- Associated Press - Wednesday, March 25, 2015

Recent editorials from Louisiana newspapers:

March 24

The Advocate, Baton Rouge, Louisiana, on inventory tax credit:

The whining of local governments, getting undeserved fat checks indirectly from the state, cannot be entirely disregarded by the Legislature when it meets to consider the fate of the inventory tax credit.

It is part of a larger problem of state-local relations in government. That unhappy relationship needs marriage counseling.

Gov. Bobby Jindal’s budget plan proposes to keep the inventory tax in place, but it suggests a huge curtailment of a program through which the state, for the last two decades, has refunded all inventory taxes paid by businesses to local governments. Instead of killing the refund program - which industry views as a $400 million tax hike - business leaders propose simply getting rid of the tax, a plan Jindal has said he’d support.

Yet either way, that would devastate the parishes who have depended for years on the inventory tax credit: The businesses pay the parishes but then get a state tax credit. It’s a wash for the businesses.

The system was a way, decades ago, for the state to end the inventory taxes, at least as far as businesses were concerned. Ending the credit would thus indirectly hit local governments. Yet the moral case for local governments is not strong.

The original argument for the inventory tax credit was economic development. Consultants said Louisiana’s inventory tax was a disincentive for warehousing businesses to locate in the state.

What no one intended at the time was that the credit would blossom during Jindal’s term in office into a budget buster, benefiting local governments but at a high cost to the state. That’s a long way from the original idea of avoiding taxes on warehouses of refrigerators or microwave ovens awaiting shipment.

Despite Louisiana’s central location, the warehousing job boom never came, but the inflation of the definition of “inventory” proved a huge bonus for local governments in industry-heavy parishes. They got the revenue, and the state paid the companies back; once “inventory” became larger, the locals benefited, and the state paid and paid and paid.

It’s the picture of an irresponsible relationship.

Irresponsibility is not limited to sheriffs and the like. Lawmakers let the situation drift. Few legislators are knowledgeable about the complexities of the state-local relationship, dysfunctional as it is.

State subsidies for all sorts of things - local police pay, road repair, civic centers and exhibition halls large (the Morial Center in New Orleans) and small - engender political maneuvering and controls that are out of place in most states, if not bizarre.

Sorting all of that out in the context of a budget crisis is difficult if not impossible, especially as Jindal and, for that matter, the Jindal-influenced Louisiana Association of Business and Industry are holding to an anti-tax orthodoxy that hobbles the kind of trading that would allow one spouse to make reasonable accommodation for the other’s needs.

Calling Dr. Phil, to the State Capitol, stat.




March 23

American Press, Lake Charles, Louisiana, on budget shortfall’s effect on New Orleans-area health care program:

Louisiana state government has funded a number of local programs over the years, and the costs are finally coming home to roost. Unfortunately, one of the first areas to feel the effects of a $1.6 billion budget shortfall for the fiscal year beginning July 1 could be a health care program serving 57,000 uninsured patients.

The Greater New Orleans Community Health Connection (504HealthNet) coordinates 41 health care clinics in Orleans, Jefferson, St. Bernard and Plaquemines parishes. Many of those who are treated in the clinics could have joined an expanded Medicaid program under Obamacare, but Louisiana officials declined to participate.

Kristy Nichols, state commissioner of administration for Gov. Bobby Jindal, said $7.7 million for the New Orleans area program is one of the proposed budget reductions necessary to help close that shortfall. The appropriation ensures the federal government commits another $12.6 million for the program, so over $20 million would be lost.

Nichols said she understands the clinics provide valuable services, but the state had hoped local governments would find a way to pick up the costs.

Charlotte Parent, director of the New Orleans Health Department, said she believes the state does have a responsibility for funding the program.

“The city believes and feels that, while it serves those parishes in our area, this is a state issue,” Parent said. “We are part of the state and our people are part of the state. And we should want to provide services that are going to provide good outcomes. And for a state that has poor outcomes, this is a project that helps up move forward.”

Susan Todd, executive director of 504HealthNet, said people would still get sick and the clinics have been able to care for people in their own communities. It is definitely preferable to having patients show up at hospital emergency rooms, some of the most expensive medical care available.

