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Archive for the ‘Health Care’ Category

Forget Boehner, Obama and sequestration; the real debate is between Kristy Nichols and John Kennedy over state budget

Posted in BESE, Budget, Education, Governor's Office, Health Care, Legislature, Legislators, Privatization, Revenue on March 4, 2013| 5 Comments »

The relationship between the offices of Gov. Bobby Jindal and State Treasurer John Kennedy, if indeed a relationship ever existed in the first place, has deteriorated into a colorful exchange of pointed jibes and name calling—mainly by Commissioner of Administration Kristy Nichols who certainly knows how to use the terms “going forward” and “the reality is” to make her point.

Actually, the running feud between the two offices has been simmering for some time but this week took an ugly turn on the heels of a radio show appearance by Nichols and an op-ed column written by Kennedy.

“Imagine, God forbid,” Kennedy wrote, “that your boss just cut your salary by 25 percent because business is bad. Instead of reducing your spending or getting a second job, you elect to do the following:

• Take a cash advance on our credit care to pay your car note.

• Refinance your mortgage, but instead of choosing to lower your monthly payments, ask for the one-time savings up front to pay for your Disney World vacation.

• Decide reluctantly to sell your bass boat. It’s worth $2,500. You ask $10,000. You wonder why it doesn’t sell.

• Instruct your kids they must begin paying for room and board. When they ask where they’ll get the money, tell them to borrow it.

“Your plan may work—for a while. Then, as sure as ‘eggs is eggs,’ you’ll go broke, just like Louisiana eventually will if the legislature passes the Jindal administration’s proposed, yet again unbalanced budget for the fiscal year beginning July 1.

“Here’s how the administration plans to ‘balance’ state revenue and spending this time (with Nichols’ boldface response in parentheses):

• Pretend the state will have an extra $800 million to spend as a result of the yet-to-be-realized savings from leasing state hospitals to private hospitals, even though the leases have not been negotiated (With this point, Treasurer Kennedy reveals himself to be an opponent of reforming the old charity hospital model, not to mention that he apparently does not know how to read the budget.);

• Refinance the state’s tobacco bonds (good idea) but dump the $90 million one-time savings into the operating budget and spend it next year (bad idea) (The Treasurer insults Louisiana’s young people by comparing the state’s commitment to providing them a college scholarship to paying for a ‘Disney World vacation.’);

• Proposed to sell state real estate at inflated prices well above appraised value and spend the money before they sell (Again, the Treasurer exposes himself as a big government defender of the status quo who would rather keep underutilized property in government’s hands instead of downsizing the government’s footprint and returning the property to the private sector.);

• Borrow $100 million from the New Orleans Convention Center to keep our colleges open while promising to repay the loan with proceeds from future bond issues that will exceed the state’s constitutional debt limit (It was the Treasurer’s office itself that recently created a manufactured crisis over the state’s debt limit because of its inability to count. Thankfully, the Division was able to correct the Treasurer’s error.);

• Raise college tuition 10 percent for Louisiana students who already owe $900 million in student loans, despite the fact that education is the new currency of our global economy and 8 percent fewer Louisianans have a college degree than the rest of America;

“Call this budget what you like: a fond illusion or smart accounting,” Kennedy said. “The result will be the same: mid-year budget cuts for the sixth year in a row, because the budget is not balanced. Why should we care? Because making a college cut $10 million with six months left in the fiscal year is like a $20 million cut from day one. That shreds muscle, not fat.

“There’s a better way. It’s not complicated: don’t spend more than you take in, and when you do spend money, spend it on things you need, not things you simply want.

“Louisiana families know that. So do Louisiana businesses. Why can’t government figure it out?”
Because Jindal can never face up to a confrontation, he sent Nichols in as his proxy for this fight. Her response was almost immediate.

“We appreciate the treasurer’s opinion,” she said, “but given his long track record of half-baked gimmicks and his office’s recent miscalculation of the state’s debt, we will pass on his suggestion.”

Ms. Nichols, let’s clarify a point here: were you talking about half-baked gimmicks on the part of the State Treasurer or the Governor? It’s a little difficult to distinguish.

“The reality is that the budget is balanced,” she said.

Last week, when appearing as a guest on the Jim Engster Show on Baton Rouge public radio, Nichols said, “We have sufficient funding for construction projects going forward. The reality is we have many significant opportunities and may options in terms of how we finance construction going forward and do not have an issue with the ability to continue construction projects today and to move forward with construction projects going forward.”

Nichols told Engster that the Medicaid reductions “gave us an opportunity to look at the public hospital infrastructure and find ways to deliver services in partnership with local providers. The reality is once we made reductions to Medicaid, we were faced with $300 million in mid-year reductions,” she said.

