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.

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

For Mitt Romney's Health Plan, Look to Gov. Jindal

Want to know how Mitt Romney would fix America's healthcare problem?  Just look to how Gov. Bobby Jindal is reforming healthcare in Louisiana: by eliminating it.  If you think I am kidding, look at the Governor's travel schedule.  Louisianians already know that Jindal spends more time with Romney and raising money for him than he does at the state capitol.  Who else would Romney look to for advice other than the Republican-proclaimed healthcare guru?

Every time Jindal and his band of suck-up, "whatever you say, boss" state healthcare administrators have reassured us they are only cutting healthcare costs without sacrificing services, it has turned out to be a boldface lie.  Each time, they and Jindal have known exactly what the plan was all along, then proceeded to tell the public the exact opposite.  

It all started with mental health. Three years ago, the state's Medical Director clearly stated their intent to eliminate inpatient psych services for youths.   Remember New Orleans Adolescent Hospital? Remember how all those beds in New Orleans were moved to the northshore?  Isn't it convenient how NOAH was sold earlier this year just before the state decided publicly announced that Southeast Louisiana Hospital was closing and that those "psych beds" would be relocated back to the southshore?  I put "psych beds" in quotes because even though the state has already moved the patients out of Southeast Louisiana Hospital, it has yet to even identify where those "beds" will ultimately physically exist, which means they don't exist. And they likely never will.  Just like those more abundant outpatient services to replace the shuttered hospital units don't exist -- and in many cases never did. 

Using the loss of federal Medicaid funding as an excuse for decimating the LSU system is, in my estimation, Jindal and Greenstein being less than totally honest, to put it charitably.  The trip down that road has been underway since last summer when Jindal single-handedly and against the will of the legislature, and therefore that of the people, CHOSE to eliminate about $24 million in federal healthcare funds when he CHOSE to veto the renewal of the 4-cent cigarette tax.  The trip continued with the privatization of Medicaid with his brainchild the Bayou Health Program and with giving control of mental health services to the private insurer Magellan which slashed reimbursement rates to providers 30-40% before Jindal even learned of the federal Medicaid funding cuts, which of course led to even deeper cuts.

The latest outcry, which will of course be ignored by Jindal, is against his cuts to the LSU system that stand to cripple the training of future doctors.  Even his handpicked henchmen on LSU's Board of Supervisors weren't aware of the extent of Jindal's destructive plans:

"The shortage came as a surprise to members of the LSU Board of Supervisors, who recently approved a plan to cut $150 million out of operations of seven LSU hospitals in south Louisiana." -The Advocate 10/29/2012

Oh wait. Except they were lying about not knowing.  An article from six days earlier titled, "Medical Plan Caught Up in Cuts to LSU," noted:

"...the LSU budget cuts could jeopardize training programs’ accreditations and standards, threatening medical education in Louisiana and chasing away medical students needed to treat patients in a state that already has issues about access to health care and doctor shortages in rural areas.  LSU leaders and the governor’s health secretary, Bruce Greenstein, say they’re keeping all of that in mind and have graduate medical education at the forefront of their planning." -The Advocate, 10/23/2012

How are you surprised to learn of something you promised a week ago to keep in the forefront of your mind?  Seems to me that Jindal and his yes-men are lying about saving medical education too.  Why would they if they're getting rid of the places those doctors would practice?  

So if you're down with that, then by all means, cast your vote for Romney and roll out the welcome mat for incoming Secretary of the U.S. Department of Health and Human Services & new Cabinet member Gov. Bobby Jindal.

Mitt, Big Government, and the Deeply Confused Deep (Red) South

People living on the Gulf Coast, especially Louisianians, should be the last ones complaining about big government programs.  D-SNAP, FEMA, NFIP, USACE, National Guard, Road Home Program, etc.  Need I say more?

No I don't.  But I will.

Many local Republicans decry the amount of federal dollars spent on those no-income-tax-paying leeches living off the government dole, those same leeches who Mitt believes will never support him.  What many local Republicans seem unable to recognize, or at least admit, is that they are those leeches.

Source: http://cdn.theatlantic.com/static/mt/assets/politics/nonpayers.banner.taxfound.jpg

Such folks are either misled, uninformed, or disingenuous.  Either way, if they want the rest of us to start taking them seriously, Republican politicians and their local supporters need to walk their talk.  The ones living in St. John the Baptist, Plaquemines, and St. Tammany need to vote for enough new taxes to cover the full cost of the levees they want.

