Jindal, critics argue Medicaid cuts
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U.S. Rep. Bobby Jindal launched his political career by bringing Louisiana’s runaway Medicaid budget under control before he was 26.
But Jindal’s health-care cuts in the mid-1990s haunt his efforts to become governor.
Voters in the Oct. 20 primary election are being presented with two very different views of the Republican congressman.
State Sen. Walter Boasso, D-Arabi, contends the Rhodes scholar made budget cuts at the state Department of Health and Hospitals that show he has a big brain but little heart. Boasso aired a commercial that blames Jindal’s Medicaid cuts for the eviction of a mentally disabled man from a New Orleans nursing home.
Jindal, R-Kenner, responded to the criticism with a commercial featuring a Richland Parish physician who praises him for rescuing a Medicaid program teetering on the brink of collapse from corruption.
Jindal reined in a runaway Medicaid budget and landed a position on Capitol Hill. But it casts a shadow over him as a campaign issue.
He contends he cut Medicaid spending by $300 a person without sacrificing care.
His political opponents say that is not possible.
Lois Simpson, executive director for The Advocacy Center in New Orleans, said the budget cuts affected people and included “ridiculous” proposals, such as severely limiting Medicaid patients’ prescriptions.
“Thinking back it seems like there were a lot of across-the-board kind of cuts instead of looking at individual needs. It’s very wonkish,” Simpson said.
Dr. John Cooksey, a Monroe ophthalmologist and a former congressman, said Jindal helped the elderly and others by restoring a state Medicaid program that was practically bankrupt.
“He provided leadership to get Medicaid back on an even footing. Had it been left the way it was, a lot of people would have been let out of nursing homes,” he said.
Budget problems
Jindal was 24 in 1996 when Gov. Mike Foster appointed him to be secretary of the state Department of Health and Hospitals. He served two years before taking a $110,000-a-year job in early 1998 as executive director of the National Bipartisan Commission on the Future of Medicare.
In 1996, the state was grappling with significant health-care budget cuts. The state and the federal government share in the cost of Medicaid, a program that helps provide medical care to the poor and uninsured.
Louisiana got itself into a bind by taking advantage of a federal loophole to draw triple the dollars for caring for poor patients.
Basically, the state leveraged federal funds to attract more federal funds through a match program. Between 1991 and 1995, the state’s Medicaid spending increased by about 30 percent a year, said David Hood, who worked for Jindal and later replaced him as DHH secretary.
Congress eventually put an end to the spending spree, forcing the state to cut millions of dollars in costs.
The Legislature at the tail end of the last term of former Gov. Edwin Edwards chopped almost $1.1 billion from the DHH budget for the fiscal year beginning July 1, 1995.
Jindal was given the task of cutting another $400 million right off the bat.
Jindal admits that some of his proposals were less than ideal.
“We never argued to the Legislature that it was good policy to do across-the-board cuts,” Jindal said.
Hood said it is inevitable that someone “got a bad deal” in the cuts that followed.
“We were very careful,” Hood said, “to make sure that they had the smallest impact on patient care.”
Beginning in 1996, Louisiana’s Medicaid spending started falling short of the national average. Between 1995 and 1996, the state’s spending decreased 22 percent while the national average increased about eight percent.
Medically needy
Five months into the job of running the state health department, Jindal gave a legislative budget panel a list of suggested cuts. He proposed scrapping funding for the critically ill, limiting Medicaid clients to five prescriptions a month and reducing nursing homes’ profits.
Lawmakers loudly objected to his suggestion of cutting the $58 million Medically Needy program, which helped cover the catastrophic health-care costs of people who did not qualify for Medicaid. Constituents, some of whom relied on the program to prevent costly treatments and drugs from sending them into the poorhouse, also railed against the move.
Jindal quickly located money to keep the program going and fully restored funding the following fiscal year.
Legislators subsequently accused Jindal of not listening to their warnings about the likely fallout of cutting the program.
Jindal now says he made a mistake in putting the program on the chopping block. He noted that he found an alternative funding source to maintain patient care.
The prescription limit proposal was not implemented during Jindal’s tenure. However, some are critical that he suggested it.
The Legislature stopped the move because of its potential impact on the mentally ill, elderly and children, said Sandra Adams, executive director of the Louisiana Maternal and Child Health Coalition.
Adams said Jindal could have cut costs by doing such things as negotiating with pharmaceutical companies to lower drug prices.
Reimbursement rates
Part of Jindal’s campaign platform calls for emphasizing preventive care by increasing patients’ access to private providers. He wants to redirect some of the dollars currently going to charity hospitals and wean the uninsured from relying on emergency rooms for primary care.
Dr. Steven Spedale, chairman of the Medicaid policy committee for the Louisiana chapter of the American Academy of Pediatrics, said Jindal’s cuts at DHH included a reduction in rates paid doctors in private practice who treat Medicaid patients.
As a result of Jindal’s cuts, Spedale said, doctors stopped seeing Medicaid patients, especially children.
“We’re actually still reeling today from lowered reimbursement,” he said.
Currently, more than half-a-million children in Louisiana receive medical care through the traditional government Medicaid program.
But Hood said the number of physicians participating in the Medicaid program actually increased while Jindal was at DHH. In 1995, nearly 8,940 physicians participated in Medicaid in Louisiana. Two years later, nearly 9,760 physicians were participating.
Jindal said he would not characterize his campaign platform as an about-face from his reimbursement rate cuts. He said the cuts were made out of necessity.
