From the Editor: Differing diagnoses for health care

This will be the only story in this edition devoted solely to health care. But it’s all over the paper.
On Page 9, you’ll learn that U.S. Sen. Bill Cassidy, R-Baton Rouge, will speak Aug. 30 to the St. Mary Chamber of Commerce in Morgan City. Expect health care to come up in the questions if not in Cassidy’s remarks.
He’s a physician from Baton Rouge, and he’s been an important figure in Senate Republicans’ attempts to repeal, replace or change the Affordable Care Act, better known as Obamacare.
Cassidy’s name was attached, along with South Carolina Republican Lindsey Graham’s, to a 2017 effort to do away with the most important Obamacare provisions, including the requirements to make individuals obtain health insurance and for most employers to offer it. That measure didn’t make it.
You may remember a more famous anti-Obamacare effort that year, the one that Arizona Republican John McCain rose from his sickbed to shoot down with a dramatic 1 a.m. thumbs down. That was a watered down version called the “skinny repeal.”
For St. Mary Parish, this is more than just politics.
Obamacare includes an expansion of Medicaid, the state-federal health coverage program for low-income people.
The feds had been paying for something like two-thirds of the cost for regular Medicaid, with the state paying the rest.
Washington was supposed to pay for 100% of the expansion at first, gradually diminishing to 90% in 2020. For important classes of potential Medicaid enrollees, the expansion raised the upper income limit for eligibility to 138% of the federal poverty line.
Republican Bobby Jindal, who was governor when Obamacare kicked in, refused to implement Obamacare. Jindal had his own plan for improving Medicaid based on contracts with private providers. And, like other red state governors, he was philosophically opposed to Obamacare anyway.
Democrat John Bel Edwards instituted the expansion in Louisiana soon after he took office in 2016. More than 400,000 people have been added to the Medicaid rolls since.
Those new Medicaid enrollees included 6,300 St. Mary people, according to the Louisiana Department of Health. Total Medicaid enrollment here topped 22,000 late in 2018.
The selling point for the expansion, and Medicaid in general, is that by spending money, we save money. The idea is not just to provide treatment for the sick but to improve access to preventive care such as checkups and mammograms.
A flu shot might cost $20, the thinking goes, but a hospital stay for flu-related pneumonia can easily run into five figures.
Others point to the cost. Something like 28% of Louisiana’s state budget is wrapped up in Medicaid by the time you figure in the money we take in from the feds and the state and federal money that gets spent. The state government begins to look like a health care system that dabbles in education and criminal justice.
The datausa.io website, which tracks a variety of economic and social statistics, figures Medicaid enrollment in a way that differs from the Department of Health numbers. The site put Medicaid enrollment in St. Mary at about 28% of the population in 2017. Another 11% of the people were on Medicare, and about 1% received veterans’ health benefits.
So the government was providing the health care for four St. Mary residents in every 10.
About 46% had employer-based or other private health insurance. That left nearly 14% with no coverage at all.
Medicaid is part of a larger fight over how health care should be run. Obamacare, despite its unpopularity when it passed in 2010, has grown on Americans. Polls say we especially like the prohibition against denying health insurance coverage to people with pre-existing conditions. Conservative opponents are looking for ways to keep the prohibition even as they sue in federal court to have Obamacare effectively repealed as a federal encroachment on the marketplace.
Some Democratic candidates, meanwhile, are pushing for an even bigger government role in health care with plans like Medicare for All. Some even propose doing away with private health insurance altogether.
Getting the current U.S. Supreme Court to go along with a private insurance ban will be like trying to sneak a pork chop past a hungry wolf.
Also on Page 9, you’ll see an item about a groundbreaking for a 30,000-square-foot expansion at St. Martin Hospital in Breaux Bridge. That’s the second bit of good news for the region’s rural hospitals this year.
You’ll remember that LifePoint, which has operated Morgan City’s Teche Regional Medical Center under lease from St. Mary Hospital District No. 2 since 2004, decided to pull out of Louisiana. That led to nearly a year of consternation about the 165-bed hospital’s future at a time when rural hospitals in general face immense challenges.
There were worries that St. Mary might lose the hospital. That would be a blow to a parish that didn’t need to be hit again. Aside from the health benefits of having a nearby hospital, it would have been an economic loss in an industry that employs more people than the energy sector.
Many of those fears went away in March, when the hospital district reached a preliminary agreement with Ochsner Health System to take over management of Teche Regional. Ochsner is one of Louisiana’s largest employers and its biggest name in health care.
A thriving hospital generates a benefit that isn’t as obvious as the others.
I once covered University Medical Center, the state-run charity hospital in Lafayette. This was the early 1990s, when Louisiana was still struggling with the 1980s crash in energy prices. Because Louisiana’s constitution and laws put most of the budget-cutting burden on law enforcement, higher education and health care, UMC was struggling.
That was true nowhere more than in its residency programs. UMC was no longer getting the residents it wanted most from the LSU School of Medicine because it was in danger of losing accreditation and couldn’t afford the latest technology. Young doctors want to work with the latest imaging, not iron lungs.
To become a physician, you undergo four years as an undergraduate, then medical school, then a residency of three years or more. During most of residency, these doctors-in-training provide health services at teaching hospitals while working like horses and getting paid about as well.
So when residents emerge from these trials in their late 20s or early 30s, with maybe a spouse and a kid or two, they’re probably not looking to be kindly old Dr. So-and-So who passes out lollipops with the tetanus shots and lets needy patients slide on the bills. Maybe they’d like to be, but they can have student loans that run into six figures.
Maybe they have an attending physician as a mentor and potential partner in an established practice, so they won’t have to rent an office and hire a nurse and clerical help. They definitely want to practice in a place where they’ll have connections, and privileges, at the local hospital.
The word in those days was that three-quarters of physicians practiced within a couple of hours’ drive of the hospital where they were residents. The better the health care facilities, the more attractive St. Mary is for doctors looking to begin earning their living as doctors.
And the more attractive St. Mary is to physicians, the less likely we’ll have to drive to Lafayette or Houma for basic medical care.
Bill Decker is managing editor of The Daily Review.