Shut up, go back to work, do not ask any questions

As we've already noted, the sale of Blue Cross Louisiana to a notorious for-profit corporation is a terrible deal. Even your also notorious Louisiana Legislature seems to understand this. 

Legislators, who came prepared with detailed questions about every aspect of the complex transaction, returned repeatedly throughout the marathon hearing to Elevance’s track record in other states. The company has racked up more than $26 million in regulatory fines for violations that included denying coverage of needed medical care, failing to cover preventive service like immunizations and breast cancer screening, and failing to pay claims in a timely manner.

Louisiana, where Elevance administers the Healthy Blue Medicaid plan, was among the seven states where the company has incurred fines.

But, because the deal also grants the new Governor and Commissioner of Insurance seats on the board of the new entity the sale will create, and sway over how some of the proceeds are spent, it will likely gain the approval of both. The Governor, in fact, has already made a public endorsement.  

There appears to be public momentum gathering against the sale. Note the skeptical legislators above and, here, even our reactionary Treasury Secretary John Fleming is militating against it today.  In the meantime, though, let's look at Jeff Landry's stated reasons for accepting his bribe lending his support. To begin with, he says it's a good excuse to boot people off of Medicaid.

Landry’s strongest comments in favor of the Blue Cross sale centered on the nonprofit foundation, Accelerate Louisiana Initiative, that will funded with the bulk of sale proceeds and surplus Blue Cross reserves, for a total of more than $3 billion.

The foundation will seek to operate as a nonprofit public-private trust, a designation that will require a change of state law. It is to have four focus areas, all centered on poverty and health outcomes. Landry praised the first pillar, which supposedly would move people from dependence to independence.

“In other words, we’re going to be able to have an organization that is going to work towards trying to move those people off of Medicaid,” the Republican governor said.

It used to be, you had to just pull the inference out of the policy choice itself and explain how hostile the intent was.  Nowadays, they just come out and say what they are doing.  

The other thing they've given up on pretending to anymore is the notion that there are fiscally "conservative principles" at work here. It's about being cruel for the sake of being cruel.

That federal government-sponsored health insurance program for poor people was dramatically expanded under Landry’s predecessor, Democrat John Bel Edwards. Almost half the state’s population is now on Medicaid, most of which is paid for by the federal government.

Landry said Accelerate money will also be used to help get the state’s “safety net programs” working in sync. He used the example of a hypothetical patient with Type II diabetes, a chronic health condition that leads to other health problems. Landry said the patient might receive a “shiny brochure” from her doctor telling her to eat healthy and lose weight to help her condition.

“Then, she puts it in her purse, goes to Piggly Wiggly and goes down the aisle to the soda, chips, cookies, and then she goes to the cash register with her Louisiana Purchase card,” said Landry, using an old trope that criticizes welfare recipients. “How about if we had an organization that helps the government start to integrate the food stamp program with the Department of Health, so instead of getting a fancy brochure we could give her $100” if she engages in healthy lifestyle choices,” he said.

“When else are we going to get that opportunity again?” he said. “Those are the things we will do.”

Poor people deserve to be bullied and shamed by the state.  It's the only way to keep the help in line.  And that is, in fact, all they are good for. Landry is saying that out loud as well. 

The plans for the foundation, which were changed late last year as Blue Cross sought approval from state regulators for the deal for a second time, now specifically prohibit research money for health outcomes from going to higher educational institutions — except for the LSU-affiliated Pennington Biomedical Research Center in Baton Rouge.

Landry said that giving the money to other Louisiana research institutions, a list that would include LSU and Tulane University, would be wasteful.

“I don’t want money going to higher education. I want the money used in our workforce because everywhere I go, people are telling me they don’t have skilled labor. And I’ve seen these deals around the country and all the money gets sucked up by the universities and we got nothing,” Landry said.

When we consider this is how the Governor view his people; not so much as humans with human appetites for joy and knowledge and experience to be nurtured, but only as a "workforce" to be disciplined; then it's easier to understand why he's keen to sell their health care off to capitalist vultures at the nearest opportunity. It's an extremely efficient way of liquidating lives into profits.  

How we are buying the bombs

Joe Biden announced today that the US will contribute the following to the growing pit of death and destruction in Ukraine.

The new $800M package includes:
- 800 anti-aircraft systems
- 9,000 anti-armor systems
- 7,000 small arms
- 20 Million rounds
- Unmanned aerial systems
And more.