(Well OK, they don't have to hold that vote now.  We can wait until after they get out of the disaster food stamp line.)

I Am So Not Gellin', Magellan!

Louisiana completely privatized mental health services on March 1, 2012.  The behavioral health insurance company Magellan is now the gatekeeper to pretty much ALL mental health services paid for by the state.  

True, there appear to be some advantages.  Services heretofore unavailable to LA Medicaid recipients, such as group therapy and reimbursement for meeting with your child's therapist without the child having to be present, are now available. 

Other than that, it's been HELL.  Where do I even begin?

1. Provider reimbursement rates have been SLASHED by about 30%.  Imagine finding out    

on March 5th that your salary would be cut by 30% -- beginning March 1st.  Yes, March 1st of the same year.  Uncle Bobby Jindal decided to privatize healthcare, or so he says, because the private sector provides the same or better services for lower costs without all the bureaucratic overhead and logjams.  What he didn't mention is that in his kingdom, he would let the private sector insurance company pay psychiatrists and therapists 30% less for services provided to its Medicaid customers than it pays the very same psychiatrists and therapists to see its non-Medicaid customers. 

2.  As of yesterday, zero of my clinic's claims appear to have been processed, so we have no feedback regarding whether Magellan is the type of insurer that will regularly deny 15%, 30% or whatever% of our claims (i.e., payment for services already provided).  You would think the lauded private sector would understand that to keep a business from going under you need to be able to project your revenue.

3. As reported yesterday by Gambit, Clinical Advisor still doesn't work.  

Clinical Advisor is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It's not working. As a result, providers — many of which, like the Guidance Center, serve Medicaid clients — haven't been able to submit Medicaid claims. What's more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid. [Gambit, 3/20/2012]

4. Forget about Magellan paying for your child to undergo a formal psychological evaluation.  They are denying ANY test that in ANY way could POSSIBLY be used to diagnose learning or educational problems even if the test has other uses, AND even if the psychologist states s/he wants to use that test for one of its other uses.  Magellan reasons that the federal government already provides that service.  In reality, the federal government mandates that school districts evaluate any child 0-21 years of age suspected of having a learning or emotional disability.   They just don't provide the schools with all the funding needed to accomplish that.  

5. Our insurance specialist has spent most of her time on hold when calling Magellan, one time for 30 minutes before the call was simply disconnected.  I emailed a question to the provider account plastered all over their website and on DHH's site -- 8 days ago.  Still no response, not even a form reply stating they have received my email.

6. We have heard that Magellan is requiring inpatient psychiatric providers to obtain daily authorization for hospitalized patients, a process that colleagues say is taking about 2 hours/day.  This despite what is written on page 15 of their 21-page FAQ document for providers [updated 2/24/2012]:

Q: For our inpatient unit, I was requesting authorizations practically every day, for different patients. I would get multiple authorizations of two days or three days or four days. If a patient comes in to this short-term unit, am I going to have to get an authorization every day?

A: You do not have to obtain an authorization every day, but the authorizations will be for short periods of time. We want to be sure first of all that the person still clinically needs the inpatient level of care and could not be safely returned to services in their community. Secondly, we want to have a discussion at every review about the discharge plan. Discharge planning, in our view, begins at the time of admission. We want to make sure that members have a well-established plan for aftercare services in place when they are discharged. So we are going to be reviewing every two to three days depending on the status of the person’s clinical condition and the plan for discharge.

And those are just the things I care to write about right now. 

Is LA Medicaid Putting Fat Cats' Profits over Patient Health?

No, I don't mean the so-called "fat cat" doctors that people who aren't doctors think get rich off Medicaid payments.  I mean pharmaceutical companies.

I learned today that Medicaid patients need prior authorization for generic ADHD medications.  Name-brand (i.e., more expensive than generic) ADHD medications are on the current Louisiana Medicaid Preferred Drug List, but generic versions of those same medications are not.  This means that LA Medicaid will pay, no questions asked, for Adderall XR, Focalin, Focalin XR, and Concerta; but physicians must submit Prior Authorization forms for the less expensive generic forms of these medications.

That means that providers who prescribe these drugs to Medicaid patients must fill out additional paperwork, and may even have to call the state medicaid office, to justify why the state should pay for the CHEAPER  generic version.    

