With congressmen back in their districts for August recess, the month ahead could be when the American people begin to get their minds around how to change the healthcare system. For Alan Levine, it’s about time.
How national healthcare will change and how Louisiana will adjust to it consumes much of the waking hours of the secretary of the Department of Health and Hospitals, whose daily to-do list, as it is, might be the most demanding in state government.
There are days when Levine’s plight seems like that of Sisyphus, the mythical king condemned to push a giant boulder uphill, only to have it roll back down over and again. The difference is that Levine, rather than being beaten down, seems ready to hit the rock each morning with wonkish enthusiasm, ready to talk healthcare with whoever will listen.
Since he came here from Florida last year, his overarching goal has been to revamp Louisiana’s dysfunctional public healthcare system, which is built around an outdated statewide charity hospital network that anyone with the means or a Medicaid card avoids. He is the lead architect of the Jindal administration’s proposal to the federal government to phase in a managed-care insurance model that would rely on community-based primary care clinics instead of public-hospital emergency rooms. But he must wait to see if and how his proposal fits in with whatever new healthcare mandates arise from Congress.
That long-term goal would be challenging enough if his short-term problems did not seem so insurmountable. Within the context of overall declining state revenues, Levine has some immediate crises threatening to make everything worse.
His and the state’s most pressing concern is a looming big jump in the Louisiana’s Medicaid match rate, which goes from 28% to 37% beginning late next year. That would cost the state an extra $700 million more per year, beginning in late 2010. The feds tie match rates to personal per capita income, which spiked in Louisiana in the post-hurricane economy. Despite Levine’s entreaties, federal bureaucrats have shown litle flexibility toward the unprecedented circumstances, and so it will take an act of Congress to save the state’s healthcare system from being wrecked. The congressional delegation is working on it.
“There are no marginal solutions” to a $700 million cut, he said, which would cause “massive elimination of programs,” especially with another $400 million in federal stimulus funds running out the same year the new Medicaid costs kick in.
At the same time he is trying to work out a repayment plan on $771 million owed to the feds for disallowed Medicaid and transportation payments from ten years ago.
Then there is the $492 million the state claims that FEMA owes it for replacing Katrina-wrecked Big Charity hospital in New Orleans, though FEMA has offered only $150 million. Before then, Levine must referee a turf battle over governance of a new hospital between LSU and Tulane, which he has likened to the Arab-Israeli conflict.
Lastly, a new audit role will decrease the federal government’s payment to state hospitals for treating the uninsured by $130 million next year, or almost 15%.
Adding to the weight of the rock Levine pushes is that his boss, Gov. Bobby Jindal, is sitting on top and writing opinion pieces in national publications panning the president’s and Democrats’ healthcare revamp plans.
The state needs some big breaks, amounting to over $2 billion, from the Obama administration and Democratic Congress, about whom Jindal–potentially a presidential contender himself–has had few kind words to offer, from the stimulus bill to healthcare reform.
Levine keeps his shoulder to the rock while fearless leader reloads his slingshot.
Still, the secretary has taken time to read most of the 1,000-page House healthcare bill–“some portions twice”–and shares Jindal’s concerns about what changes a government-run plan would force on private insurance in years to come. He also fears what employer mandates or penalties would do to small businesses, like the hamburger restaurant he still owns in Tallahassee.
One senses, however, given the historic changes in the works, that Levine is primed for the challenge of integrating his vision for improved coverage and access to public healthcare with whatever plan Congress sends to the states. If the rock doesn’t crush him first.