— The White House (@WhiteHouse) March 16, 2022

It surprises no one to learn that this expenditure did not immediately elicit a chorus of "BUT HOW WILL WE PAY FOR IT" howls from the psychopaths who dominate American media and politics.  They do love to yell that. But only when it refers to expenditures on things like food or medicine for poor people.  It's fine when we spend the money on murder. That's what our enlightened rulers enjoy most. 

So, anyway, how will we pay for it?

Next week, the White House says it will start to wind down a COVID-19 program that pays to test, treat and vaccinate people who don't have health insurance.

It's one of several immediate impacts after Congress declined to add $22.5 billion in funding to a broad government spending bill passed last week. President Biden signed the bill into law on Tuesday, hailing it as a bipartisan achievement without mentioning the lack of COVID-19 funding.

The COVID-19 funding request met with political pushback from Republicans and concern among some lawmakers that the White House has not fully explained how trillions in COVID money has been spent so far and what funding remains. Republicans in particular have been unwilling to agree to new spending.

Ah okay we've given up even pretending to care about COVID and kicking millions of Americans off of Medicaid. That's plenty money right there. What else, though? 

The bill also does not include further Hurricane Ida aid, but time likely remains to appropriate more dollars for that storm, which hit in August and affected a range of states, including New York, whose congressional delegation holds strong sway.

Rep. Garret Graves, R-Baton Rouge, sought an amendment to include $3 billion for 2020 and 2021 disasters, but the proposal was rejected. He said that while he supported the billions appropriated for Ukraine, and noted aid being sent to Haiti and elsewhere, needs here should be taken care of as well.

“How do you do that and not provide aid for our own citizens, for people that are in need?” he said. “You’re treating people of other countries better than we're treating our own. I want to be clear: I'm not necessarily saying that with Ukraine. We're not under missile attack right now. But for some of these other countries, that’s exactly what's happening.”

Garret Graves isn't "necessarily saying that with Ukraine" but I will.  It is unconscionable to let people suffer the effects of multiple major hurricanes in order to send even more instruments of death into a war zone. Despite what the hunky Ukranian guy everybody loves says, the US can still choose to do some actual good things for people instead of helping him start Word War III.  But in American politics it's always easier to kill a million people in Europe than it is to figure out how to feed and clothe them here.

Reason for the season

Happy Thanksgiving to the 46,000 Louisianians just booted off of Medicaid this month because they didn't answer a letter.  Maybe that means none of them need it anymore. But it probably doesn't mean that.

Imagine if the system just provided health care to anyone who needed it instead of constantly making them prove their eligibility or jump through bureaucratic hoops designed to discourage them from even seeking care in the first place.  Crazy talk, I know.

In the public health department

Let's see what day was this?  It was a long weekend and I have no idea what I did with most of it.  Was it Friday?  I think it was Friday.  Anyway I went to see Tim Faust speak at Garden District Book Shop.  The book he's promoting is called Health Justice Now: Single Payer and What Comes Next.  I'm sure it's very good. I did buy a copy but it's at the bottom of a pile quite similar to if not worse than this one from the middle of the summer. I'll get there eventually.  If you've seen, read or heard any of Faust's work advocating for a better health care system than the nightmare we live and die at the hands of today, then, well, this talk was very much like that.

In his talk, Faust says the US is "the most dangerous place to be sick the most dangerous place to be poor, the most dangerous place to be black or brown, the most dangerous place to be disabled, the most dangerous place to be queer..." There is a mutually reinforcing relationship between poverty and illness. The so-called "health-wealth gap" in the United States adds up to a 20 year difference in life expectancy between the richest and poorest. All of these states of precariousness are direct reflections of an unjust health system. 

By that, he means the US health care delivery apparatus is fraught with such waste and unfair distribution that the negative health outcomes compound upon each other. "In the US all prices are fake," says Faust. The costs of primary and preventative care are grossly inflated as large corporate providers force smaller health clinics out of business in order to charge hospital rates for everything. And, of course, insurance companies can only profit by denying patients care when they need it. 

Unjust wealth allocation leads to unequal health outcomes in all sorts of ways.  Faust travels all over the country talking to people about health care and gave a few examples. In Houston the prisons have become warehouses for people with untreated mental illness. In Memphis environmental racism has led to a situation where black children die at 20 times the rate of white children.  When Indiana Governor Mike Pence inhibited needle exchange programs during the height of an opioid crisis, it  resulted in "one of the biggest HIV outbreaks in decades."  These are all essentially questions of resource allocation.

The day after I saw Faust talk, I read in the Advocate that the state has finally responded to public pressure at least to the point of agreeing to study the effect of the Denka neoprene plant on cancer rates in St. John Parish. As we know, the State of Louisiana subsidizes the proliferation of plants like Denka to the tune of billions of dollars each year.  Poor Louisianians are subsidizing the profits of the petrochemical industry with their very bodies.

