Wednesday, November 11, 2009

Louisiana Has Shaped Healthcare Debate

Congress, or congressional Democrats, move closer to passing major healthcare legislation that would extend insurance coverage to nearly all Americans, whether they want it or not. Major provisions, from the public option to employer mandates and taxes, are still to be decided. But barring some intra-party blow-up, and a Republican goal-line stand notwithstanding, the president most likely will get a bill that will largely reshape the healthcare system.

As a recent public opinion poll indicates, voters in few states are more opposed than in Louisiana to what President Obama and Democratic leaders propose. The Southern Media survey showed 58 percent of respondents oppose "the Obama administration healthcare reform position" to 36 percent who favor it. That should be no surprise to anyone who attended any of the town hall meetings on the subject held in Louisiana in August and September.

Yet, despite that strong local opposition to the Democrats' plan, few states' voters have done more to move it forward than in Louisiana. They re-elected Mary Landrieu.

Because of last year's election, which was closer than polls and pundits predicted, John Kennedy is not the junior senator from Louisiana, Republicans do not have 41 votes to maintain a filibuster, and Democrats have just wide enough a window to push through most of what they want in a bill. The handful of Minnesota voters who provided the thin margin of victory for liberal Democrat Al Franken are just as responsible. Yet, with the possible exception of Sen. Blanche Lincoln of Arkansas, who is up for re-election next year, no Democratic senator is swimming against a stronger tide of public opinion than is Landrieu by even considering voting for the bill under discussion.

But for the choice made by Louisiana voters last year, the president and liberal Democrats would not have as strong a hand in fashioning maximum change.

Landrieu has not committed to support whatever bill emerges. But she, who wants to find a way to expand coverage to 650,000 uninsured Louisianians, is in a key position to negotiate major aspects of a final bill and, as these things go, to get something in return for the state for her vote. As for accountability, she must face the voters again in 2014. For the next five years, however, she will work within a possible Democratic majority either as a player or a marginalized maverick, largely depending on this vote.

She has maintained her opposition to the controversial public option provision, which appeared to be killed a few weeks ago, but, appropriate to the season, has returned from the dead. Many voters oppose the government getting into the health insurance business on conservative philosophical grounds, even though senior citizens can't imagine life without Medicare and the middle-aged can't wait to get on it. Another major concern is that many workers would be forced into the public system because their employers will dump private healthcare plans for it. There is strong disagreement that would be the case, just as it is irrelevant to growing numbers of the self-employed and those whose employers don't offer health insurance.

The resurgent public option would be a major problem for Landrieu but for the best idea to come out of the whole healthcare debate, an opt-out provision for the states. This would allow Landrieu to vote for a bill that contains a public option, knowing full well that state legislators will be falling over themselves to vote to keep the government-run plan out of Louisiana.
More than just a political solution, the opt-out idea would set up a national experiment that would compare states with public options to those without. Over the not-so-long-term, the fears of government-run insurance plans will be confirmed or dispelled state by state, instead of by Congress betting one way or the other.

There are other hard points for Landrieu to settle on, such as employer or individual coverage mandates, funding restrictions on abortions, how much it will cost and who will pay. But by her statements, it's clear the senator is looking for more reasons to vote with the president and her party than against. That would not be her choice to make had voters chosen differently last fall.

Sunday, November 1, 2009

Presidents Visit, Secretaries Bring Checks

It's been a week since President Barack Obama spent his half day in New Orleans, but the visit deserves a postscript, beginning with, all together now, a huge sigh of relief that he left when he did.

When his itinerary was announced--a visit to a Ninth Ward school, a town hall meeting and take-out lunch from Dooky Chase's--it was greeted by a chorus of dismay that he was giving short shrift to the four-year-old Katrina recovery effort, that he needed to go to Chalmette and Lakeview and--don't forget Rita--Lake Charles.

Moreover, the complaints went, he was completely ignoring the ongoing disaster of coastal erosion by not helicoptering over the open waters of the gulf to view where the land used to be. The salt in the wound was that he was departing early for a Democratic Party fundraiser in San Francisco.

In cool hindsight, though, consider the flip side of be-careful-what-you-ask-for, which is be-glad-for-what-you-didn't-get. Had the president stayed overnight, he would have wakened to the headlines of the yahoo justice of the peace in Tangipahoa Parish who refused to marry interracial couples out of concern for the children of those unions.

With the traveling national press corps panting, Obama, the most famous son of an interracial marriage, would have felt compelled to offer a teachable moment on the sin of intolerance, to the terminal embarrassment of the state.

But with the president gone, official first responder duties appropriately fell to Gov. Bobby Jindal, who publicly castigated the hidebound JP and called for revoking his license.

So the state should have counted its PR blessings when Air Force One winged westward toward the setting sun. Better yet, it should appreciate the real blessings he left behind. While Obama was making nice with his inspirational message to schoolchildren, across town his administration was making a huge difference in the lives of 19,000 Louisiana families.

In what otherwise would have been the day's lead story, Housing and Urban Development Secretary Shaun Donovan approved the release of $600 million in additional grants for low- to moderate-income households to close the gaps between their Katrina/Rita Road Home grants and the inflated costs of repairing and rebuilding their houses.

It comes to an average of $34,000 per household, above the $50,000 cap on additional grants, which will go far toward finally getting many of the poorer storm victims back in their homes, long after their plight had faded from public attention.

That's how it works: presidents visit, cabinet secretaries bring checks. As far as Louisiana Recovery Authority Director Paul Rainwater is concerned, more gets done from a trip by a Cabinet secretary than when Air Force One touches down. "I love having cabinet secretaries here," he said. "I can talk real stuff and we can move things."

Their boss may be a day-tripper, but both HUD Secretary Donovan and Homeland Security Secretary Janet Napolitano have spent days on the ground here in the last year and more time back in Washington making the state's case on a number of issues.