To a caller who ask how the state would save money by having physicians see patients when under the Charity Hospital system, Nichols said, “The reality is as again, we moved forward with the challenge of reductions of federal Medicaid rates and we looked at ways to transform and continue to provide public hospital services, we looked at the cost structure of the public hospital system. As private hospitals take over services, by leveraging those economies of scale, we were able to reduce the cost of the same care provided in public hospitals and the reality is that same service in public hospitals was very costly on a per unit basis.”

When Engster asked about the Medicaid expansion as it relates to the Affordable Care Act (ObamaCare), Nichols said, “We balanced the budget irrespective of the Medicaid expansion. The reason we are not participating (in ObamaCare) is very clear. The way it is structured…the program in totality needs to be structured in a way to give the state flexibility to provide services in a way reflective of the state’s needs and reflective of the state’s budget. The reality is the state will be faced with coverage of half-a-million more people on the Medicaid rolls. That’s a 40 percent growth.”

When another caller from New Iberia asked about cuts of 45 percent to the University of Louisiana Lafayette budget since 2008, she said, “As we looked at moving forward past mid-year, we made a decision not to reduce the higher education budget. We are committed to that going forward. We are committed to not cutting budgets and to work with higher ed to consider options to increase revenue. As we move forward, we look at opportunities to raise revenue.

The reality is we’re certainly glad she cleared all that up as the administration moves forward.

Gov. Jindal couldn’t have said it better.

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Notable Quotables (in their own words)

Posted in Auditor, Health Care, Legislature, Legislators, Notable Quotables on March 1, 2013| 6 Comments »

“In January 2011, DHH eliminated all but one internal audit position. In February, the one remaining auditor retired, leaving no internal audit function at all at the end of Fiscal Year 2011.

“Each year, in the Appropriations Act, the Legislature requires agencies with budgets in excess of $30 million to use existing positions for internal audit services.

“Considering DHH has over $650 million in assets and over $7 billion in annual revenue, an effective internal audit function is critical to safeguard state assets and operations.”

—Wes Gooch, audit manager for the Legislative Auditor’s Office, in testimony before the Legislative Audit Advisory Council on Feb. 21.

“I am outraged that a member of our staff would allegedly willfully misuse public funds that were intended for health care services.”

—DHH Secretary Bruce Greenstein, in a prepared statement Friday after it was learned that a DHH employee in the Bureau of Health Care Integrity is suspected of misappropriating $800,000 in DHH funds.

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Greenstein eliminates internal audit function at DHH; two years later, $800K misappropriated (privatization at work)

Posted in Auditor, Health Care, Layoffs, Legislature, Legislators, Privatization on March 1, 2013| 7 Comments »

Two years after the Department of Health and Hospitals (DHH) eliminated its six internal audit positions, an employee of the Louisiana Department of Health and Hospitals (DHH) has been placed on leave and is expected to be fired and prosecuted for the misappropriation of more than $800,000 in state funds, LouisianaVoice has learned.

The employee, a woman, is accused of depositing checks made payable to DHH into a non-DHH account. She would then withdraw the funds from that account for personal use, investigators said. The internal investigation was conducted by DHH’s Bureau of Health Care Integrity.

In addition to conducting its own investigation, DHH notified the Louisiana Legislative Auditor’s Office and the office of East Baton Rouge District Attorney Hillar Moore. The district attorney’s office will be asked to conduct an external investigation and to prosecute the employee. Restitution also will be sought by DHH.

“In January of 2011, DHH eliminated all but one internal audit position and the following month the one remaining auditor retired, leaving no internal audit function at all at the end of Fiscal Year 2011,” Wes Gooch of the Legislative Auditor’s office told a meeting of the Legislative Audit Advisory Council just over a week ago, on Feb. 21.

He said a recent audit showed for the second year, there was “no effective internal audit function” at DHH.

“In December of 2011, DHH contracted with one auditor to perform internal audit services from December 2011 through December of 2012,” he said. “In May of 2012, this contractor submitted a proposed updated internal audit charter and one internal audit report. No other internal audit activity occurred that year,” Gooch said.

“In June of 2012, this contractor exercised the contract termination clause, leaving no internal audit function in place at the end of 2012.

Gooch told the seven legislators in attendance that each year in the Appropriations Act, “the Legislature requires agencies with budgets in excess of $30 million to use existing positions for internal audit services.

“Considering that DHH has over $650 million in assets and over $7 billion in annual revenue, an effective internal audit function is critical to safeguard state assets and operations,” he said in his testimony.

For his part, DHH Secretary Bruce Greenstein was appropriately outraged over the latest findings. We know this because he said so. “I am outraged that a member our staff would allegedly willfully misuse public funds that were intended for health care services,” he said in a prepared statement.