As if that isn't problematic enough, there is a shortage of stimulant medications used to treat ADHD, and many pharmacies only have generic versions.  They couldn't get the name-brand versions of the drugs if they wanted to.

I find this policy interesting, considering Governor Jindal's push to save healthcare dollars by privatizing Medicaid and his constant hootin' and hollerin' about how much Louisiana pays to fund Medicaid. 

Nungesser Bathroom Graffiti

This was written on the wall above a urinal at Tracey's on Magazine St., where Nungesser spoke last week:

"Vote Billy Nungesser Lt. Gov. Oct 22. Thank you. [signed by what appears to be "Billy]

Now that's what I call a thorough ground game by Nungesser's campaign.

Vitter's Balanced Budget Amendment and Other Stupid Ideas

I was pondering this Balanced Budget Amendment idea and kept coming to the conclusion that it would be a horrible way to run the country, and that was before I read The Pelican Institute's post stating: "Despite a balanced budget requirement, Louisiana has still managed to acquire $21 billion more in liabilities than it has assets to offset them."

It was also before I read that Norman Ornstein, a resident scholar at the conservative American Enterprise Institute said: "It is about the most irresponsible action imaginable. It would virtually ensure that an economic downturn would end up as a deep depression, by erasing any real ability of the government to pursue countercyclical fiscal policies and in fact demanding the opposite, at the worst possible time."

I think good ole Norm was getting at what I was thinking. I was thinking: where will Louisiana get federal disaster help the next time a levee or an oil well explodes? Given the state's Republican leaders' non-stop pleading for help cleaning up the oil and making the fisherman financially whole again, we'd be up shit bayou if we need those funds if while operating under a federal Balanced Budget Amendment we have a disaster at a point in the fiscal year when all federal disaster funds have already been allocated.

I emailed Senator Vitter and posed this very question to him when I learned of his refusal to vote for a debt ceiling bill unless it is tied to a Balanced Budget Amendment, but he didn't respond. Which brings me to the point of this post. Why does Senator Vitter keep wasting his time on stupid legislation that even other conservatives consider stupid? We all champion lost causes now and again, but Vitter seems to have made a career out of being on the wrong side of issues, being ineffective, and even worse, being consistently counterproductive.

Jim Donelon Can Kiss My Ass on Canal Street!

State Farm will raise rates for mom-and-pop landlords, drop their wind and hail coverage

While the statewide average rate increase is 18 percent, actual increases in South Louisiana can be much higher.

In Orleans, Jefferson and protected parts of St. Bernard and Plaquemines, the average increase will be 59.2 percent, according to State Farm; in areas outside of levees in Plaquemines it will be 93.8 percent; and in areas outside of levees in St. Bernard, it will be 21.1 percent. In St. Charles Parish, the average increase will be 19.2 percent. In St. James and St. John the Baptist, it will be 22.6 percent... Other coastal parishes will also see increases.

State Farm spokeswoman Molly Quirk said that part of the rate increase calculation is the value of cutting the wind and hail policy. [Times-Picayune, 1-16-2011]

Can someone explain how you can charge more for less coverage? How did that get past the Louisiana insurance commission, and how much is Insurance Commissioner Donelon profiting from this? What is he getting that's worth throwing us under a bus?

The article talks about how State Farm has also raised rates on other policies, which were so numerous they probably ran out of room to list the auto insurance increases I also received from State Farm over the past year. I was wondering how my rates could increase on an 11-year-old vehicle on which I cut my coverage IN HALF because I couldn't even afford the insurance before the rate increase. It seems the answers to my questions are to be found in them new fangled calculators the State Farm home office sent to Baton Rouge.

Turns Out Rust Colored Water Probably Not So Good After All

This always happens when I can't sleep. I lie in bed checking my CrackBerry and come across something that angers or excites me leaving me even more awake. You'd think I'd have learned my lesson by now, but alas, I am just as human as you are.

This time the culprit was a brand spanking new study showing that exposure to the substance manganese found in groundwater is linked, for perhaps the first time, to IQ deficits in children. "Yawn." I know. Big deal considering exposure to the current sociopolitical climate is making all of us more stupid by the day.

