NOLA Healthcare May Be Headed for Radical Change

The bulk of the New Orleans' area's uninsured population will receive free or subsidized health insurance under the plan proposed by the Louisiana Health Care Redesign Collaborative.

The blueprint will combine two proposals that the collaborative has considered: private health insurance for the poor and highly managed care for special needs patients, such as the mentally ill and elderly, said Dr. Floyd Buras, president of the Louisiana State Medical Society.

"Funding is the issue," Buras said. "It's going to be a problem that we will have to address, whether at the state level or with (Health and Human Services) Secretary Michael Leavitt."

The plan for Jefferson, Orleans, Plaquemines, and St. Bernard parishes will cost between $150 million to $200 million more than the state now spends in the region. Leavitt has said he wants a revenue-neutral plan, although the federal official has also said additional money could be made available.

Leavitt also wants a plan that will offer everyone portable healthcare coverage so that the money follows the patient. Under this scenario, patients can choose their doctors and hospitals, rather than being tied to one of the state's charity hospitals. Leavitt's deadline for the plan was Oct. 20.

The United States Department of Health and Human Services pays 70 percent of the healthcare costs for the poor and uninsured. Louisiana picks up the remainder of the tab.

Gov. Kathleen Blanco has complained that Leavitt is asking the state to provide everyone with health coverage with no guarantee of additional federal help.

Buras said if Leavitt is serious about making Louisiana the model for an innovative healthcare solution, he's going to have to help.

"If you want Louisiana to get away from a two-tiered system of healthcare, you're going to have to pony up some money, at least to get it off the ground," Buras said.

The New Orleans area has somewhere between 100,000 to 130,000 people without health insurance, according to the latest census figures.

The proposed plan would provide free insurance for the poorest non-elderly, non-childbearing adults and subsidies for the working poor, Buras said. The state would also work with employers to make sure that the people who are eligible for employer health plans get that coverage.

High-risk patients would fall under a healthcare program similar to the existing one, but highly managed, Buras said.

State Health and Hospitals Secretary Dr. Fred Cerise has recommended establishing "a medical home" for poor and uninsured patients. Patients would first consult a healthcare professional, such as a family doctor, who would either treat them or coordinate their care.

The medical home would link patients to specialists, emergency care and other services, Cerise has said. The concept is expected to lower costs because patients won't get all their care in emergency rooms.

The state medical society, which has proposed a private insurance model, and some other collaborative members, including Cerise, had butted heads over which concept to use.

But the Oct. 9 collaborative meeting appears to have resulted in a compromise proposal with which everyone can live, Buras said.

For instance, about half of the money needed for the program would come from the savings generated by the new healthcare system, Buras said. Fewer hospital stays and emergency room visits would cut the amount of Medicaid dollars needed.

This would free up Medicaid disproportionate share funds, money set aside for hospitals that treat large numbers of low income patients with special needs, which could be rolled into the insurance plan, Buras said.

Other savings could come from managing end-of-life issues, Buras said. At present, roughly 75 percent of the Medicaid funds are spent caring for 25 percent of the patients.

"A lot of dollars are spent keeping Grandma alive the last two days, when it's not really what Grandma wants," Buras said. "But no one's really sat down and talked about it in a holistic way."

However, a number of issues remain, Buras said.

The reimbursement rates for Medicaid, now set at 60 percent of Medicare, will have to be made equal to Medicare, according to Buras.

Providers in New Orleans have some special needs. Many of them were wiped out by Hurricane Katrina — Buras is one of them — and they have to rebuild their businesses while providing care.

"If you're going to get buy-in from general providers, you'll have to get reimbursements at least up to Medicare, he said.

Other hurdles must be cleared before the new plan can become a reality. In addition to Leavitt's approval and kicking in additional federal funding, state legislators must sign onto the proposal, Buras said.

This will require thinking about healthcare in a completely different way and understanding how healthcare and its funding model will change, Buras said. The reform package is complicated and will take time to absorb.