Todd said 18 health centers are involved at the 41 site locations. In 2013, the program experienced nearly 97,000 patient visits that generated jobs for 188 people in full-time medical related positions.

The Times-Picayune said the program is essentially a waiver of Medicaid eligibility for people age 19 to 64 who are at or below the federal poverty level and who don’t meet the current Medicaid eligibility requirements.

The newspaper said the cooperative program has received accolades in national public health circles because of its innovative approach in bringing quality health care to underserved areas.

“.Yet every year for the past several years, advocates of the program have found themselves begging for funding to be able to extend the (Medicaid) waiver,” the newspaper said.

Two other state-funded local programs don’t have that problem. The untouchable homestead exemption has made it necessary for the state to help fund local government operations. Hundreds of millions of dollars are also spent each year to supplement the pay of local first responders, and that appropriation has been given constitutional protection.

The health care of 57,000 people deserves equal consideration and protection.




March 25

The Times-Picayune, New Orleans, Louisiana, on benefits of Medicaid expansion:

The uninsured Louisiana residents who would benefit from the federal expansion of Medicaid are often described as a lump sum, just one big number. They are, of course, tens of thousands of individuals. And they are working as waitresses, retail sales clerks, bookkeepers, janitors, daycare workers and in other “occupations that Louisiana residents rely on,” according to a new study from Families USA.

The study, which is based on census data, lists the top nine occupations in Louisiana that would benefit from the Medicaid expansion: food service, sales, construction, cleaning and maintenance, office support, personal care, transportation, production and health care support. These are jobs that touch all of our lives.

Those nine categories include an estimated 171,000 Louisiana residents who are working but uninsured. Another 30,000 uninsured residents hold other types of jobs, the study found.

In total, these uninsured workers make up 56 percent of the 362,000 state residents the study says would qualify for Medicaid under the expansion. Those who are unemployed include students, non-working spouses, people with disabilities and people who have left the workforce.

The Families USA study illustrates the people left behind when Gov. Bobby Jindal opted not to accept the federal Medicaid expansion. They aren’t covered on the job. They make too much money to qualify for Medicaid currently in Louisiana, but not enough for the insurance tax credits that are part of the Affordable Care Act.

So they are caught in the middle without health coverage.

Maybe they will be lucky and stay healthy, but people shouldn’t have to count on that. Many of them no doubt are already dealing with health conditions. They may delay seeing a doctor and end up in an emergency room, which is a bad approach both for their well-being and the cost to the health care system.

The Legislature or the next governor could reverse the decision and accept the Medicaid expansion, which covers families earning up to 138 percent of the poverty level. But the state has missed out on the first of three years of the program when the federal government is paying 100 percent of the cost.

The extra Medicaid money not only would relieve stress on families, but could help ease cuts in health care as the governor and Legislature look for ways to close a $1.6 billion budget deficit for next fiscal year.

The Medicaid expansion could pay for more doctors and other health care workers and put hospitals and clinics on stronger financial footing. The additional money could help keep a vital network of primary health clinics going in the New Orleans area.

The 41 clinics are one of the region’s greatest post-Katrina success stories. Roughly 57,000 uninsured patients are getting primary care and mental health services. That keeps them healthier and holds down medical costs.

Gov. Jindal’s administration acknowledged the clinics’ benefits in presenting its proposed budget for 2015-16 to legislators this month. But the governor’s office still zeroed out the clinics to balance the budget.

If legislators don’t find a way to put the money back, the clinics will lose $7.7 million from the state. That would trigger the loss of another $12.6 million in federal matching money.

That is just a small example of the good that the estimated $16 billion in additional federal money for Medicaid could do in Louisiana.

David Bronner, who is CEO of the Retirement Systems of Alabama and an expert in economic development, argues that turning down millions in health care money and the jobs that could go with it is “totally irresponsible.” He’s right.

A Baton Rouge hospital is closing one of its emergency rooms at the end of this month because of the cost of treating uninsured patients. Health clinics in New Orleans are under financial pressure, and tens of thousands of residents across the state have no way to pay for medical care.

That isn’t healthy for them or for Louisiana.



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