What's the Whole Story Behind Louisiana's Medicaid Expansion for the Dead?

I've read the legislative auditor's report and various articles on Louisiana compensating private industry insurers for Medicaid services rendered to dead people; and the more I read, the more unanswered questions I have.

In this article, Kathy Kleibert blamed it on Social Security records.

Department of Health and Hospitals Secretary Kathy Kliebert said Monday that the problem occurred because DHH was relying on “a very sloppy database in Social Security” to determine who should be enrolled in the managed care plans. Most of the cases involved older adults with disabilities qualifying for Medicaid through the Social Security system, she said.

“In the future we are going to be using our vital records database,” she said, referring to the state’s registry of birth and death records.
http://theadvocate.com/home/7492510-125/auditor-state-pays-health-coverage

This Town Talk article implies the state relied on data from the DHH vital statistics office.  http://www.thetowntalk.com/viewart/20131104/NEWS01/131104017/Audit-Louisiana-DHH-paid-1-9M-Medicaid-dead-people

The legislative auditor definitely used DHH Vital Stats data to conduct the audit, but why would he use that method if the state uses/used Social Security info? http://app1.lla.la.gov/PublicReports.nsf/5BBFA4B0591132DB86257C14004DD0C4/$FILE/00035F69.pdf

Also, wouldn't Kleibert's response suggest that all of those people kept receiving federal and/or state SSI payments after they died?

I understand using a different methodology to audit payment errors.  That makes sense, but why wouldn't the state legislative auditor also use the same methodology as a means for comparison to lend more validity to his findings?

Or did the auditor intentionally employ a methodology that provides a safety escape hatch for DHH?

Why Are We Buying What Donelon Is Selling?

Louisiana insurance Commissioner Jim Donelon explained last week on Angela Hill's radio show (at about minute 13:00) why our auto insurance is so high.  Auto insurance rates in Jefferson, Orleans, and a couple of other parishes are 40% higher than rates in the rest of the state because of a prolific "soft tissue" market, Mr. Donelon said.  That is, the proclivity of locals, aided by lawyers and doctors, towards seeking compensation for injuries resulting from auto accidents.  It pains me to agree with that characterization of the local citizenry.

It also leaves alot unexplained, in my opinion.  Seven years ago I paid about $74/mo. for a policy in Nashville with $100,000/$300,000 (100/300) limits and about $80/mo. for the same coverage in Chicago.  When I moved back to New Orleans, I had to slash my coverage limits to 50/100 just to barely afford auto insurance here.  Turns out I couldn't even barely afford it.  I just plain could not afford it, not even if I doubled my deductible.

With each passing year, I tacked on 365 more days to my flawless driving record *knock on wood*.  Still, my premiums continued to rise despite my car and me both being six years older and my having aged into an (allegedly) cheaper rating class; and five years into my move back home, I had to drop my coverage to the 25/50 state minimum.  

Commissioner Donelon's explanation does not even come close to explaining why I and every Louisianian shell out 50% more money for about 1/5th of the coverage that we would get in other major cities.  The WDSU report that ran last evening seems to confirm my hunch that the prevalent "soft tissue" industry is not to blame for much of this disparity in auto insurance rates because it only accounts for approximately 10% of the increased premium.  That news story also makes very fuzzy links between a national rise in auto insurance fraud and cell-phone caused driver distraction, but Louisiana's ridiculously high insurance rates long pre-date either of those phenomena.  

Even if auto insurance fraud accounts for 40% of our premiums in metro N.O., that does not satisfactorily explain why it's 40% more for WAY less coverage.  I am, in fact, now paying 40% more than I paid in Chicago and Nashville, but shouldn't I be paying 40% more for 100/300 coverage instead of 40% more for shitty 25/50 coverage?  Maybe there is an actuarial table somewhere that that backs up Mr. Donelon's explanation, but until I see it, I ain't buying it.

Senatron Vitter and The Talking Points

I think my Senator might be an automaton.

This past summer, I emailed Sen. Vitter what I thought were two simple questions: "Could you please explain your reasons for voting NO on the nomination of Richard Cordray for Director of the Consumer Financial Protection Bureau?  Who do you think would have been a more appropriate choice for this position, someone you could have voted for?" 

A little over two weeks later, he responded:

Dear Friend,
 
Thank you for contacting me in opposition to Majority Leader Harry Reid's planed "nuclear option" to change procedures in the Senate. I appreciate hearing from you, and I completely agree with you. 
 
As you know, Senator Reid was advocating ending the 60-vote threshold currently needed to confirm Executive branch nominees. He was considering a "nuclear option" to lower the threshold to 51 votes, which would have drastically changed the rules and norms of the Senate. I am vehemently opposed to this hypocritical idea that would severely hamper a minority party's constitutional right to advise and consent. A last minute deal was reached to defuse this current crisis, but Democrats could still attempt this maneuver in the future. 
 
If Senate Democrats insist on changing how the Senate operates, it will not be because Senate Republicans have forced their hand. Of the 1,564 nominations President Obama has sent to the Senate over the past four and a half years, only four have been rejected. Also, according to the Congressional Research Service, President Obama's cabinet nominees are, on average, moving from announcement to confirmation faster than nominees from the last two previous Presidents. Majority Leader Reid's plan is based on false premises, not on facts. Democrats would do permanent damage to the Senate for immediate and temporary political gain. Rest assured that I will hard to oppose this "nuclear option." 
 

