Louisiana's secretary of health and hospitals unveiled a broad reform plan earlier this month that would revamp how healthcare is delivered, especially to the uninsured and underinsured.
The plan, called "Beyond 2000," sets three main goals for the state: ensuring care for the indigent, disabled and working poor; moving resources into primary and preventive care; and developing Louisiana as a center of excellence in medical education.
Health Secretary Bobby Jindal wants to explore managed care and vouchers for Medicaid. "Managed care and vouchers are ways we can use private insurance to move our Medicaid program into a unified healthcare market instead of maintaining the separate and unequal system we have today," Jindal said.
With the dollars saved through Medicaid managed care and vouchers that can be used to pay for private health insurance, Jindal hopes to provide improved health coverage for the working poor and indigent.
About 650,000 Louisiana residents are on Medicaid. With the decline in federal aid, the state faces a major Medicaid funding crunch next year that it hasn't figured out how to solve. Further, an estimated 800,000 to 1 million Louisianians have no health insurance or inadequate coverage.
"It is cheaper for us to get uninsured citizens into insurance plans which stress preventive medicine than it is to treat them later when they are sick," said Jindal, who was 24 when Gov. Mike Foster appointed him to his post last January.
A press release and summary of the plan offered no financial details about how this would be accomplished.
The Louisiana Hospital Association "probably won't respond for a while," said its spokesman, Frank LeBlanc. "It's like apple pie and motherhood. You don't attack anything like this."
He said the association would work with the Legislature on the plan. "You see what's going on and then respond accordingly," LeBlanc said. "It really doesn't look too bad."
But an executive at a major New Orleans hospital said that in a closed-door meeting the hospital association made clear it did not favor Jindal's plan in its current form.
The state proposal is too vague, the executive said. The ideas look nice on paper, but it's not clear how the plan would work or be paid for, he said.
As part of Jindal's plan, the state would try to move elderly and disabled Medicaid beneficiaries out of institutional settings and into the community.
In a bid to reform "charity hospitals," Jindal would allow them to earn and keep revenues from fees, third-party reimbursements and cost savings. He also would convert part of disproportionate-share payments-which compensate hospitals for treating large numbers of poor patients-into health insurance premiums for uninsured persons. His plan also would establish a sliding scale of premiums for Medicaid managed care.