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The Jindal paradox: he adores but would never work in the private sector (but he would make a splendid Sheldon sub)

Posted in ALEC, American Legislative Exchange Council, Campaign Contributions, Civil Service, Contract, Contracts, Education, Ethics, Governor's Office, Health Care, Higher Education, Layoffs, Legislature, Legislators, Privatization, State Agencies, Transparency on February 24, 2013| 12 Comments »

The burning paradox that is Gov. Bobby Jindal comes down to this: for someone who so obviously loves and embraces the private sector, it’s curious that he has never earned his livelihood in it.

Yes, we know that he “worked” for four whole months for McKinsey & Co. in 1994 but that could hardly be considered as the private sector since the firm primarily serves as a training ground for future bureaucrats and elected public servants.

To paraphrase a 1981 line from actor Burt Reynolds at his Friars Club roast, he’d probably like to thank the little people for putting him into office—but he’d never associate with them.

Of course, should he ever decide to re-enter the private sector and if Jim Parsons should decide to leave the CBS sitcom The Big Bang Theory, Jindal could step right into the role of Dr. Sheldon Cooper and never miss a beat.

Sheldon Cooper, in case you are not a regular viewer (you can catch the show on CBS at 7 p.m. Thursdays or reruns on Tuesdays at 7 p.m. on TBS), is the glue that holds the popular show together. He is academically brilliant (as most would concede Jindal to be) but completely unable to relate to mere mortals (as all would have to agree is a persona that fits Jindal like a glove).

Sheldon is a fount of book knowledge, possessed of an eidetic memory and able to spout figures, dates and statistics with the comparative ease of reciting one’s ABCs but is unable—or unwilling—to perform the simple task of driving a car.

Jindal is a fount of book knowledge, possessed of an eidetic memory and able to spout figures, dates and statistics with the comparative ease….well you get the picture.

Sheldon is completely and totally devoid of human emotion, is unfeeling and unable to communicate in a normal conversation because he has no empathy for his fellow human being. Even in casual conversation, it is impossible for him to avoid insulting the intelligence of those around him, be they peers or subordinates.

Jindal is similarly lacking in those same qualities and likewise cannot speak without offending—be it civil service employees, department heads or fellow Republicans whom he now publicly refers to as being stupid.

Sheldon, when playing board games or video games with his friends, is prone to make up his own rules as he goes along—much to the consternation of Leonard, Raj and Howard, his three friends on the show.

Jindal also is not above tweaking the rules to his advantage as in his exempting the governor’s office from the state’s public records laws—much to the consternation of the media.

But most striking of all the similarities between the two: Sheldon is stubborn and steadfastly refuses to admit to the prospect that he could ever be wrong—about anything.

Jindal, too, is mulishly stubborn and just as steadfastly refuses to entertain the thought that he might be wrong about anything—a trait that goes at least as far back as middle school, according to a former teacher who described him as unwilling to accept correction even then.

But back to Jindal’s undying devotion to the private sector:

His is a strange relationship indeed.

Visit the home a professor, and you’re likely to find shelves upon shelves of books. Visit a hunter and you will find hunting rifles and mounted deer, elk and moose heads. Same with fishermen and the mounted bass that adorn their den walls.

Visit an aficionado of the private sector like, say, the governor of Louisiana and you’re likely to find…photos of smiling campaign contributors.

But you would never find him putting in a typical 8 to 5 day in a cubicle or toiling away in the workaday world like the rest of us. That is so far beneath him as to be comical to even consider.

No, he would never stoop to such a low level. That is for people who can be manipulated, used and even fired at will—by people like him.

Instead, Jindal chooses to reciprocate the private sector’s political campaign contribution largesse by selling off the state, piece by piece, agency by agency to his corporate benefactors while at the same time, selling out hard-working, dedicated state workers without so much as a second thought or a thank you.

The private sector is Jindal’s benefactor, not his employer. Accordingly, he must pander to the corporate suits like Rupert Murdoch, K12, Dell Computers, Marathon Oil, Wireless Generation, Altria, Hospital Corp. of America, Magellan Health Services, Meridian, CNSI, Information Management Consultants, Innovative Emergency Management, Anheuser-Busch, Corrections Corp. of America, AT&T, Koch Industries, the entire membership of the American Legislative Exchange Council (ALEC), and most of his appointees to prestigious boards and commissions.

No, Bobby Jindal would never earn—has never earned—his living from the private sector.

But make no mistake about it: he owes his political existence to corporate America and the private sector.

And he believes with equal conviction that he owes nothing to state employees or the public sector.

Yes, he could step right in and fill Jim Parsons’ role as Sheldon and the difference would be negligible—except for the obvious cultural imbalance that would create.

