09 May 2007

Committee action, May 9: SB 1, HB 436

SB 1 by Sen. Joe McPherson would tweak indigent health care in Louisiana. Secretary of Health and Human Services Fred Cerise explained the broad outlines of the program. The plan would be to create “medical homes” to which the indigent would be assigned and could receive care. Any participating provider could provide their care and be reimbursed, so long as they agreed to install health information technology systems electronically based. The state’s existing charity hospital system was expected to be a major component of this system. All of this was to produce a more efficient system.

While various senators asked for more details, Chairman McPherson responded by saying this bill was intended to be a broad outline, containing the medical home and electronically-transferable records provision. While vague at this time, it was supposed to be brought into specific reality over time. Further, the state needed to create this outline now because it was currently not feasible economically from the private sector’s perspective unless government got behind it. Several supporting senators pitched questions to Cerise that gave him the chance to say money was available to get it going.

McPherson said the bill was supposed to be budget-neutral – no additional expenditures beyond current costs. He had produced a fiscal note which said the two regions (I and V) to be covered would be $227 million, although some costs were still undetermined. McPherson talked about finding ways to divert other federal funds to support the system, and said federal government rules were too rigid at present to allow some reforms they wanted.

Sen. Tom Schedler noted that, historically, the existing system had fought allowing a certain kind of federal funding (“disproportionate share’) outside of the charity system. He said this system had to be genuinely competitive, which he didn’t see in it and the system would resist letting those funds go outside of the system as a result. Through other questions, he noted that the vagueness of this bill allowed all sorts of promises to be made for more competitiveness but that they didn’t have to happen, and seemed skeptical that the bill would make any substantive changes.

Supporters who testified said the current system had costs that were too high and outcomes that were too low, and that this system would work. They also argued that the state had more poor and higher-cost insurance than compared to others, making giving the poor vouchers to buy their own insurance more problematic. Opponents, perhaps because the bill did not necessarily exclude market-driven solutions, were nowhere to be found to testify.

Technical amendments were offered and accepted without objection, and reported favorably without objection.

HB 436 is to reform the indigent defense system. Author Rep. Danny Martiny noted the present funding mechanism, a combination of low state funding, user fees, and local court fees, was unstable and inadequate that enabled little oversight. He felt this bill would provide for uniform delivery of indigent care even if it disrupts the present arrangement of the 41 separate boards (conforming to the state judicial districts). This would enhance chances of reforming the fiscal portion of the system, with the state chipping in more funds.

Martiny explained the 41 boards would be eliminated, and would be governed by a successor state board. Districts and their employees would remain the same. Regional districts could be created, up to 11. Existing funding would not be removed at the local level. More focus would be put on training and evaluation of public defenders.

Supporters noted that the concept of local boards has become obsolete, but that local districts would be given maximal freedom to run their affairs, as long as they showed accountability. They noted an impressive number of endorsements from the legal community backing the bill, and reflected best practices. Adequate defense meant real criminals would not escape punishment, and innocent people would not be jailed.

A number of specific, technical questions were asked, but members seemed pleased. Technical amendments were passed without objection, as was the bill.

I hope I live long enough to see it.
Schedler, when told the charity system was going to adopt a system more like the non-government sector in the future.

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