Votes sought to get federal waivers on health-care plan

On the eve of today’s first legislative vote on the governor’s health-care revamp, Louisiana senators questioned the need to rush changes.

Some state senators on Wednesday voiced skepticism of Gov. Bobby Jindal’s plan that could expand government-paid insurance to 106,000 more people without increasing costs.

State Department of Health and Hospitals Secretary Alan Levine promised lawmakers plenty of opportunity to put their imprint on the direction the state will go.

But Levine said he wants the lawmakers to vote on allowing the Jindal administration to apply for a waiver from federal regulations.

Submitting the plan to federal authorities “does not bind the Legislature,” Levine said at a Senate health-care briefing.

Levine assured legislators the proposal is “budget-neutral,” prompting a senator to say he wanted data to prove that.

A joint meeting of the House and Senate committees on Health and Welfare is scheduled to vote today. Then, the Joint Legislative Committee on the Budget is scheduled to vote Friday on whether to allow the state to apply for a waiver.

Jindal is proposing experiments in four regions of the state for children and some adults covered by Medicaid.

Medicaid is government insurance for the poor and uninsured. The state spends $7 billion on the program that covers 1.1 million people.

The Jindal plan proposes, in part, to change the way physicians, hospitals and other health-care providers are paid. Instead of the state paying the providers directly, Jindal wants to restructure the system to pay privately owned, competing networks of providers to care for Medicaid patients.

Several features of the plan require federal authorities to waive Medicaid regulations. A state law requires the Legislature’s health and money panels to sign off before submitting the waiver request.

Two-thirds of the 39 member Senate attended all or part of the State Capitol briefing.

Senate President Joel Chaisson II, D-Destrehan, told Levine at the outset that there is “a lot of concern regarding the timing.” He asked why filing the application was so necessary before the end of the year, particularly with Barack Obama becoming president on Jan. 20.

Levine said he wanted to get the request in the pipeline because it could take up to a year to complete negotiations with federal officials.

State Sen. Rob Marionneaux, D-Grosse Tete, said he was “a little suspicious of the desire, the urgent need to do it now.”

Marionneaux said he wants to see the administration propose some options for the restructuring of health care. “I’m not sure the one before us is the right one,” he said.

State Sen. Cheryl Gray, D-New Orleans, said she had not been given the time necessary to study the proposal. She said she wanted to “look at all the options other than what’s been put in front of me by the administration.”

Levine said the document laying out the administration’s plan does not commit the Legislature “to any one specific way of doing it.”

And, he said, the state does not have to act even with the federal approval of the request.

State Sen. Joe McPherson, D-Woodworth, said lawmakers and some health-care groups worry “if the horse gets out of the barn and starts running, how do you put the brakes on?”

McPherson sponsored the law that set out the framework for what the Jindal administration is proposing.

Senators wanted to know the cost.

“It’s revenue neutral based on our calculations,” Levine said.

State Sen. Robert Adley, R-Benton, said he wanted Levine to provide “clear numbers” by Friday, when money panels are expected to vote, to prove its budget neutrality.

Adley said the law directing development of a plan would require the full Legislature to sign off on it if there are increased expenses — not just the health and budget committees.

“I just don’t think anybody feels comfortable with what those costs are going to be,” McPherson said.

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