“We were in a time of deficits,” he said. “We had to cut the budget by $1 billion.”
But Jindal’s health-care cuts in the mid-1990s haunt his efforts to become governor.
Voters in the Oct. 20 primary election are being presented with two very different views of the Republican congressman.
State Sen. Walter Boasso, D-Arabi, contends the Rhodes scholar made budget cuts at the state Department of Health and Hospitals that show he has a big brain but little heart. Boasso aired a commercial that blames Jindal’s Medicaid cuts for the eviction of a mentally disabled man from a New Orleans nursing home.
Jindal, R-Kenner, responded to the criticism with a commercial featuring a Richland Parish physician who praises him for rescuing a Medicaid program teetering on the brink of collapse from corruption.
Jindal reined in a runaway Medicaid budget and landed a position on Capitol Hill. But it casts a shadow over him as a campaign issue.
He contends he cut Medicaid spending by $300 a person without sacrificing care.
His political opponents say that is not possible.
Lois Simpson, executive director for The Advocacy Center in New Orleans, said the budget cuts affected people and included “ridiculous” proposals, such as severely limiting Medicaid patients’ prescriptions.
“Thinking back it seems like there were a lot of across-the-board kind of cuts instead of looking at individual needs. It’s very wonkish,” Simpson said.
Dr. John Cooksey, a Monroe ophthalmologist and a former congressman, said Jindal helped the elderly and others by restoring a state Medicaid program that was practically bankrupt.
“He provided leadership to get Medicaid back on an even footing. Had it been left the way it was, a lot of people would have been let out of nursing homes,” he said.
Budget problems
Jindal was 24 in 1996 when Gov. Mike Foster appointed him to be secretary of the state Department of Health and Hospitals. He served two years before taking a $110,000-a-year job in early 1998 as executive director of the National Bipartisan Commission on the Future of Medicare.
In 1996, the state was grappling with significant health-care budget cuts. The state and the federal government share in the cost of Medicaid, a program that helps provide medical care to the poor and uninsured.
Louisiana got itself into a bind by taking advantage of a federal loophole to draw triple the dollars for caring for poor patients.
Basically, the state leveraged federal funds to attract more federal funds through a match program. Between 1991 and 1995, the state’s Medicaid spending increased by about 30 percent a year, said David Hood, who worked for Jindal and later replaced him as DHH secretary.
Congress eventually put an end to the spending spree, forcing the state to cut millions of dollars in costs.
The Legislature at the tail end of the last term of former Gov. Edwin Edwards chopped almost $1.1 billion from the DHH budget for the fiscal year beginning July 1, 1995.
Jindal was given the task of cutting another $400 million right off the bat.
Jindal admits that some of his proposals were less than ideal.
“We never argued to the Legislature that it was good policy to do across-the-board cuts,” Jindal said.
Hood said it is inevitable that someone “got a bad deal” in the cuts that followed.
“We were very careful,” Hood said, “to make sure that they had the smallest impact on patient care.”
Beginning in 1996, Louisiana’s Medicaid spending started falling short of the national average. Between 1995 and 1996, the state’s spending decreased 22 percent while the national average increased about eight percent.
Medically needy
Five months into the job of running the state health department, Jindal gave a legislative budget panel a list of suggested cuts. He proposed scrapping funding for the critically ill, limiting Medicaid clients to five prescriptions a month and reducing nursing homes’ profits.
Lawmakers loudly objected to his suggestion of cutting the $58 million Medically Needy program, which helped cover the catastrophic health-care costs of people who did not qualify for Medicaid. Constituents, some of whom relied on the program to prevent costly treatments and drugs from sending them into the poorhouse, also railed against the move.
Jindal quickly located money to keep the program going and fully restored funding the following fiscal year.
Legislators subsequently accused Jindal of not listening to their warnings about the likely fallout of cutting the program.
Jindal now says he made a mistake in putting the program on the chopping block. He noted that he found an alternative funding source to maintain patient care.
The prescription limit proposal was not implemented during Jindal’s tenure. However, some are critical that he suggested it.
The Legislature stopped the move because of its potential impact on the mentally ill, elderly and children, said Sandra Adams, executive director of the Louisiana Maternal and Child Health Coalition.
Adams said Jindal could have cut costs by doing such things as negotiating with pharmaceutical companies to lower drug prices.
Reimbursement rates
Part of Jindal’s campaign platform calls for emphasizing preventive care by increasing patients’ access to private providers. He wants to redirect some of the dollars currently going to charity hospitals and wean the uninsured from relying on emergency rooms for primary care.
Dr. Steven Spedale, chairman of the Medicaid policy committee for the Louisiana chapter of the American Academy of Pediatrics, said Jindal’s cuts at DHH included a reduction in rates paid doctors in private practice who treat Medicaid patients.
As a result of Jindal’s cuts, Spedale said, doctors stopped seeing Medicaid patients, especially children.
“We’re actually still reeling today from lowered reimbursement,” he said.
Currently, more than half-a-million children in Louisiana receive medical care through the traditional government Medicaid program.
But Hood said the number of physicians participating in the Medicaid program actually increased while Jindal was at DHH. In 1995, nearly 8,940 physicians participated in Medicaid in Louisiana. Two years later, nearly 9,760 physicians were participating.
Jindal said he would not characterize his campaign platform as an about-face from his reimbursement rate cuts. He said the cuts were made out of necessity.
“We were in a time of deficits,” he said. “We had to cut the budget by $1 billion.”
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