The US spends over $3.6 trillion annually on health care. According to Faust at least 1/3 of that is "waste." It would cost approximately 10 percent less to implement a single payer system. And the savings can be applied to giving people better housing, better transit, better food access, a fairer criminal justice system etc. all of which support better health outcomes.  So the fight for health justice really is at the center of a struggle for a radical societal overhaul.  Efforts to combat the problem at the margins via schemes like Obamacare or Medicaid as we know it are not good enough. It is in Faust's words a question of giving people "insurance or emancipation."

Which is why the expansion of Medicaid under Obamacare that John Bel Edwards' reelection campaign touts as a major accomplishment doesn't get us where we want to go. In Louisiana, Medicaid is privatized. And the MCO contracts, in addition to just being inefficient means of shoveling money to for-profit insurers and providers, amount to one of the biggest slices of political patronage a Governor can hand out. This year, the dispute over those contracts has left over half a million Medicaid patients in a wholly unnecessary state of uncertainty just as the start of open enrollment for next year looms. 


Finally, Faust fielded a few skeptical questions from audience members about whether or not a single payer system would garner support from doctors, some of whom, at least, might find certain aspects of their practices less profitable. But, while that isn't really true for most doctors,  the question did remind me that a professional association of Louisiana doctors has endorsed Ralph Abraham for Governor.

The Louisiana Medical PAC hasn't issued an endorsement in the most recent governor's races, but jumped at the chance to endorse one of their own.

“It’s been a number of years since we decided to take a position in the governor’s race, but we have one of our own running,"  Dr. Robert Bass, chairman of the PAC, said in a statement. "We believe that physicians supporting physicians is important, and when you have a candidate like Dr. Abraham, it’s very easy to make this decision.

"Dr. Abraham has a wealth of knowledge that is critical to helping Louisiana improve healthcare outcomes."

That's interesting. As it happens, this week the Bayou Brief provides us with an example of one health outcome Dr. Abraham has used his "wealth of knowledge" to bring about.

“Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths,” states the CDC. “Opioids were involved in 47,600 overdose deaths in 2017. A staggering 67.8% of all drug overdose deaths are due to opioids, and while nationwide these numbers have declined, Louisiana is one of a handful of states in which deaths from opioid overdoses have increased.

During the past year, overdose deaths went up by 4.7% in Louisiana.

“Louisiana also ranks among the top 10 states with the most opioid prescriptions written per capita, according to its state’s lawsuit against 17 companies, including Purdue Pharma,” according to a report published yesterday by APG Wisconsin. “Since 2007, the state has spent at least $677 million ‘for treatment of opioid use and dependence.’”

During the seven-year timeframe, Abraham’s pharmacy in Winnsboro doubled the number of opioids it dispensed to patients; opioid prescriptions filled at his pharmacy in Mangham, which is located near his former medical clinic, surged a staggering 67%.

In Mangham (2017 population: 638), Abraham’s pharmacy supplied enough opioid medication to provide every man, woman, and child 6.1 doses every year (or 43 pills in total) for seven consecutive years; his pharmacy in Winnsboro (2017 population: 4,652) could have provided every resident 4.4 doses per year (or 31 in total). (Note: Annual doses per person were based on Census estimates, not the most recent American Community Survey).

If a single payer system focused on health justice for all means a less profitable pill pushing scheme for Dr. Feelgood that's just something we are going to have risk.

Getting a lot of buy-in

The John Bel Edwards re-election campaign continues to take shape.

In recent weeks we've seen John Bel strike a deal to steer hundreds of millions of dollars toward highly questionable Superdome renovations. Among the planned changes are the destruction of much-loved stadium exit ramps and the addition of a  "natural lighting" source which many of us believe would ruin the atmosphere in there.  At the state bond commission meeting where the funds for this were approved, the commission deferred a decision on $7 million for affordable housing in New Orleans because they had too many questions.

But the important thing for John Bel is that he's satisfied the state's most high profile billionaire and the criminal sports entertainment empire she represents. That's not just good campaign "optics." It's how you pay off powerful potential allies to make sure they stay that way.

Speaking of which, we also find that John Bel has handed a massive state "energy services" contract to serial disaster profiteer Jim Bernhard.  The benefits to the state in this privatization deal are murky and debatable. The immediate political benefit to John Bel for entering into it is easier to figure out.