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Surprise! Jindal admits in brief press conference that he ‘doesn’t have a plan’ (clue) on abolishing state income tax

Posted in Broadband, Internet, Charters, Education, Exemptions, Incentives, Governor's Office, Health Care, Higher Education, House, Senate, Legislature, Legislators, OGB, Office of Group Benefits, Prison, Privatization, Retirement, Revenue, State Agencies, Taxes, Vouchers on February 15, 2013| 14 Comments »

Whenever Gov. Bobby Jindal speaks, be it on Fox News, CNN, to fellow Republican governors or at a rare press conference such as the one held on Thursday, his threefold purpose always seems to be to inflate weak ideology, obscure poor reasoning and inhibit clarity.

His less-than-masterful tax plan for the state, which he admitted to reporters is like so many of his ill-conceived programs in that it actually remains a non-plan, might well be entitled “The Dynamics of Irrational and Mythical Imperatives of Tax Reform: A Study in Psychic Trans-Relational Fiscal Recovery Modes” (with apologies to Calvin and Hobbes, our all-time favorite comic strip).

It’s not certain what drives him to wade off into these issues (see: hospital and prison closures, higher education cutbacks, charter schools, online courses and vouchers, state employee retirement “reform,” and privatization of efficiently-operating state agencies like the Office of Group Benefits) but his actions are probably precipitated by deeply ingrained biological, psychological and sociological imperatives that have triggered a reduced functionality in the cerebral cortex (Pickles).

Or it could be some depraved attempt to inflict vengeance on society because his two imaginary childhood friends teased him and wouldn’t let him play with them.

And though he insists he has the job he wants, we can’t help but wonder if he isn’t even now casting a covetous sidelong look at the advantages of plundering (Frazz) in case his presidential aspirations fail to materialize.

The reason for all this speculation is brought on by his admission in that ever-so-brief (less than 12 minutes or six question, whichever came first) press conference Thursday that the administration does not have a proposal as yet to eliminate personal and corporate income taxes despite his well-publicized announcement that he wants to scrap state income taxes for individuals and corporations (especially corporations) in a “revenue neutral” way that would most likely involve increased sales taxes.

But he doesn’t have a proposal yet.

Are you listening, legislators? He doesn’t have a proposal yet. That means the onus is going to be on you and if he doesn’t have his way with you (as he has for the past five years—and you can take that any way you please), he’s going public with the blame game.

If everything goes south, you don’t really think he’s going to take the blame, do you?

He doesn’t have a proposal yet. Now we see where State Superintendent John White gets his prompts on running the Department of Education. White has not submitted a completed plan for any project begun at DOE since he took over; everything—vouchers, charters, course choice—is in a constant state of flux. He announces rules, retracts, readjusts, re-evaluates only to lose a lawsuit over the way his boss proposed to fund state vouchers.

Jindal doesn’t have a proposal—for anything. His retirement “reform” package for state employees was a disaster from the get go. Even before he lost yet another court decision on that issue in January, the matter of whether or not the proposed plan for new hires was an IRS-qualified plan—meaning a plan the IRS would accept in lieu of social security—remained unresolved.

He didn’t have a proposal: let’s just do it and see later if the IRS will accept it. Throw it up against the wall and see if it sticks.

Remember when he vetoed a bill two years ago to renew a five-cent tax on cigarettes because, he said, he was opposed to new taxes (it was a renewal!)? Well, now he’s considering a $1 tax increase on a pack of cigarettes.

“Everything is on the table,” he said. “That’s the way it should be.”

But isn’t he the same governor who closed hospitals and prisons without so much as a heads-up to legislators in the areas affected.

Isn’t he the same governor who rejected a federal grant to make boardband internet available to rural areas of the state but had no alternative plan for broadband?

Isn’t he the same governor who continues to resist ObamaCare at the cost of millions of dollars in Medicaid funding to provide medical care for the state’s poor?

He said he is looking at different ways to protect low- and middle-income citizens.

By increasing the state sales tax by nearly two cents on the dollar? By rejecting another $50 million federal grant for early childhood development? By shuttering battered women’s shelters and attempting to terminate state funding for hospice? By pushing for more and more tax breaks for corporations and wealthy Louisiana citizens? By appointing former legislators to six-figure state jobs for which they’re wholly unqualified while denying raises to the state’s working stiffs? Yeah, that’ll really protect the low income people of the state.

“It’s way too early to make decisions on what’s in and out of the plan,” he said of the soon-to-be proposed (we assume) income tax re-haul.

Well, Governor, it’s your job to make decisions, to come up with a proposal to present to the legislature so House and Senate members may have sufficient time to debate the issues—unlike your sweeping education package of a year ago.

In your response to President Obama’s State of the Union address this week (not your disastrous response in 2009 in which the Republican Party subjected you to national ridicule), you said, “With four more years in office, he (Obama) needs to step up to the plate and do the job he was elected to do.”

That’s right, folks. You can’t make up stuff this good. The response is so easy that it’s embarrassing but here goes:

Pot, meet Kettle.

In retrospect, drawing on comic strip for inspiration when writing about Jindal somehow seems entirely appropriate.

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