services which are responsible for providing services to those struggling with mental disease and addictive disorders.

The budget also decreases funding for developmental disability services by $25.9 million, transitioning individuals from institutions into “more independent living settings.”

The governor’s budget recommends cutting $110 million from LSU Health Care Services ivision, a 12% reduction from last year. The administration plans to save $63.1 million by eliminating 276 health care jobs—doctors, nurses, and administrative staff—who serve Louisiana’s uninsured population through charity hospitals and clinics across the state.

Now let's take a closer look at what Jindal’s intransigence toward the Affordable Care Act will cost the state in real terms. The health care of poor children and seniors have been negatively affected by Jindal’s budget cuts but, we will focus in this post on the AIDS epidemic in Louisiana.

AIDS as an Example
Data Courtesy of Louisiana Office 
of Public Health STD/HIV Program
By any measure, Louisiana has a significant HIV/AIDS problem. Just look at the figures. 
In the most recent CDC 2009 HIV Surveillance Report (Vol. 21), Louisiana ranked 5th highest in estimated state AIDS case rates (19.4 per 100,000).

The metropolitan New Orleans area ranked 9th and the metropolitan Baton Rouge area ranked 2nd in estimated AIDS case rates in 2009 among the large metropolitan areas in the nation. 

At the end of 2010, 18,540 persons were living with HIV infection in Louisiana, of whom 10,141 (55%) were diagnosed with AIDS. There are persons living with HIV in every parish in Louisiana, and this number continues to increase each year.

Louisiana's black community has been hardest hit by the epidemic. According to the Louisiana Office of Public Health STD/HIV Program, the majority of new infections are in males, African Americans, and persons aged 25-44.
The case rate for African Americans continues to be disproportionately high in Louisiana; the HIV case rate for African Americans is over six times higher than that among whites. Although African Americans make up only 32% of the state’s population, 74% of newly-diagnosed HIV cases and 78% of newly-diagnosed AIDS cases were among African Americans in 2010.
The problem is compounded by the fact that, while Louisiana has the second-highest poverty rate in the United States at 27% ( second only to the state of Mississippi) black poverty is nearly double the white poverty rate: 34% compared to 14%. Consequently, any health care program that reduces costs for the poor and uninsured also benefits those people living with AIDS.

Nationally, fewer than one in five (13%) people living with HIV has private insurance and nearly 24% do not have any coverage at all. The rest are covered by government programs, such as Medicaid, Medicare and the Ryan White HIV/AIDS Program. 

In Louisiana, those particular programs have been consistently reduced year after year. That's one of the most important things that ACA will do for them. A true safety net that cannot be cut down for the expediency of state budgets.

An important feature that helps people with AIDS is its built-in consumer protection provision. For instance, ACA was drafted to prevent insurers from denying coverage to children because of their HIV or AIDS status (or any other pre-existing condition). Furthermore, insurance providers will not be able to cancel coverage for adults or children (except in cases of fraud or intentional misrepresentation of a material fact.) They will no longer be able to impose a lifetime dollar limit on essential health benefits. Additionally, the provisions of the ACA will give people with Medicare who are living with HIV and AIDS more resources to pay for life-saving medications. (See here for more information.)

There are even more benefits for people living with AIDS. For example, there’s also preventative care. Under the reform law:
Medicare and many private insurance plans are now required to cover many recommended preventive services, including screening for HIV, mammograms and other cancer screenings, with absolutely no cost-sharing for patients.
Keeping people healthy is, by far, the most cost-effective, means of providing health care.
* * * * 

It is clear that, despite the growing numbers of the afflicted by this disease, before going on television and making his speech against the reforms, Bobby Jindal gave little serious thought about how the The Affordable Care Act would impact the lives of people living with AIDS in Louisiana (or uninsured children or senior citizens). If he had, he certainly would have understood how important “Obamacare” would be to Louisiana residents, particularly those who live with AIDS. 

But that's assuming he actually cared.

What Bobby Jindal said in the interview was absolutely correct. Elections have consequences. We have seen the consequences of the mid-term elections which saw the Tea Party victory and which swept into power the 112th Congress. That session of Congress ended last year with an approval rating of a mere 11%- the lowest in the 30 year history of Gallup polling. 

And state elections are also have consequences. One consequence of elections going wrong is that it can put people into governor’s mansions who do not belong there and who do not represent all of the voters but only the most prosperous. It can place people into powerful seats who refuse to learn the lessons of history. 

That may be true of Bobby Jindal. It appears that the governor of Louisiana has failed to learn the most important lesson of Hurricane Katrina. Namely, when a mismanaged government with misplaced priorities decides to abandon the sick, the elderly, the poor and the minorities, it deservedly earns the contempt of a nation.