Bernhard Energy Solutions partnered with the HVAC company Johnson Controls at the request of the Edwards administration after both firms submitted proposals to the state. Bernhard Energy Solutions is one of several companies controlled by Bernhard Capital Partners, a private equity firm run by former Shaw Group chief executive and Democratic Party official Jim Bernhard, who was floated as a potential candidate for governor before ruling it out last year.

And then there is the strange case of John Bel's handling of the state's Medicaid contracts. This year the Governor decided to cut out Aetna and Louisiana Healthcare Connections and hand their shares of the $8 million pie over to Humana.  While I still haven't seen any reporting that points us to exactly why that choice makes political sense for the Governor (it does seem to have upset Cedric Richmond) there must be some reason. The companies who lose out on the deal seem to think so, for what that's worth.

A Louisiana state health department evaluator fell asleep during the sales pitch for one of the companies trying to land a state contract worth billions.

At least that’s the way Kendra Case, the chief operating officer at Louisiana Healthcare Connections Inc., recalled the June 24 meeting in a sworn affidavit presented as proof that the state had gamed the competition to keep them from winning one of the lucrative “managed care” contracts.

The point is, as election time rolls around, John Bel is doing the most to attract a lot of buy-in from some powerful players around the state.  Which is why this shouldn't come as much of a surprise to anybody.

Jim Ward and Fred Heebe, the owners of the River Birch landfill in Waggaman whose prodigious political donations were at the center of a sweeping, four-year federal criminal probe that eventually imploded without any charges being filed, have re-established themselves as a dominant force in Louisiana king-making.

Ward, Heebe and other landfill executives are some of the largest financial backers of the effort to reelect Gov. John Bel Edwards even as they gird for a civil trial that will air long-standing accusations that some of their earlier political donations constituted bribes — in particular, a batch of checks they gave to disgraced New Orleans Mayor Ray Nagin, who sits in prison on unrelated corruption charges.

New Horizons USA PAC, a political group formed by Dominick Fazzio, the longtime chief financial officer at River Birch, has donated at least $200,000 to Gumbo PAC, an organization that is expected to play a crucial role in Edwards’ reelection bid. That tied New Horizons for the title of largest in-state donor to Gumbo since Edwards took office.

 Nothing untoward there, for sure.

Some of the ends are coming aloose

Just last week, we noted that John Bel was gearing up for reelection by paying off Gayle Benson with a sweetheart deal for Superdome renovations right before he paid off Jim Bernhard with this Energy Partners/Johnson Controls deal. So far so good.

But the largest contracts let by the state are with the managed care firms who administer the state's privatized Medicaid program. Altogether these contracts total something close to $8 billion. The current deals were negotiated during the Jindal administration (that process was not without its controversies) and were kept in place by John Bel even after the state accepted the Medicaid expansion.

Those contracts are up for renewal now and, for whatever reason... just ahead of election time... John Bel has decided to shake things up a bit. The new deal brings the number of contractors down from five to four. It also replaces another of the existing companies.  Humana has been cut in while Aetna and Louisiana Healthcare Connections are out. Which means we have to ask who is John Bel paying off here and what is their relationship with Humana? 

We don't know the answer to that yet. But we do know LHCC has a friend in Cedric Richmond's orbit.

U.S. Rep. Cedric Richmond, D-New Orleans, penned a letter Friday to Edwards raising concerns about the decision to drop Louisiana Healthcare Connections from the state’s managed care system. He warned of lost jobs in his district and said 84,000 of his constituents receive health care through LHC’s network, raising the possibility of patients losing access to their providers with the change.

Today LHCC and Aetna have filed some sort of appeal.  And a joint legislative committee will begin considering the new contracts sometime in September. Again, right in the middle of election season. Can't imagine anybody there would be up to making any mischief for any reason.

"It makes sense" to govern as a rump junta

Republicans in the legislature are throwing another fit over the scandalous notion that poor people might receive health care.

Several Louisiana House Republicans took advantage Tuesday of a hearing on the Department of Health’s $15 billion budget to sharply question the agency’s leaders on issues like Medicaid fraud and eligibility problems in the wake of critical audits of the agency.

It's exhausting that we even have to take a momement to engage with these bad faith allegations of "fraud" coming from parties whose aim has always been to kick as many people off of benefits as possible.  You know, what, actually let's do ourselves a favor and igore it altogether this time.  It's done enough damage already.

There are quotes in this article from Rebekah Gee and John Bel Edwards where we see they've been intimidated into touting a new eligibility system that "provides more detailed information about enrollees."  It's a side point in the story so it doesn't get explored much further. But to get an idea of how much this already concedes, take a look at how stricter, more intrusive intake systems for social services are brutalizing poor people all over the country.

