Head of LSU public hospitals says federal health law will eventually ...

The new federal health care law will make it difficult for LSU's public hospital system to maintain current levels of service in coming years unless Louisiana joins the expansion of Medicaid laid out in the law, the new head of the system said Tuesday. Dr. Frank Opelka, who took the reins of the hospital system last month, noted that the law eventually reduces the type of federal funding that Louisiana relies on to pay for much of the care at his hospitals and clinics.

The law cuts the amount of federal dollars funneled to states to compensate for the care of uninsured patients, although these reductions are phased in over many years. The fix for poor uninsured patients envisioned by the federal health care law, often referred to as "Obamacare," is an expansion of Medicaid, which is federally subsidized, to cover more people.

But the U.S. Supreme Court's decision this summer upholding the law also left it to each state to decide whether to take the Medicaid expansion. Some governors, including Gov. Bobby Jindal, have said they will reject this provision of the law.

Jindal has taken a?lead in the Republican party's response to the upholding of the health care law. Just days after the Supreme Court decision, Jindal said the best way to deal with Obamacare would be to elect Mitt Romney, saying repeal of the federal law would presumably follow. Regardless of who is elected next month, Jindal opposes expanding the Medicaid program, saying it would cost Louisiana $3.7 billion over 10 years.

Bruce Greenstein, secretary of the Louisiana Department of Health and Hospitals, said his reading of the federal health care law is different than Opelka's. Although the type of federal payments used to compensate hospitals for treatment of the uninsured are slated to drop, Greenstein said he doesn't believe Louisiana will end up getting less money because of the state's high?cap in the program.?

"We will not see a reduction in the (federal) payments to the LSU hospitals," Greenstein said. "I am not concerned about that piece."

The Jindal administration rejects the Medicaid expansion because the program is outmoded, Greenstein said, failing to adopt in the decades since it was created to changes in the health care market. It doesn't give the state the flexibility it wants, he added.

Opelka, interviewed after he spoke to a meeting of LSU hospital administrators and others within the system, declined to say whether he personally believes the state should join the federal Medicaid expansion.

As the new head of the LSU system, Opelka has presided over deep cuts to the seven LSU hospitals in south Louisiana, working closely with Greenstein on these reductions. The cuts announced earlier this month reduced the $802 million LSU budget by 19 percent, resulting in the elimination of about 1,500 jobs and dozens of hospital beds, and forcing specialty clinics to cut back hours.

But Opelka and Greenstein have emphasized that while they are cutting services, they are talking to private health care providers about stepping in to provide care to the uninsured patients traditionally treated by the LSU system. Those services will be paid for by tapping federal health care dollars in a move that Opelka has said will result in patients eventually receiving better care that costs the state less money.

In a 2010 study for the Kaiser Commission on Medicaid and the Uninsured, researchers estimated that, under Obamacare, 366,000 people currently not covered by Medicaid in Louisiana would join the program by 2019. The Medicaid expansion goes into effect in 2014, with the federal government paying 100 percent of the cost for new enrollees for the first three years, eventually dropping to 90 percent.

A recent study by the liberal Louisiana Budget Project, which supports the expansion, estimated that one in four Louisiana adults under 65 is uninsured. While Louisiana's insurance coverage for poor children is generous ? and is partially responsible for 97 percent of children in the state having health insurance ? Medicaid eligibility for poor adults is very restricted.

But Opelka said that the planned cuts to the federal money his system currently relies on would be difficult to manage after they are implemented.?

"I don't know how we can handle the underinsured without strong consideration of the Medicaid expansion," Opelka said after he addressed a meeting of the LSU Health system. "I can't do the math and get it to come out where it works."

The effect on patients would be reduced services, he said.

"We are going to be more stressed than we currently are. And this level of stress has already had a big impact on patients that we are trying to mitigate through partnerships," Opelka said.

Opelka's predecessor, Fred Cerise, had raised some of the same questions about the impact of the federal health law on the LSU system. Cerise was ousted in August.

Greenstein said he respects Opelka and his work on transforming the LSU system, but said he doesn't have a "strong staff" to help him analyze the impact of the federal health law on Louisiana's programs.

Opelka said the LSU system is preparing to move forward without the state expanding Medicaid, but also looking at what would happen if the state changed its policies.

Source: http://www.nola.com/health/index.ssf/2012/10/head_of_lsu_public_hospitals_s.html

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