Then I suffered (because insomnia IS suffering) the thought that woke me up. Even though I can't find it anywhere online, I swear I saw a recent news story about rust colored water in St. Tammany Parish homes. I'm almost certain a spokesman in that story said it was probably because of the high levels of manganese in the area and that while the water looks weird, the manganese is harmless. An online document from the St. Tammany Parish government website calls manganese "a nontoxic substance" (see Why Is My Water Discolored on page 2).

Maybe not:

Lead author Maryse Bouchard explains, "We found significant deficits in the intelligence quotient (IQ) of children exposed to higher concentration of manganese in drinking water. Yet, manganese concentrations were well below current guidelines."

The analyses of the association between manganese in tap water and children's IQ took into account various factors such as family income, maternal intelligence, maternal education, and the presence of other metals in the water. For co-author Donna Mergler, "This is a very marked effect; few environmental contaminants have shown such a strong correlation with intellectual ability." The authors state that the amount of manganese present in food showed no relationship to the children's IQ.

-Bouchard et al., Environmental Health Perspectives, September 2010

The difference in IQ was 6 points. To put that in some perspective, the current black-white IQ gap for 12-year-olds in America is approximately 9.5 points. That realization then led me to ponder the strength of the environment-over-genetics argument for the gap in racial achievement in the U.S., and you better believe that thought REALLY had me wide awake! That's going to have to be a whole other series of posts for another day.

There was definitely no sleeping after that because now I had to get up out of bed and...sigh...save the children. So I just emailed Tammany Utilities to alert them to this. In their defense, as indicated in the research article, while airborne exposure to manganese is harmful to adults and children, manganese in the levels present in groundwater in North America has heretofore not been widely known to be a neurotoxin. Lots of other public water systems need to take heed too.

Anyway, the moral of the story is: the next time some snot-nosed, smart aleck kid mouths off at you, smile and offer them a nice glass of water.


Filtered water, people! What kind of an animal do you think I am?!

Like After Katrina, Outside Folks Getting the Disaster Contracts

The fine folk over at The Lens informed the citizenry today that "Gulf Coast states lag behind other states in getting contracts for oil disaster work." Only 12% of the $53.3 million in federal oil-spill related contracts have gone to Louisiana companies. Most of the rest of that has been contracted to companies in Pennsylvania, Virginia, Massachusetts, and Colorado -- not to other Gulf Coast states suffering the direct environmental and socioeconomic consequences of this disaster.

People in other states need work too, and it seems quite plausible to me that some of corporations best able to execute the particular terms of some contracts are not Gulf Coast business. Maybe many Gulf Coast businesses were already at full capacity due to having already received state or local contracts or contracts directly from BP to do disaster-related work.

My point is I just don't know enough about the details to know whether we're getting shafted down here in the federal contracting game for this disaster. I do know, based on past experience, that we need to dig deeper into this before it becomes like the Katrina recovery in which local workers were brazenly left out of the citizen driven recovery we were promised. That is, if it's not too late. I blogged about it on 9/16/2006, and I'm going to be quite pissed if this sort of thing is happening again...

The Army Corps, Bechtel and Halliburton are using the very same "contract vehicles" in the Gulf Coast as they did in Afghanistan and Iraq. These are "indefinite delivery, indefinite quantity" open-ended "contingency" contracts that are being abused by the contractors on the Gulf Coast to squeeze out local companies. These are also "cost-plus" contracts that allow them to collect a profit on everything they spend, which is an incentive to overspend. [Corpwatch.org, 8/17/2006]

...and we were supposed to have learned our lesson so that our federal government could protect us from shady contract deals.

I hope that last part didn't make you laugh TOO HARD.

Levine Admits Republicans Don't Know Much About Health Care

This is from today's Times-Picayune, page A-6:

"The shortest book in the world is, 'Republicans that I've known and met that know a lot about health care,' " Levine said. "And so there's been a lot of candidates for governor or state legislators from various states who reach out and call and ask, 'What are some of the basics? What are some of the real hot issues from a health policy standpoint?' " [T-P, 7-18-2010]

I guess that explains why Congressional Republicans weren't able to come up with sensible remedies to our nation's health care problems, and why the ones they keep insisting on proposing are often...well...shitty.

The T-P article also offered some insight as to why Levine has overseen the decimation of mental health care services in Louisiana. It seems he might not have known what the hell was going on down here because, like his bossman Bobby, he's been too busy traveling the country instead of doing the job we've paid him six figures to do here at home.