In the fall of 2008, Omega Young got a letter prompting her to recertify for Medicaid.

But she was unable to make the appointment because she was suffering from ovarian cancer. She called her local Indiana office to say she was in the hospital.

Her benefits were cut off anyway. The reason: "failure to cooperate."

"She lost her benefits, she couldn't afford her medication, she lost her food stamps, she couldn't pay her rent, she lost access to free transportation to her medical appointments," Virginia Eubanks tells NPR's Ari Shapiro. Eubanks is the author of a new book, Automating Inequality: How High-Tech Tools Profile, Police and Punish the Poor.

"Young died on March 1, 2009," Eubanks says. "The next day, she won an appeal for wrongful termination and all of her benefits were restored the day after her death."

Pick up Eubanks's book if you get a chance, by the way. It's a good recommendation for anyone who isn't quite depressed enough about the current state of the hellworld we live in.

Anyway,  we already know it's not above John Bel to be shitty to Medicaid recipients.  He's only recently dropped his support to saddle them with work requirements because a federal court has ruled against that.

But does it make political sense in Louisiana?  Certainly these Republicans thinks so.  And Bernie Pinsonat agrees.

The comments by Republicans echoed similar lines of attack made by GOP gubernatorial candidates at a recent forum, where they criticized the Edwards’ administration handling of Medicaid.

Pollster Bernie Pinsonat noted Republicans’ base of support in Louisiana is generally opposed to the Affordable Care Act and Medicaid expansion, which is why the Medicaid issue will likely continue to come up this election year.

“Republicans know when they go back home, attacking Medicaid expansion or attacking Obamacare, it makes sense,” Pinsonat said.

Maybe it makes some sense with regard to the Republican base... but just barely.  According to this year's Reilly survey, the Medicaid expansion in Louisiana garners 47 percent support among Republicans. That's down from 51 percent last year so it's trending downward. But, still, hovering at or near 50 percent with the base doesn't really mean a thing is unpopular.  And when you figure in the fact that 69 percent of all respondents of either party approve, then you have to wonder what it is about that one half of the Republican base that gives it such outsized influence over positions taken by the House GOP caucus and even the causes John Bel to handle it with such caution.  Why are we being governed by this rump minority?

If only we were better at means testing

You know what might make a problem like this go away?  See if you can guess.

Legislative Auditor Daryl Purpera's office found problems with the agency's infrequent use of wage data from the state labor department to determine eligibility.

The report says since Gov. John Bel Edwards expanded the state's Medicaid program in July 2016, the department has relied on Medicaid recipients to self-report changes in their paychecks in the 12-month period between the initial application for Medicaid and coverage renewal.

Auditors suggested more frequent checks using available state wage data should be used to ensure Medicaid recipients aren't earning more than allowed to qualify. Pennsylvania, Wisconsin and other states do quarterly reviews to check eligibility against income data, the report says.

The report also found errors in the work done by health department caseworkers. In addition, auditors said the agency didn't double-check income information when federal officials determined people who applied for individual marketplace insurance coverage through the Affordable Care Act were instead deemed eligible for the Medicaid expansion program. Those federal officials don't have access to state wage data, the report says.

"Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately," Purpera wrote to legislative leaders in the audit.

Imagine if we could just give people health care without a convoluted process for determining whether or not they are eligible. What if... everybody was eligible?  That's crazy talk, though, right?

Universal social programs are based on the principle, as single-payer health care advocate Dr Quentin Young would later put it, of “Everybody in, nobody out.” The goal is to establish a sense of mutual accountability and mutual benefit across society. The method is to enshrine cooperation and solidarity in the institutions by which the state distributes public resources.

Oh hey speaking of crazy talk, Senator Kennedy also has some comments.

Kennedy says: "Actions ought to have consequences. If this was in the private sector, Dr. Gee would have been fired an hour after that report." #lalege #lagov https://t.co/KnGTtiYlPI

— Melinda Deslatte (@MelindaDeslatte) November 14, 2018

John knows that Medicaid operates through private health providers, right? I mean, apart from the contracting and means testing role of the health department, we're very much in the "private sector" already. 

Anyway none of that is his point.  His point is, John is still seriously considering running for Governor next year. We should have his decision in a week or so.

They call it a career in public service

Which is just a fancy way of saying take em for all they're worth coming and going.

Former Gov. Bobby Jindal, who made his opposition to Medicaid expansion in Louisiana a cornerstone of his gubernatorial platform and a talking point in his 2016 campaign for president, has joined the board of directors of WellCare Health Plans, Inc., a Florida-based company that "focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans."

