Wanted: Oversight

by Heather Miller

Gambit's Clancy DuBos takes Jindal to task on transparency and a privatized Medicaid management system in serious need of oversight.

A new report from an independent government watchdog warns that lawmakers should keep a sharp eye on Jindal's new privatized Medicaid program, which will control $2 billion in public funds and provide care for almost 900,000 Louisiana Medicaid patients.

Medicaid is the federally subsidized health care program for poor people. States pay a healthy share of Medicaid costs (about 30 percent in Louisiana). Given Louisiana's large proportion of poor folks, Medicaid comprises a significant portion of the state's annual budget.

The good news is that Louisiana's Medicaid program is among the cheapest in the country on a per-patient basis. We rank 48th on spending per child and 41st on spending per person. Most Medicaid patients are kids.

Jindal's plan will outsource Medicaid case management for most patients to five insurance companies starting next year. The only open question is: Will anybody other than Team Jindal be minding the store?

Lawmakers in 2010 approved a bill that they thought gave them oversight of Jindal's new program. They learned after the fact that a set of "technical amendments" adopted in the Senate stripped out the oversight provision. That infuriated many lawmakers; technical amendments are not supposed to make substantive changes.

Last summer, lawmakers unanimously passed a bill providing for legislative oversight - plus a "sunset" provision ending Jindal's grand experiment in 2014. Jindal vetoed the bill after the session adjourned, rendering an override all but impossible.

While legislative attempts at oversight have failed, the issue has not gone away. Last week, the Public Affairs Research Council (PAR), a nonpartisan watchdog group based in Baton Rouge, released a detailed report on Jindal's "Coordinated Care Networks" plan and called for an independent oversight commission to make sure the plan works as touted - and to add accountability to the process.

The PAR report is a must-read. This is $2 billion a year of your money, folks. The report is objective and thorough. It does not take a position as to whether Jindal's idea is good or bad, just that it needs oversight.

One area of concern is that Jindal is privatizing health care for a segment of the population that already ranks among the cheapest to treat. If costs are already low, how will private insurers find room for profit?

The PAR report notes that Blue Cross/Blue Shield of Louisiana, the state's largest health insurer, "decided not to [participate in the program] after the company's actuaries advised against participating." In other words, the biggest player in the game concluded that there's no legitimate room for honest profit - essentially concluding that Louisiana's Medicaid program may not be so badly run after all. At a minimum, it's relatively cheap.

The governor obviously feels otherwise, and there is certainly anecdotal evidence of fraud in the system.

The bottom line, PAR says, is that lawmakers should "take the lead in providing oversight" by establishing a special committee or commission. "While the state health agency is taking the primary role, a well-focused oversight commission independent of the administration would help verify the results," says PAR President Robert Travis Scott. "Verification can build public trust and identify problems."

Trust is the key. Any objective observer of Bobby Jindal knows that he's long on spin and short on specifics - and that his administration is among the least transparent in America. Many suspect that Jindal's primary objective is to declare victory by cutting costs - not to provide good health care. His spin machine is already touting this "sweeping reform" even though it hasn't taken effect yet.

We'd all have to be insane - and irresponsible - to let him turn over $2 billion in public health care costs to private companies without any independent oversight.

Clancy DuBos is publisher of New Orleans' Gambit. A version of this column first appeared in that publication.