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Letter to Louisiana Department of Health and Hospitals Secretary: Support Medicaid Expansion


Location: Washington, DC

Today, Rep. Cedric L. Richmond (D-LA) sent a letter to Bruce Greenstein, Secretary of Louisiana Department of Health and Hospitals, requesting details on the Jindal Administration's plan for ensuring Louisiana's most vulnerable residents have access to health care. The letter highlights the need for Gov. Jindal to change his current position against Medicaid expansion and accept the Medicaid financing being offered under the Patient Protection and Affordable Care Act.

Congressman Richmond released the following letter:

December 21, 2012

Secretary Bruce Greenstein

Louisiana Department of Health and Hospitals

628 N. 4th Street

Baton Rouge, LA 70802

Dear Secretary Greenstein,

I write today to request details on the Jindal Administration's plan for ensuring financially disadvantaged Louisianans have access to critical health care should it persist in rejecting the Medicaid financing being offered under the Patient Protection and Affordable Care Act.

I have grave concerns that Gov. Jindal's announced Medicaid rejection strategy, coupled with his decision to close or weaken numerous health care facilities in the LSU system, will leave too many citizens without access to quality care. The strategy of forming public private partnerships as a means to reduce fiscal costs certainly reduces government expenditure, but it also poses serious risks to the health care delivery system that has developed in my district, and throughout the state, after Hurricane Katrina. The proposed cuts appear destined to endanger the system of public hospital and health center care. These institutions are responsible for the provision of the important outpatient care that hundreds of thousands turn to due to their limited financial means. By closing or shortening service hours or personnel at these facilities and rejecting the Medicaid expansion as mandated by the Affordable Care Act, the Jindal Administration is purposefully restricting access to quality care for lower income Louisianans. This appears to be a dangerous combination and the Administration owes the public an explanation as to how the proposed public private partnerships (PPP's) will ensure quality care access in an environment of reduced service and continued inability to cover the costs of care.

In hopes that we can work together to craft solutions to the health care problems our neighbors face I would like you to detail the Administration's plans related to the following important items:

Please provide specifics as to how the proposed PPP's will impact the low income population in Louisiana as well as how this proposed system is more efficient than combining the LSU public health system with the ACA Medicaid expansion to serve the 456,000 Louisianans left in the cold by the refusal to perform the ACA expansion.
What is the long term viability of the PPP's absent the Medicaid expansion? Given the demand for the services, how does the PPP, which contains a private enterprise, expect to be compensated in a way that is affordable for the state?
How many Lousianans do you anticipate will lose access to care under the Administration's proposed scenario, when compared to the status quo or to a possible Medicaid expansion?
Do you expect the current service levels to be fully retained so that the low-income residents in my district and others will continue to have access to care?
What will happen to the well performing network of community health centers and clinics that have ably filled the health care void for the underserved after Katrina?
The announced PPP's only cover three LSU hospitals. What are the Administration's plans for dealing with the rest of the hospitals in Louisiana's public health system?
I believe there is another path forward and I am hopeful that the Jindal Administration will do what is right to find savings elsewhere in the budget or agree to revenue increases in order to preserve the current levels of care in the LSU public hospital system and to pay for the very modest contribution required to expand Medicaid to the hundreds of thousands of Louisiana residents that currently do not qualify. Most credible estimates show that Louisiana would have to pay a little more than $1 billion over 10 years to implement the Medicaid expansion. Even your own liberal estimates of the cost put the ten year costs just under $2 billion. This is a small price to pay so that half a million people can receive the primary care they deserve as human beings.

Apart from the obvious moral and human benefits to the Medicaid expansion, the move would have fiscal benefits as well. Over the first decade of its operation, Louisiana would bear only 7% of the overall costs of the Medicaid expansion, with the federal government paying for 100 percent of the cost for the first three years. This will improve the state's fiscal position by creating tax revenues from transactions with entities and persons associated with health care such as hospitals, doctors, pharmacies and other businesses. Additionally, the Medicaid expansion would decrease the uncompensated costs to the state for acute hospital care as a larger insured population would seek preventative care, which is ultimately cheaper than emergency care. Finally, the Medicaid expansion would decrease state costs for mental health care provision, an area in which we can do much better in Louisiana. With the federal government shouldering the overwhelming majority of these costs, Louisiana actually saves money in the long run, while providing sorely needed care for half a million people. I urge you to reconsider your course for moral and fiscal reasons.

If your Administration persists according to the current trajectory, the least you can do is be frank with the public about the likely impact of your decisions. These are matters of life and death and I demand answers and explanations of the plan to ensure that the lower income voters understand their future options. The hard working people of Louisiana deserve to have a government that is concerned with their well-being and I urge you to do right by them.


Cedric L. Richmond

Member of Congress

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