Medicaid gets cut. Medicaid gets expanded or shot through with bewildering rules and mechanisms designed to benefit private insurers and drug companies.  All of this jerking around can mean stability or banruptcy or even life or death for millions of people. For amoral grifters like Bobby Jindal, though,  it's all the same. Always another way to make a little money.

According to a filing with the U.S. Securities & Exchange Commission (SEC), Jindal will be serving on the company's Audit, Finance and Regulatory Compliance Committee and the Information Technology Oversight Committee. Wellcare board members receive $90,000 per year, the filing says, with additional annual retainers of $12,000 and $8,000 for the two committee positions. Jindal also will receive 405 shares of Wellcare common stock, which was trading at $307.48 on the New York Stock Exchange at day's end, making the compensation package worth more than $230,000.

Okay well maybe not just a little money. 

How the politics works now

This paragraph is quite the mouthful.

Yesterday, she repeated her assertions in an article published by Watchdog.org, a well-known propaganda arm of the Franklin Center for Government Integrity, a far-right, anti-science organization funded by the petrochemical industry and loosely affiliated with the Koch brothers’ group Americans for Prosperity and the American Legislative Exchange Council (better known as ALEC).

Lamar is writing there about Slidell Republican State Senator Sharon Hewitt's crusade against "Medicaid fraud" which, no, that is totally not a thing.  But please read Lamar's explication. It shouts out our old pal Bruce Greenstein who is currently working in the Trump Administration and somehow I did not know about that.  (WAIT. I did know. Apparently I forgot.  Dammit, the whole reason I write stuff down on this blog is so that is less likely to happen. What are we even doing here?)

Anyway, the little bullshit pipeline Lamar describes in that paragraph is worth noticing.  It's well organized, well funded, national in scope, and it is how right wing activists get their message out. And while some tools (doctored video distributed via Facebook, for example) are more common now than they once were, the basic form of the Republican Puke Funnel has been with us for some time. It's only gotten further institutionalized at the state and local level recently and Hewitt's little exercise here is a good example of that.

I guess it's also worth pointing out to what end this is all aimed. The budget passed recently in the Louisiana House of Representatives represents an effective $1.8 billion cut to health care services (state and federal matching funds combined.) This week, the Health Department is notifying 37,000 Medicaid recipients that their benefits are in jeopardy.  The Republicans continue to not take this seriously saying at various times the deficit is not real, or that there is money to find somewhere, or that the feds will step in and fix the problem, or just kind of mumbling nonsense until their voices trail off.  Oh also, as we've seen, some of them are falsely claiming there is widespread "fraud" happening so billions of dollars in cuts is probably justified anyway.

The long term play here is the same as it was at the outset of the year.  Republicans are betting that those among their constituents who are harmed by the horror budget are likely to blame the Governor next year anyway. Which is why, even at this late hour, they're not in any hurry to fix this.

Gov. John Bel Edwards' staff also told The Associated Press he is looking at officially calling the special session to start May 22, a Tuesday, though that timeline could change. 

But Edwards and Alario have always expressed an eagerness to move on to a special session as quickly as possible. It's Barras and the House leadership that have been fuzzy on when -- and sometimes if -- they want a special session to take place.

That fuzziness continued into Tuesday. While Alario may have been certain about what the target for ending the regular session was -- and what would happen if that deadline wasn't met -- Barras was far less resolute in his statements.

"I guess you could call it the aim, but I can't guarantee anything at this point," said Barras of the May 18 date for ending the (regular) session.

 What are y'all's plans for the shutdown? 

The things John Bel caves on

Work requirements for Medicaid.

He also suggested some items that Edwards said he expected Republicans would put forth, including a transparency website to track spending, implementing work requirements and/or copays for able-bodied adults on Medicaid and implementing new spending caps. Edwards has said he doesn't oppose those measures, but they could cost the state initially on the front-end, rather than saving money immediately.

Simple as that

Cassidy: Y'all are on your own.

Cassidy acknowledged that his legislation will cut federal spending on health care. He said states that think they need more money should raise their own taxes to pay for it.

Republicans control 32 of 50 state legislatures. Let's go ask them how they feel about raising taxes to make up this gap. 

Block grant funding in 2020 would be $26 billion, or 16 percent, below projected current law federal funding for Medicaid expansion and marketplace subsidies.  The block grant would grow by only 2.0 percent annually, well below medical cost inflation and even general cost inflation.  By 2026, block grant funding would be $83 billion, or 34 percent, below projected current law federal funding.  States would be forced to sharply scale back coverage as these block grants became increasingly inadequate.

Maybe Cameron Henry has some ideas about that.... 

