One of Barack Obama’s major plans after he takes office after his inauguration on January 20, 2009 is to overhaul the nation’s healthcare systems. He is about to inherit what Health and Hospitals Secretary Alan Levine calls the “Four Horsement of the Health Care Apocalypse.” Each State has its unique health care model; some have had functional ones for many years, such as Hawaii, which Hillary Clinton talked about as the type of system she believed could serve as a prototype for the rest of the nation. Many States, however, are in the midst of a serious healthcare crisis and are having to rethink and restructure their programs.
Those without jobs, who are totally disabled and without any income, can qualify for Medicare or Medicaid. It is the working poor, however, who suffer substantially because incomes are often so little that they are unable to afford even the smallest payment for medical care and go on without until there is a crisis, at which time they end up in the emergency section of a hospital.
Louisiana is particularly in an emergency. Governor Bobby Jindal was elected in 2007 with the hope of the citizenry of the State that he would eliminate the waste and corruption that for so long has been identified with Louisiana. 2008 was spent eliminating unnecessary projects and placing oversight mechanisms into the political system to help overcome the powerbrokers who used connections and family names to maintain control over government offices and corporations. Nowhere had that been more obvious than in the actual government of Louisiana, according to the political pundits, so Bobby Jindal’s goal was to root out corruption at every level. In 2009 he is poised to overhaul the healthcare system with a medical home model where all care, including physical, mental and dental, will be part of a one stop shop, where the working poor can receive health care without charge under Medicaid. But how can this be done with funding gaps, disallowed reimbursements from the Federal government that the state is required to pay back, and shortfalls while public healthcare costs have skyrocketed? These concerns are critical as well as physician complaints about managed care that they believe will negatively impact patient care and the financial underpinnings of the system.
In Natchitoches, Louisiana the Outreach Medical Center is funded by Medicaid, Medicare, private insurance and federal funds. 40% of the population served by the Center is working poor. The goal is to have a community health center in every parish in the state of Louisiana. The State of Louisiana gave the Louisiana Primary Care Association, $41.5 million. Through new market tax credits the health centers are taking this to banks and lenders who participate in new tax credits and hope to parlay that money into three times that 41.5 million. They intend to borrow additional funds using the $41.5 million as collateral to expand centers and services. This will help consolidate medical care and costs while allowing the centers to have a portion of the Federal loan forgiven because of a tax credit provision that after seven years, if the money is used for expansion, it will be forgiven. This money will be used to expand health care for the working poor because public health care is projected to occupy 21% of the healthcare service budget. Through an organization called Capital Links the Louisiana Primary Care Association anticipates getting the project organized, developed and in operation. Bobby Jindal supports the project because of the serious costs facing the State budget. John Winston, Chief Executive Officer of Outreach Medical Center that serves three population areas in Louisiana, is optimistic that the plan will be effective.