All of these major actions, plus a number of smaller ones, indicate a toxic attitude toward Louisiana — or perhaps toward Jindal, with Louisianans treated as collateral damage. With Jindal having so loudly led the charge of governors refusing to accept Obamacare’s expansion of Medicaid, the stage was set for Obama’s team to extract payback, especially via federal health-care payments.
Hence the new outrage:
Louisiana for decades (in one case, centuries) has run a unique system of “charity hospitals,” and Jindal has been working to reform the system for years. When the feds in 2012 cut the percentage of some federal matching funds, Jindal was faced with a sudden budget shortfall. He responded by leasing out the hospitals to private managers, thereby relieving the state of direct management burdens while bringing in a steady stream of revenue. The leases were structured with extra-large “advance payments” in the first year, much like a down payment on a home or an extra month’s payment from a house renter.
In less than a year, the hospitals opened more beds for the mentally ill and in emergency rooms, provided more advanced technology for cancer screening and other care, and began improving services across the board. Already the Jindal reforms were providing proof of his (and other conservatives’) longstanding contention that state innovation could do far more to deliver better care, more efficiently, than a centrally regulated federal behemoth can.
That success may have been more than the Obamites could bear. At first, the feds seemed satisfied with the arrangement, including the advance payment, approving the lease for the hospital in Baton Rouge. But then, suddenly, two weeks ago, without the usual bureaucratic warnings, CMS disapproved the whole deal.
Its objections, on close examination, seem nearly ludicrous. CMS wrote, and has reportedly confirmed in conference calls, that it is satisfied with the idea of leasing out the hospitals and with the overall valuation of the leases — but just not with the advance payments.
Looked at practically, the only way the leases could harm the federal government would be if they somehow allowed Louisiana to attract extra federal matching funds. But the advance payments have nothing to do with this. If the total amount of the leases is not objectionable, then it shouldn’t matter if some of the payments come earlier than others, because the overall federal matching funds for the life of the leases will be the same.
Furthermore, as Louisiana officials are quick to point out, the advance payments were used not as bait for higher federal matches going forward but instead to “backfill” the budget gap in other areas caused by the feds’ tightening of the financing formula in fiscal year 2013. (For various non-political reasons, Louisiana suffered by far the largest reduction in “F-map” funds when the formula was changed.) In other words, the federal budget didn’t, and won’t, suffer from the state’s new leasing arrangement.
But now the leases are in limbo, and the state’s beneficial reforms could be in jeopardy.
All of which might be of interest only to Louisianans — if this latest slap in the face to the state weren’t so obviously part of a pattern. Combined with so much other evidence of the Obama administration’s use of bureaucratic and administrative means to punish political enemies — the IRS scandal, the sacking of honest inspectors general, the Homeland Security listing of conservative groups as potential terrorist hotbeds — this war against Louisiana takes on somewhat ominous overtones.
The message from Obamaville goes out: Cross us, and anybody in your orbit, even low-income medical patients, will suffer.
The good news for Louisiana is that the state has a good chance, on appeal, eventually to win approval of its hospital leases. For the rest of the country, this year and in 2016, the appeal for relief must come through the ballot box.
— Quin Hillyer is a contributing editor for National Review. Follow him on Twitter @QuinHillyer.