Our Stupid Senator

We've covered this dilemma previously, but it isn't really necessary to ask rather John Neely Kennedy is genuinely stupid or just faking. Either way, it's embarrassing for everyone.

Calling Medicaid a "Sharknado-sized health insurance program for 20 percent of
Americans," Sen. John Neely Kennedy wrote in an opinion column today he would be filing legislation called the “Medicaid Reform and Personal Responsibility Act of 2017," which would require "able-bodied adult enrollees" without dependents to work, go to school or perform community service for 20 hours a week in order to receive Medicaid health benefits

What does "Sharknado-sized" even mean? How big is a Sharknado? Is it bigger than a regular nado? Or is it distinguished more by virtue of there being sharks in it? No matter, you're still not getting any health care if John thinks you're a slacker. 

Ambition makes you look pretty ugly

This book review was brought to my attention by the latest Chapo. In short, it's about work and how we should fuckabuncha work. That's been a running theme here for several years now.  We do so many horrible things to ourselves and to others under the misguided premise that there is virtue in competitive self-abuse. In other words, unbridled capitalism is a race to the bottom that is isolates us and causes the lives we live to become ever less healthy and ever less free.

Anderson’s most provocative argument is that large companies, the institutions that employ most workers, amount to a de facto form of government, exerting massive and intrusive power in our daily lives. Unlike the state, these private governments are able to wield power with little oversight, because the executives and boards of directors that rule them are accountable to no one but themselves. Although they exercise their power to varying degrees and through both direct and “soft” means, employers can dictate how we dress and style our hair, when we eat, when (and if) we may use the toilet, with whom we may partner and under what arrangements. Employers may subject our bodies to drug tests; monitor our speech both on and off the job; require us to answer questionnaires about our exercise habits, off-hours alcohol consumption, and childbearing intentions; and rifle through our belongings. If the state held such sweeping powers, Anderson argues, we would probably not consider ourselves free men and women.

What I'd like to emphasize here is that the problem is we do this to ourselves. We spend so much time internalizing the competitive values of capitialism that individual achievement becomes its own moral validation for all manner of atrocities against our neighbors and against ourselves.

As long as this ethic is allowed to persist, expect more like this.

Louisiana is eyeing an effort that would require able-bodied adults to get a job if they want to receive Medicaid benefits — mimicking efforts in other states that have been bolstered by ballooning Medicaid rolls and encouragement from the Trump administration.

Until we stop buying into the con that tells us we don't deserve even the basic necessities unless we breathlessly and pointelessly fight one another for our individual shares, there's never going to be any progress.

Protest every day

No reason to stop now. Things are only gonna get worse.  Here they come to block grant Medicaid.

Bi-partisan can kicking

John Bel Edwards boots a Medicaid payment across with an assist from Bobby Jindal.

But the bulk of the $315 million midyear budget deficit will be dealt with by pushing off $152 million worth of financial payments to Medicaid providers into the next year. The payments will eventually have to made -- so the expense doesn't go away -- but delaying them will help the state avoid substantial cuts in the short term.

This is the second year in a row these Medicaid payments have been delayed to deal with a midyear budget deficit. Gov. Bobby Jindal also pushed off the payments a year ago to cope with a $500 million midyear budget shortfall last November.

Under Jindal, the state government made just 11 payments to Medicaid providers in 2015, instead of required 12. To make up for that, the Edwards administration was supposed to make an extra payment, 13 in total in 2016. But now, Edwards' administration will make just 12 payments -- leaving the extra payment that wasn't made during the Jindal administration still hanging.

"It's the Jindal payment that seems to be lingering," said House Appropriations chairman Cameron Henry, R-Metairie. "We are just pushing the payment so we are not really fixing the problem."

Maybe they can keep stiffing these Medicaid providers until Trump scraps the whole social safety net anyway. What will they win, then?

Congratulations, Rep Abramson

Moving up in the world.

BATON ROUGE, La. (AP) - Two New Orleans area lawmakers were chosen Thursday to lead the House committees that will be essential to deciding the fate of Gov. John Bel Edwards' budget and tax proposals.

House Speaker Taylor Barras announced his committee assignments, saying he thought the list contained a balance of leadership from various geographical, political and racial backgrounds.

"This is an outstanding group of dedicated public servants who are ready and able to tackle some of the most pressing issues facing our state," Barras, R-New Iberia, said in a statement.

Republican Rep. Cameron Henry of Metairie was named chairman of the Appropriations Committee, which crafts the state's budget and handles most spending bills.