"LA Health and Hospitals Secretary Alan Levine...has been busy doling out policy advice to Republican political candidates around the country,"

"In recent weeks he's written a health care "white paper" for the Republican Governors Association, addressed Republican U.S. House members about the effects of the new health care law on the states, and spent a day in California recently with policy advisers to Meg Whitman, the former eBay CEO who is running for chief executive of the Golden State." and said he hopes to continue doing so through the 2012 presidential cycle." [T-P, 7-18-2010]

So cut the guy some slack, y'all! He didn't KNOW that our children's psychological well-being was in the terlet. How was he to know? He wasn't even here! So lay off of him, people!

The upshot for Alan is that he has used all of these connections he's been busy cultivating to land a posh private sector job back home in Florida, now that he's done fucking the good people of Louisiana over. Way to go, Al! Best Wishes!

Why Is Jindal Taking Our Money?

I just read two news reports that share an interesting common thread. The first story involves the dissolution of the Louisiana Recovery Authority, formed after Katrina to guide the state in its expenditure of federal recovery dollars:

HB1173 would have required legislative approval of proposals and contracts for the use of more than $50,000 in recovery dollars while HB1175 would have allowed parishes to seek alternative uses for allocated recovery funds. Under opposition from the Jindal administration, neither bill won final passage.[Louisiana New Link].

With the dissolution of the LRA, the Jindal administration essentially is allowed to write a blank check on the remaining funds"[2theadvocate.com]

The second story is about how Jindal wants to hold on to the money the state has gotten from BP and prefers that the affected coastal parishes go obtain any money BP owes them on their own.:

Gov. Bobby Jindal unleashed his veto pen late Friday, nixing lawmakers’ attempt to direct $24.9 million to parishes and small towns affected by the oil leak...In his veto message, Jindal said BP should pay the municipalities directly for the impact of the April 20 rig explosion in the Gulf of Mexico.

Left unnoted in Jindal’s veto message was the fact that the money legislators wanted to give to the municipalities comes from a fund fattened by a grant from BP. The Jindal administration wants state agencies to have use of the money. “If it’s acceptable use for state government, then why isn’t acceptable for local governments?” said state Rep. Sam Jones, D-Franklin, who co-sponsored the amendment that would have diverted much of the BP money in the state’s Oil Spill Contingency Fund to help 11 coastal parishes and the towns of Lafitte and Grand Isle. [2theadvocate.com]

"Ain't Nobody Gonna Wanna Eat an Oirly Crab"

Wise commercial fisherman Oliver Rodesil aptly summed up the latest predicament facing south Louisiana (at about the 2:00 mark). Definitely the quote of the day.

Now Learn the Reverse Jindal Two-Step

In my previous post, I taught y'all how to do the Jindal Two-Step. Now I'm going to show you the Reverse Jindal Two-Step. You may recall that in the simple Jindal Two-Step you do something THEN you claim you're not doing that exact same thing. The Reverse Jindal Two-Step is merely the same thing except backwards:

1) DON'T do something (or say you're not going to do that thing):

Governor Jindal said: Unlike Alabama, California, Florida, Georgia, Maine, Maryland, Massachusetts, Missouri, and New Mexico, which all assumed in their budgets that FMAP aid would be extended for their states - this budget does not anticipate federal relief for FMAP, out of an abundance of caution. [nwlanews.com, 2/15/2010]

2) Then do that thing you told the world you would not do:

By relying on a federal bailout to solve the 2010-11 budget deficit, Jindal is courting potential opposition from legislators who might be leery of using that money until Congress has acted. [T-P, 4/17/2010]

As you can see, you'll add flair and pizazz to the first part of this dance move if you also criticize others for doing something that you'll turn right around and do yourself. Try out these moves at your next Fais Do Do. It'll be a hit! Let me know how it works out.

