Louisiana Department of Health Secretary Rebekah Gee told members of the Senate Finance Committee on Friday morning that House-ordered cuts to her department contained in HB1 would result in cuts totaling nearly one billion dollars.
Gee, who is an MD and holds a master's degree in public health, says the $234 million dollar cut in state funding contained in HB1 and the areas that the department and the Division of Administration were prohibited from cutting would translate into $920 million in cuts to the department because of the loss of federal dollars that those state dollars are used to draw down.
The Senate Finance Committee heard from LDH in what will be its final day of reviewing the impact of the House version of HB1 with the heads of state departments and agencies. Committee chairman Eric Lafleur has scheduled a Saturday session of the committee to allow the public to weigh in on the budget.
After the brief run-through of department funding in recent years and an examination of the impact of mid-year cuts and the proposed executive budget and the impact of HB1, Lafleur told Gee and his committee that LDH constitutes half of the state budget.
"We have about a $29 billion budget and LDH is about $14 billion of it," Lafleur said. "You almost should have your own committee just to focus on our department."
Gee ran through a series of statistics to demonstrate that LDH has been bringing better healthcare outcomes to people in need while at the same time helping state finances. She focused attention on the impact of Medicaid expansion on the state.
"Medicaid expansion brought the state an additional $320 million in federal funding," Gee said. "That's allowed 91,000 people to gain access to a primary care physician and preventative care, many of them for the first time in their lives."
Gee told the committee that total Medicaid expansion enrollment stands at 428,000, bringing total Medicaid enrollment in the state to 1.6 million people.
Gee said her department is working with the private partners who are operating the former LSU Hospital System facilities to come up with a more stable funding mechanism than the system that relies on supplemental payments that come well after the care has been delivered.
She said that because of the cuts and the areas of the department's budget that were ruled off limits by the House Appropriations Committee, graduate medical education in the state is at risk. Graduate medical education is the way the state trains doctors and other professionals. Much of that work is tied into the pubic-private hospital partnerships.
Gee said the fact that Appropriations did not consult with her department about the cuts and their impact made them "arbitrary and irresponsible."
"You can't cut $1 billion from our budget and not have a negative impact on the people of our state," Gee declared. "You can't cut $1 billion and not eliminate valuable programs that help people."
According to Gee, HB1 would force the elimination of Medicaid behavioral health services. "Think about what that would do for the safety of our citizens and our communities," Gee told the committee. She noted the link between behavioral health problems and the size of the state's prison population.
Gee explained that because of the nature of so much of the department's work, cutting positions as HB1 orders translates into cuts in services.
"We do direct service provision for people. We are their safety net for those people," Gee said. "When you can't fill positions, you put people at risk including patients and our workers."
Gee told the committee that because House Appropriations ignored the complexity of the state and federal funding relationship, it amplified the negative impact of the cuts contained in HB1 more drastic.
Lafleur and the Finance Committee will likely meet again over the Memorial Day weekend to meet their goal of having a revised budget ready for the full Senate by the time that body reconvenes on Tuesday afternoon.
Gee's testimony contained what has become a refrain in testimony from department heads who have paraded through Senate Finance over the past two weeks: They were not consulted by House Appropriations on the impact of final budget decisions on the operations of their respective departments.
The session must end by 6 p.m. on Thursday, June 8. The Senate could act on the budget next week, sending it back to the House to either accept or reject the changes. The House will likely reject the changes, sending the bill to a conference committee.
House Speaker Taylor Barras has tentatively planned for the House to be in session over the weekend of June 3-4, according to Albert Speer, Clerk of the House.
It's not clear how much time a conference committee on the budget would need to reach a compromise agreement or how many votes each chamber might be able to take on a compromise if one is reached and rejected by either chamber. Gov.John Bel Edwards has vowed to veto any budget that emerges from the session that resembles the HB1 that originally emerged from the House.