Democratic Rep. Neil Abramson of New Orleans was chosen chairman of the Ways and Means Committee, which handles tax legislation and state construction spending plans. Abramson was the only Democrat to vote for Barras as speaker, and the chairmanship was seen as a reward for that decision.

Thanks, for that Neil.  You're really helping. 

Gov. John Bel Edwards withdrew a key Medicaid expansion item from the a legislative budget committee agenda Friday morning (Jan. 29), hours after the Louisiana House announced its committee members would be mostly Republicans.

The Edwards administration was planning on asking the Louisiana Legislature's joint budget committee to approve the hire of an additional 248 employees at the Department of Health and Hospitals to handle Medicaid expansion. The hires are needed to fulfill one of the Democratic governor's top priorities to provide more access to health care in the state.

The yanking of the item may be a signal the Louisiana House will make it difficult to Edwards to execute Medicaid expansion. The governor has typically had a lot of control over who legislative leadership, but the Republican-controlled House is exerting more independence this year. 

As though Bobby Jindal were just some bad dream

Looks like a big reason Obama is visiting is he wants to talk about making the hurt go away. 

But one of the specific items that was likely discussed as the president made his first official visit to Baton Rouge: Obama plans to propose a new Medicaid expansion measure that would give states like Louisiana credit for the federal money they have missed out on because they have waited to expand Medicaid.

Day One

Governor elect Edwards announced some appointments today. Among those was the new head of DHH.

BATON ROUGE, La. (AP) - An LSU public health professor is Gov.-elect John Bel Edwards' choice to lead Louisiana's health department, the largest agency in state government.

Dr. Rebekah Gee was named Tuesday as Edwards' secretary for the Department of Health and Hospitals.

In that role, she'll oversee a $9.7 billion agency that accounts for more than one-third of the state's budget. She'll also be the figurehead for Edwards' plan to expand Louisiana's Medicaid program as allowed under the federal health care law.

This will draw attention not only because of how important it is in and of itself but also because of its political significance. Edwards' commitment to immediate Medicaid expansion was a major campaign promise which differentiated him from every other candidate. It’s is crucial that this promise be kept.

The good news is it looks like they're taking that seriously.

Dr Gee says La will expand Medicaid on first day of the Edwards administration

— Mark Ballard (@MarkBallardCnb) January 5, 2016

Update:  On the other hand, another major campaign promise of Edwards's involved "firing" John White.  His new BESE appointees appear to be crawfishing a bit.

In an interview Edwards' three BESE appointees all said they would be "open" to working with White, but didn't outright endorse him. Two of three appointees have an existing relationship with White, because they are already active in primary and secondary education.

One of these is not like the others

Louisiana should have accepted the federal money for expanding Medicaid as soon as it became available a few years ago. Unfortunately, the Governor was already running for President on a platform based on adherence to a crazy cult of cruel austerity and so we've already thrown millions of dollars away that we'll never see again. 

Because they are also in the crazy cult, three of the four candidates running to replace him are running the risk of throwing away even more.

And the longer the state takes to obtain a waiver, the more it costs: Under the current Medicaid program, the state is reimbursed for just over 60 percent of costs for Medicaid patients. Under the Affordable Care Act, the state receives 100 percent reimbursement. Many states have waited more than a year for federal approval of a waiver.

Also, the reimbursement starts to phase out in 2017, meaning the state will have to start paying a 5 percent match that year until it gradually increases to a 10 percent match in 2020. So if the state is going to expand Medicaid, it will save more money the sooner it begins getting the 100 percent match.

There is added pressure to expand Medicaid sooner rather than later because of a deadline the Legislature agreed to during the spring legislative session. If Louisiana expands Medicaid by April 1, 2016 the Louisiana Hospital Association's members have agreed to cover the state's matching funds starting in 2017 using a fee charged through hospitals.

The three crazy cult members are crazy, though. Louisiana has already painstakingly "reformed" its Medicaid delivery system according to their preferred privatized model. There's no need to appoint any new committees to study the issue and there's no need to apply any sort of "waiver."  All we need to do now is take whatever is left of the federal money the law entitles us to.  Only one candidate says he understands this. 

Edwards: We should stop sending our federal tax dollars to Washington, D.C., so they can send it to the 30 states that have expanded the Medicaid program. I'm not going to back down, I do support the Medicaid expansion because it's the right thing to do.

Last month, Gambit recommended a candidate who clearly does not.  They did this either because they are too stupid to understand it (not likely), or they believe their readers are (possible).  In either case they're putting their fear of being embarrassed by David Vitter's hookers over articulating a clear policy choice for Louisiana. And they're asking you to accept the costs of that choice.