Again, thank you for sharing your thoughts on this important issue. Please do not hesitate to contact me in the future about other issues important to you and your family.

__________________________ 

OOOOOOK, Take 2.  Although I should have been pleased over the personalized comment tacked onto the end of his email in a totally different font, I ungratefully wrote back:

Senator Vitter,

I do appreciate your taking the time to respond to my message.  It appears, however, that you responded to questions different from the ones I asked.  My questions were:

Senator Vitter, Could you please explain your reasons for voting NO on the nomination of Richard Cordray for Director of the Consumer Financial Protection Bureau? Who do you think would have been a more appropriate choice for this position, someone you could have voted for?

Could you please answer those questions?  Thank you.

_________________________

That was two months ago.  

Could the appropriate staffer please reboot the Senator in order to complete the installation of his most recent talking points?  It's not like y'all are doing anything else.  

An Open Letter to LA State Treasurer John Kennedy

Dear Mr. Kennedy,

I would like to begin by lauding your tireless efforts in ensuring that Louisiana's tax dollars are spent wisely and, specifically, your vocal advocacy for sensibly balancing the needs of our citizens with those of individuals and companies who contract with the state.  Because of the credibility you've established in addressing such matters, I urge you to ensure that the money received from pharmaceutical settlements finds its way back into the healthcare services budget from which it originated and to which it belongs. 

$38.8 million from Allergan, Covidien, United Research Laboratories, Merck, and Pfizer 

+

$258 million (+ $70 million for attorneys' fees) from Johnson & Johnson

+

$8.5 million from Watson Pharmaceuticals  
+

$45 million from GlaxoSmithKline (+ $7 million for attorneys' fees) 

_________________________________________________________________

= $350.3 MILLION DOLLARS FOR MEDICAID 

Attorney General Caldwell and DHH Secretary Kliebert acknowledge that these monies are "the result of Caldwell's office aggressively pursuing the recovery of Louisiana taxpayer's vital Medicaid dollars."  One of the attorneys for the state also stated that the money "will go directly to Louisiana’s Medicaid program."  By my estimate, at least $258 million of this money (from the J&J settlement) should specifically go back into the state's mental health budget.  

Mr. Treasurer, please make sure that happens.  

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/category/false-advertising/#sthash.VVI5MdXy.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/category/false-advertising/#sthash.VVI5MdXy.dpuf

K +8

Budgeting for Little Outcomes

The little things in life really are important, probably because those little things -- a child's smile or embrace, a joke told in passing by a friend that lifts your spirits on a shitty day -- eventually end up playing a big role in the quality of your life.

The same holds true for the little things that bring not joy but irritation, and eventually, high blood pressure if you're not careful.  Take light bulbs and dollar-store paint, for example. 

At 4:36PM yesterday during school zone hours, the school zone lights in front of KIPP Believe on S. Carrollton were not flashing, but I saw the speed camera flash on at least 5 different drivers who couldn't have been driving more than the regular posted speed limit of 30mph due to the volume of traffic at the time.  As was the case THREE MONTHS AGO when I reported this issue to my Councilwoman whose office then notified 311 and Dept. of Public Works Traffic Engineer Allen Yrle of the issue, the school zone lights were flashing on the opposite (lakebound) side of S. Carrollton, but not on the riverbound side.   New school year, same problem.  

Another little thing that bothers me in New Orleans are parking tickets, especially the ones for parking within however many feet ordained by city law from an intersection or crosswalk.  Now maybe it's just me hating on the meter maids for their amazing ability to eyeball distances with such pinpoint accuracy, but folks like me who were not blessed with that talent would appreciate a visible demarcation of the forbidden parking zones.  Every other city I've lived in has accomplished this through the modern miracle of painting white, sometimes yellow, lines on the pavement.  Yes, we are New Orleanians, and we pride ourselves on marching to the beat of a different drum; but maybe doing this one thing the way other modernized Western civilizations do it isn't so bad.  Just this once.  I SWEAR, just this ONE THING, and that's it.  And only temporarily, just until we come up with parking stripes more representative of our unique culture that have something to do with Mardi Gras Indians, or second lines, or the Saints or something.

It just so happens that we are once again upon that most wonderful time of year <*cue Johnny Mathis*> when the mayor requests citizen input regarding the next year's budget.   "Budgeting for outcomes," I believe he likes to call it.  Well, here's my advice, Mayor Landrieu: How about we start with budgeting for easily achievable, even cheap, outcomes like replacement bulbs for school zone signs and heavily discounted gallons of paint?  Nothing says RE-ELECT ME like a list of accomplishments!  Yes, even if it's just a list full of the little accomplishments. 

Where Is This on the Teacher Evaluation Form?

Just wondering...how many points is this worth when calculating a teacher's performance ranking?

Jindal: No need to expand Medicaid since Obamacare will be effective

There you have it, folks.  Gov. Jindal finally gives a legitimate reason for why he won't expand Medicaid eligibility.  You see, contrary to all of his previous arguments against healthcare reform, the Governor argues that Obamacare WILL be effective in reducing the number of uninsured Americans.  See Argument #4 in this article:

Without expanding Medicaid, and once eligible people are enrolled into healthcare exchanges set up by the federal government, there will be less than six percent of Louisianians without health insurance. That's why the state is focused on implementing public-private partnerships with charity hospitals across the state to expand access.

http://www.businessreport.com/article/20130422/BUSINESSREPORT02/130429997#ixzz2RpBwwhJF