4 years after Katrina: Lessons from the Gulf Coast

Four years ago, Hurricane Katrina hit New Orleans. As the Gulf Coast struggled to keep its head above water, the rest of us were glued to the news - astounded at first by the awful destruction, and then by the inadequate response to so much human suffering. 



In those days, our TV sets became microscopes ─ magnifying in shockingly clarity the divide in our nation between those who could afford to escape and those who could not. The Gulf Coast continues to be a microcosm for a nation in search of economic recovery.

What can New Orleans tell us about how to rebuild, revitalize, and recover?

Root economic recovery in clean energy

In the quest to rebuild, New Orleans has become a leader in energy saving and clean energy, from solar-powered streetlights and hybrid city buses, to building energy-efficient homes for residents who were made homeless by Katrina.

Why choose clean energy? For one thing, clean energy means jobs for a devastated region. A $615 million investment in clean energy is projected to create over 6,000 jobs in New Orleans, according to a recent report from Green For All and the Natural Resources Defense Council. In fact, clean-energy investment creates roughly three times as many jobs as the same level of investment in fossil fuel technologies, and the jobs generated are more accessible to workers with relatively low levels of formal education.

With the challenge of rebuilding much of the city's infrastructure, New Orleans is finding that clean-energy projects make the most sense in the long term - by benefiting the environment, and the local economy.

Jobs must be good and accessible to local residents

The Gulf Coast recovery, however, has seen its share of challenges, particularly in ensuring that recovery plans create quality jobs for the community.

Many of the rebuilding jobs in the Gulf region are going to two groups: professionals from out-of-state and undocumented workers, mostly from Latin America. The first group is made up of mostly highly-educated, highly-paid professionals in fields like urban planning. The undocumented workers, meanwhile, face temporary, dangerous jobs with dismal pay and no benefits, and have no way to address these issues for fear of being turned over to the authorities.

This lack of standards is leading to low-road jobs that don't benefit workers or the local economy. Similarly, the professional jobs are drawing new people to the region, but doing little for the folks who lived in New Orleans before the storm hit.

The Louisiana Green Corps, in contrast to this trend, provides real opportunity and access to the job market for local residents, many of whom have few other options. The Corps teaches practical job skills in green construction, weatherization, and energy-saving techniques to local youth who have had trouble with the law. Another successful project, Make it Right, is building energy-efficient homes in the Lower 9th Ward, a working-class New Orleans neighborhood. Make it Right is not only providing homes for families that have been displaced by Hurricane Katrina. It is also providing jobs and much needed entrepreneurial opportunities.

The Louisiana Green Corps and Make it Right are now partnering with the City of New Orleans to create more jobs, homes, and local opportunity - using President Obama's Recovery Act. The partnership is jointly applying for Recovery funds to expand the number of workers it trains and energy-efficient homes it builds.

Lessons for Washington, DC

The challenges and successes Louisiana has faced offer important lessons to the nation, and particularly to our leaders in Washington.

The Senate is now crafting a crucial clean-energy bill that could create hundreds of thousands of American jobs. It is absolutely essential that the Senate legislation include investment in green-collar job training so that programs like the Louisiana Green Corps can prepare America's workforce for new jobs across the country. 

Equally important are standards to prevent a low-road economy that excludes local workers. The Green Construction Careers Demonstration Project is a key provision in the clean-energy bill that ensures that green construction jobs have quality standards and are accessible to local workers.

Both of these provisions were included in the clean-energy bill the House passed this summer. They must also be included in the Senate version. America's workers and middle-class depend on it.

The rebuilding in New Orleans is far from done. There are thousands of people who still need homes, jobs, and health care - thousands who need their communities back. But in the past four years we've learned a lot about the right and wrong ways to help the region rebuild and thrive.

It is time as a nation to put these lessons to use.


Green Energy
Extreme Weather
Poverty
Phaedra Ellis-Lamkins - Chief Executive Officer, Green For All (www.greenforall.org)