While Greenstein said the new media initiative was a “directive” from Gov. Bobby Jindal, it’s also likely that his official statement on the 19th Judicial District ruling was in line with what the top brass wanted as well. Jindal, a Republican with unquestionable national ambitions, ushered in a law in June making it easier for the state to shut down abortion clinics — and the governor has been bragging about this legislative accomplishment at every conservative fundraiser between Los Angeles and New York recently.
But it wasn’t until Oct. 22 when Greenstein popped his political cherry. That’s when he was forced to announce a $50 million funding deficit in Medicaid that was caused by unfunded increases in utilization. As a way to partly address this shortfall, Greenstein said DHH would be shuttering the state’s Primary Care Case Management Program, known as CommunityCARE, which was originally created to provide a “medical home” for Medicaid recipients.
Greenstein made no bones about his distaste for the program. Looking back, one could even argue that Greenstein was hellbent on trashing it, hated it even. “This program has failed to show the results promised and is a perfect example of why this model of managed care in Medicaid doesn’t work,” Greenstein said. “For our $6 million per year investment in state general funds, CommunityCARE has done nothing to make people healthier. In fact, we’ve actually seen reductions in some key health measures under the program. We can’t continue to invest in programs that do not deliver value by improving the health of the people they serve.”
Four weeks later, however, Greenstein was singing a different tune. The same program that had “failed” and “done nothing” would be revamped, not scrapped, he announced. In fact, when Greenstein addressed the House Health and Welfare Committee late last month, he offered up an explanation of bureaucratic proportions. “We are no longer eliminating the program,” he said. “We are eliminating the program as we know it.”
So, what happened? In short, DHH’s stakeholders flipped out. Health care providers, in particular, banded together to form the Coalition to Protect Louisiana’s Healthcare, which counts as its members the State Medical Society, Louisiana Ambulance Alliance, Louisiana Hospital Association, MedicineLouisiana and the Metropolitan Hospital Council of New Orleans. Specifically, the coalition is urging lawmakers and the administration to investigate solutions that “may be politically inconvenient, but necessary to protect access to health care.”
Dr. Andy Blalock of Lafayette, vice president of the Louisiana State Medical Society, says he was ready to hoot and holler about DHH’s proposed elimination of the Medicaid program — and by no means was he alone. “We already have an access to care issue,” he says. “If these cuts go forward, it will only get worse.” Blalock adds that physicians are already running away from the Medicaid program, and any significant changes that pull money away from physicians would only serve as a stronger repellent.
Blalock’s sentiment was mirrored all over the state this fall and winter, and may have caused Jindal’s health leaders to fold like a cheap suit when it comes to the matter of shuttering CommunityCare.
Tyron Picard, executive vice president of Acadian Ambulance, argues the original plan to scrap CommunityCare as a means to developing a new coordinated care network, or CCN — a network that would be run by private insurance companies — was actually created by Greenstein’s predecessor, Alan Levine.
But since Greenstein was hired, Picard says, health care providers have been given more of a voice. “To his credit, Secretary Greenstein not only heard the provider concerns about the original version, but acted upon those concerns by starting a statewide dialogue on how to tweak the CCN model to alleviate the concerns providers had about the ambiguities in the original version,” Picard says. “My experience has been that he has been attentive to the concerns raised, engaged in learning as much as possible about those concerns aired, and willing to dialogue about possible solutions. I have found him accessible and responsive.”
Greenstein now wants the revamped CommunityCare program, which takes effect Jan. 1, to serve as a “bridge” to the proposed coordinated care network that would be run by insurance companies. In case you haven’t heard, the Jindal administration has also pushed the implementation date of the proposed CCN to late 2011, at which time the governor and lawmakers will be done with the approaching election cycle — a period that is traditionally bereft of political courage.
The Coalition to Protect Louisiana’s Healthcare, meanwhile, is working on its own CCN proposal that will likely place the state’s existing providers at the helm. Once it’s introduced into the mix, it’s highly likely that everything will change again. But that’ll be par for the course. It will also serve as yet another reminder of how difficult it is to make tough decisions in state government — and how easy it can be to change them.
Jeremy Alford can be reached at
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JUNE 17 If anyone ever wonders why Saints fans hate Atlanta with a capital H, here's a good indication. Radio "professionals" at an Atlanta station created an entire segment around making fun of former Saints player Steve Gleason, who is now paralyzed by ALS. Listen, nobody's ever accused DJs of being rocket scientists. But how could someone think it is amusing to pretend to ask a man with a degenerative, fatal disease if he will be alive next week? The DJs have been fired, and are now whining about how gutless their former bosses are. Wow.
JUNE 18 Here's the latest from the Advocate on the fatal hit-and-run accident allegedly involving the president of the Livingston Parish School Board. He's accused by police of hitting a 21-year-old man on a highway early Sunday and driving away. The man died at a hospital later. On Monday, police seized the president's truck and towed it away. But he's available for board meetings: apparently a $500 bond is sufficient for this type of thing over in St. Helena Parish.
JUNE 18 Former broadcast journalist Griffin Scott has posted this plea on his blog for financial assistance from his readers. Scott, who says he was fired after he wrote something fairly innocuous (for Facebook) on his wall, is suing a media giant for his job back. He's framed himself as David going after a bloated media giant, and he's probably not far off.
JUNE 18 Here's a fairly absurd column posted on DIG Magazine about the completely absurd practice of naming killer storms. Tornadoes don't have names. Blizzards don't have names. But hurricanes do, and there's a big process to bestow them, Jacques Cormery writes. He's right about the crazy assemblage of names -- this year, there's everything from Tanya to Humberto -- and his idea that we don't waste good names on killer storms is a good one.
JUNE 17 Political columnist John Maginnis has some advice for Louisiana Republicans: grow up. After the schism that occurred in this past session - fiscal hawks teaming up with Democrats to spank the Republican "majority" and hand Gov. Jindal his, er, aspirations for continued solon control -- they need to figure out how to get along with each other, Maginnis writes.
JUNE 17 Here's the Picayune's obit story for Dorothy 'Miss Dot' Domilise, the lady who made poboys at the uptown restaurant that bears her name. Miss Dot moved to New Orleans during World War II, where she met and married her husband Sam. When she passed away Friday she was 90, and had spent more than 60 of those years working at the restaurant on Annunciation Street.
JUNE 17 This editorial in the Advocate speaks in favor of the consent decrees that have federal judges overseeing police operations and the sheriff's parish prison in New Orleans. Mayor Landrieu and Sheriff Gusman can't get along, so outside forces, like the Inspector General and the judges, are needed to make sure things run right, the editorial opines.
JUNE 18 Here's a post from Manny Schewitz on Forward Progressives that is good for a chuckle. Manny had an epiphany back in November, and is sharing it with us today: he believes that Fox "News" is killing the GOP by pandering to right wing nuts. Now, don't get it twisted: Manny's not broke up about it. He says he enjoys watching the downward spiral with a shot of whiskey and "a schadenfreude chaser."
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