The beginning of Louisiana’s 2019 fiscal year begins July 1, 2018. Taxes set to expire June 30, 2018 have resulted in a $648 million budget cut for the Louisiana Department of Health. Those cuts will have a tremendous impact on Louisiana elderly, blind and disabled. That impact is also very personal.
The 2019 Louisiana budget moved forward without any replacement for nearly $1.4 billion in temporary taxes set to expire June 30th. Governor 
Edwards vetoed the 2019 budget bill on Friday. Another special session begins today to address the budget shortfall. The legislature, however, hasn’t solved this problem since 2016 when temporary taxes were put in place to bridge the fiscal gap. The deepest cuts are to the state’s Medicaid program. When you add the federal matching dollars to the Department of Health budget cuts, the overall cuts to the department could exceed $1.5 billion.
THE TERROR OF LOSS
Letters from the Louisiana Department of Health went out after more than a week of media announcements about potential evictions from nursing homes across Louisiana. Many of us have family members or friends with elderly family members who reside in a long term care facility. By the time news reports began detailing the cuts, my wife and I had had several conversations concerning the impact on our family. We’d reached out to friends in the medical community (closure of the local University Hospital and Clinics (UHC) was also threatened) and state government for their opinions on the likelihood of actual evictions and closures. We read every news article available and researched available options.
I can’t imagine a world where we don’t take care of those who nurtured and guided us when they need us most. But I am furious at Governor John Bel Edwards for his use of terror tactics in his budget process. I’m angry because he has terrorized countless families across the state. He weaponized the fears of those with family members receiving Medicaid to supplement their health care. It all seems like a power play to get the Louisiana legislature to enact measures to replace expiring temporary taxes. Proposing Medicaid cuts in the Louisiana budget will leave those we owe the most in a state of peril. While it’s interesting how we got here, how we talk about it is far more interesting.
The letters begin by stating that the addressee, or someone in the addressee’s household, receives Medicaid benefits under one of several programs. The announcement that the Medicaid programs listed in the letter could end on July 1, 2018 due to State of Louisiana budget cuts followed. The fact that federal approval was required to end the Long Term Care Medicaid program was wholly irrelevant. The panic had set in. It was clear what Governor Edwards intended – to terrorize families and force them to begin a campaign to lobby the legislature to do what he couldn’t . . . or wouldn’t.
Our first question when we heard about the budget cuts was about what a family would do since Medicaid is a vital supplement to health care for many. The letter answered that question. Apply for Supplemental Security Income (SSI). The trouble with that option is that it could take months to get a definitive answer from the Social Security Administration. Essentially, we were to do nothing . . . the Louisiana Department of Health also says it will review the records of all Medicaid recipients in hopes that they qualified for another Medicaid program. Residents in nursing homes across the state were promised another letter from Louisiana Medicaid if there is a change in Medicaid coverage. Oh, and by the way, the department suggested that families visit the LDH website for updates.
After an examination of the facts, we were rather confident that the budget crisis wouldn’t result in the evictions Governor Edwards and the Louisiana Department of Health threatened. That was little comfort, however, given the terror that had already ensued. Every account of the proposed budget cuts seemed to simply ignore the plight of the seniors in long term care facilities or the patients and students who would lose medical services and the opportunity to be trained by some of the finest physicians in southwest Louisiana. Instead, we hear of how Governor Edwards didn’t have the authority to issue the letters or how Louisiana legislators are pushing a narrative (and HB 480) that focuses on the likelihood that Medicaid fraud is the actual problem.
EARLY IN THE PROCESS
Dr. Rebekah Gee, Louisiana’s Secretary of Health, attempted to address the impact of the budget cuts on the state’s most vulnerable. Dr. Gee and her staff attempted to put a human face on the proposed Medicaid cuts in meetings with both the House Appropriations and the Senate Finance Committees. Those efforts failed to convince legislators that action should be taken to enact measures to replace the expiring taxes. After these failures the letters seemed a last ditch effort to further emphasize the human impact of the budget cuts.
More than 46,000 elderly, blind and disabled Louisianans participate in Medicaid’s long term care special income level program. Those under the program are considered technically an optional Medicaid population because they earn at least $750 but not more than $2,250 a month. They’re considered optional because many have worked their entire lives, have income, but now need long term care that exceeds their financial means. Medicaid provides an avenue for those in the long term care special income level program to receive long-term care in nursing facilities or through home and community-based services. Many of these people could not otherwise afford these much needed services without Medicaid. The impact is horrendous. Terrorizing those who have no other way to afford these services with the letters sent out last week is undoubtedly inhumane.
THE RIPPLE EFFECT
A month ago, we had basically ignored reports of the cuts to UHC in Lafayette, LA. Lafayette General Hospital (LGH) has operated UHC since 2013 under an agreement with Louisiana State University (LSU) and the state. Prior to this public-private partnership, LSU operated charity hospitals across the state that also served as teaching sites for medical students. UHC currently houses a Graduate Medical Education program with a staff of about 800.
As early as April 3, 2018, LGH president David Callecod notified Governor Edwards of his intent to terminate its agreement with the state and shutter the doors at UHC on June 30, 2018 if the state fails to fully fund the venture. UHC employees have since been notified that they could lose their jobs; students and post-graduate residents could lose their training program. These budget cuts impact five other public-private partnerships throughout the state. More than 800 residents and physicians are in a holding pattern as a result.
Politics as usual now employs terror tactics using the working poor as weapons to move the agenda forward. We talk about terrorism as though terror tactics are confined to use as a weapon of war when, in fact, we merely look the other way when those same tactics are used to weaponized one group of American citizens against the other. In this case, the people we have elected to serve us have chosen to terrorize and take advantage of the most vulnerable among us. All because of political in-fighting and budget cuts.
