EDITORIAL: If Louisiana legislators want to save taxpayers millions of dollars, they’ll reform elderly care

Advocate, The (Baton Rouge, LA)

March 11--Though it cost almost $1 million, the just-completed special session of the Legislature accomplished zero toward resolving Louisiana's budget problems.

But when the regular session of the Legislature convenes on Monday, there is a cost-effective and politically popular way to save millions. Lawmakers can reform elderly care in Louisiana.

But to do so, legislators will have to put the interests of patients and taxpayers ahead of the wishes of nursing home owners. For politicians addicted to campaign cash, that's not going to be as easy as it sounds.

Over the last decade and a half, a handful of the industry's leaders, their lobbyists and their relatives have pumped nearly $6 million dollars into Louisiana political campaigns -- and that's just the contributions that were recorded electronically, a requirement that's only been in place since 2010. Those contributions included about three quarters of a million dollars each to our current governor and his predecessor.

It's a lot of money, but it's a sound investment, since a large percentage of revenues come from the taxpayer, principally via Medicaid coverage for long-term care. The industry has bought its overseers.

The battle for those federal dollars pits nursing homes against home health care providers, who offer services like cooking and cleaning to elderly and disabled folks who do not want to live in an institution. Home health care is cheaper for the state and preferred by clients, so the choice should be simple.

But in Louisiana, nursing homes sponge up 77 cents of every dollar spent on the elderly and disabled. In other states, the nursing home share is typically 60 percent.

Moreover, Louisiana is moving in the wrong direction. From 2009 to 2016, total home- and community-based funding for the elderly declined by 7 percent, even as nursing home funding increased by 34 percent.

Not surprisingly, 30,000 people -- roughly the population of New Iberia -- are on wait lists for home health care services while nursing homes are overbuilt.

The current system neglects the wishes of thousands of elderly and disabled, but it also ignores the interests of the Louisiana taxpayer. Analysts have argued that the state could reap $100 million from savings and policy changes by introducing managed care for elderly and disabled patients. One benefit of the changes is that, in theory, managed care companies would choose the best and cheapest options, while politicians tilt the scales in the opposite direction. The state already takes advantage of managed care oversight for regular Medicaid patients.

In July, $1 billion in temporary taxes expire. Democratic Gov. John Bel Edwards and Republican legislative leaders are at an impasse over the mix of tax increases and budget cuts needed to avert the crisis.

But they have one thing in common: They're both loyal to their campaign contributors. So if there is going to be reform -- and savings -- the pressure is going to have to come from taxpayers.

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