Learn the Jindal Two-Step

Here's how you do the Jindal Double-Talkin' Two-Step:
1) Do something:

[LA Education Superintendent Paul Pastorek said:] “While the governor’s proposed budget does not dedicate state funding to support teacher stipends... [2theadvocate.com, 3/7/2010]

2) Then claim you're not doing the very thing you're doing:

...our Nationally Board Certified Teachers will receive their annual $5,000 stipend through their local school districts.”[2theadvocate.com, 3/7/2010]

To sum up, Jindal and Pastorek would have us believe that even though the Governor hasn't included money for teachers' stipends in his budget like he did last time, he's not the one cutting teachers' stipends because the local school districts have these surpluses they can use to pay the bonus stipends. Unfortunately, the local school districts beg to disagree:

Local school board officials counter that without the traditional annual cost-of-living bump, Jindal’s proposed standstill MFP saddles them with increases in a variety of costs such as health care and retirement... John Dilworth [Superintendent of the East Baton Rouge Parish School System] wrote a letter to The Advocate’s editor Thursday challenging the validity of Pastorek’s numbers. He says declines in revenues, such as sales taxes from which the public schools receive much of their money, are being offset by the surplus. Dilworth does not commit to paying the stipends. [2theadvocate.com, 3/7/2010]

If this song-and-dance seem familiar to you, it may be because you remember that Gov. Jindal dispatched his minions to try and pass the same okee-doke routine over on us when they closed NOAH and cut inpatient psych services while claiming that they weren't cutting services at all.

Jindal, OMH Decimating Outpatient Psych Services Too

Remember back when Gov. Jindal, DHH Secretary Alan Levine, and top OMH officials assured us that by closing New Orleans Adolescent Hospital (NOAH) they were freeing up $14 million to "improve much-needed outpatient services"? I can't help but assume that money never made it down to the outpatient clinics I work at everyday because no one in Baton Rouge wants to even pay for us to have voicemail, and it's not because they're paying to lease clinic space after removing us from the space we had at NOAH. The lease at our cramped new digs is $0 where, incidentally, they have consolidated so many employees that the power goes out 3-5 times a day from the now overloaded circuits. Try faxing in a prescription authorization to pharmacies when the power goes out whenever you hit "Send," or when that telephone/fax line periodically goes dead. When I receive a call, I have to walk down the hall because we can't transfer calls to each other despite being in the same building; and while I'm on the phone, no one else can call. OK, actually that's not true. People can still call us but that call goes immediately to a voicemail system that no one from here to Baton Rouge can tell us how to access. All we can do is hope none of those are urgent, which is a fantasy since we serve very ill, troubled youths. Actual assistance or a simple acknowledgment of these problems from OMH are also fantasies much of the time.

We serve the same number of clients even though we have fewer therapists. They left because they were fed up with this sort of foolishness, but they won't be replaced because of Jindal's hiring freeze even though the state has already budgeted for those positions just like they budgeted for all that money closing NOAH was supposed to free up.

Working at a place where your co-workers, even some of the ones making close to six figures, openly discuss finding a new job and share job leads with one another can be nerve-racking. That sort of stress will complicate any job but especially when your job is helping others deal with their own constant psychological stress.

A story about continuing cuts to healthcare in Louisiana is, interestingly, posted to a web page titled Accidents & Disasters. I fear we'll being seeing more of those in the near future. Not just the spectacular, front-page headline kind, but also the excruciating, painful type of tragedy that slowly and quietly ruins families' lives. If you need an example, think of the economic and social ruin left in the wake of an Orleans Parish school system starved of basic necessities. Talk to anyone now in the position of trying to provide state-funded services within LA's Office of Mental Health(OMH). Ask them how employee morale is these days. I should know. I am one of them.

LA Legislators Think About Doing Something

From the Baton Rouge Advocate:

Legislative leaders are expressing concern about the cuts to health-care programs in the governor’s $24.2 billion proposed state operating budget.

However, members of House and Senate budget committees said they do not have an alternative spending plan for the fiscal year that starts July 1.

Senate President Joel Chaisson II, D-Destrehan, said there still is time for legislators to develop their own agenda. [Advocate, 2-18-2010]

Umm, yeah, y'all might want to get crackin' on that.

Here's an Idea for Improving Student Test Scores

$150 million for improving accountability measures?

If Louisiana is selected by the U.S. Department of Education for the grants, about half the money would be distributed to districts to help with programs aimed at helping the poorest performing schools improve their rankings and student test results. Stronger accountability measures and teacher evaluations would be part of the process. [T-P, 1-9-2010]

I'm all for accountability, but here's an idear: How about spending the money on mental health services and more special education resources like more individualized supports, speech-language therapy, occupational therapy or on-campus health clinics or supports for parents to help their kids do better in school -- you know, all of the things that research has actually shown to help kids perform better in school.