Rainwater says about $1.3 billion worth of drawn-out disputes with the Federal Emergency Management Agency were promptly settled by the new administration. He looks forward to successfully negotiating another $3 billion in 3,000 disputed projects in the coming months.
A major example is the arbitration process that should finally break the four-year-old impasse with FEMA over replacing Charity Hospital in New Orleans.

"They (Obama administration) supported Sen. (Mary) Landrieu's idea of independent arbitration," said Rainwater. "The former administration did not." Resolution is expected by early next year, a far better alternative than spending years more in court fighting FEMA.
If the arbitration panel's decision is short of the $492 million the state claims it is due, the president has told the governor he would be open to discussing additional funding.

Should it come to pass that way, instead of a presidential visit, Air Force One could simply circle the state Capitol, drop the check and keep on going-- and no one with a lick of sense would complain.

Tuesday, October 13, 2009

White House Embraces Jindal's Message

A recent poll among Republicans shows Gov. Bobby Jindal has slipped from even the second tier of GOP presidential prospects. Yet he still has no trouble raising money out-of-state or making headlines on the national stage, though perhaps not the kind he had in mind.

During his fundraising trip to Washington last week, the governor gave an interview to Politico, an on-line magazine read closely in the capital, that briefly thrust him into the middle of the healthcare debate--uncomfortably, that is, between the Obama White House and Republican leaders in Congress.

With the Senate Finance Committee preparing to vote on a bill opposed by nearly all Republicans, Jindal told Politico, "I think now is the perfect time to pivot and to say, not only here's what we're against . . but here's what we're for."

The headline read, Jindal to GOP: Work with Obama.

Jindal's remarks were not much different from what he's said all along about healthcare, but his timing and calling for Republicans to "pivot" was seized upon by White House press secretary Robert Gibbs, who in that day's press briefing said, "I think I saw one of the more popular Republican governors, Bobby Jindal, say today that it was time for Republicans to offer what they're for, not just talk about what they're against." And he urged the GOP leadership to listen to the young governor's call for cooperation.

They heard him, all right, none too happily. Jindal's remarks were likely galling to many Republicans, including the one who succeeded him, Rep. Steve Scalise of Metairie, who has written the president asking for a meeting to discuss areas of agreement and to offer alternatives.

If Obama and Jindal were to kick back over a beer, they would agree on insurance portability and coverage for pre-existing conditions, as the Republicans have. But they would disagree over the Medicaid expansion and penalties on employers who don't offer coverage, as the Republicans have.

So, besides his choice of softer words, Jindal's position on healthcare is the same as the Republican leadership's and just as irreconcilable with the president's. Yet the White House cast Jindal as Mr. Reasonable, whose example the GOP hacks should follow.

By then, the governor may have noticed he was being used. He sought to create some distance from his new admirers in the White House by responding in a statement, "The American people do not want to raise taxes, increase government spending or give government more control of our healthcare system."

But the story had moved on and congressional Republicans were no doubt pleased to see Jindal return home to resume his schedule of ribbon-cutting and medal-pinning ceremonies.

Besides image, however, there is another big difference between Jindal and congressional Republicans, that could explain his conciliatory tone. GOP congressmen can speak against, vote against and run against whatever healthcare bill the Democrats manage to pass. But Jindal, like other Republican governors, will have to take it and make it work within the budgets and frameworks of state government.

Provisions of bills being debated, if they become law, would fundamentally change public healthcare in Louisiana, spelling the end of the charity hospital system as we know it. Jindal's plans for overhauling the state's Medicaid program would have to conform to new federal rules.
Beyond that, Louisiana seeks special treatment from the feds on pressing healthcare issues. It desperately needs a $1 billion fix on its Medicaid match rate, caused by an artificial spike in personal incomes in the post-hurricane economy.

Also, if the state doesn't get all it seeks in arbitration with the Federal Emergency Management Agency to replace Charity Hospital in New Orleans, the president has said he would consider providing additional funding.

How those crucial matters are resolved could largely define Jindal's first term and shape his reputation as a problem-solving, can-do governor. Success greatly depends on cooperation from the Obama administration and, whether conservative voters like it or not, a good working relationship between the governor and the president.

So if Jindal's comments proved useful to the White House, it is hardly a bad thing for him or Louisiana. With so much on the line, I'd kiss up too.

Saturday, October 3, 2009

Kennedy Steals the March on Government Change

He's been so busy lately, helicoptering to every corner of the state to deliver jumbo-sized ceremonial checks to parish officials, to pin medals on veterans and to attend church services that Gov. Bobby Jindal must have missed that, back at the Capitol, someone else was leading the charge to cut state government down to size.

Treasurer John Kennedy is merely the chairman of a subcommittee of an advisory panel for streamlining government, but he grasped its publicity potential and has stolen the march on not one but both blue-ribbon commissions on budget-cutting and restructuring.

Kennedy has been traveling the state too, not as deeply into the piney woods as Jindal, but rather to Chamber of Commerce luncheons and editorial boards to promote his big ideas for change, from a 15,000 reduction in state employees to a single board of higher education.

Going strictly by appearances, Kennedy is looking like a governor; Jindal, a lieutenant governor.

Appearances deceive, of course. The governor does focus intently on economic development opportunities. And his staff has been actively engaged with both commissions, particularly the Postsecondary Education Review Board, exploring how to make a big idea like a single college management board actually work.

But with Kennedy capturing the limelight by default, Jindal may have felt the need to re-assert his role of budget-cutter-in-chief.

If so, he chose a curious way to go about it, by giving both commissions specific dollar-amount goals for budget reduction recommendations: $802 million from the streamlining commission and $146 million from the college board.

Nothing wrong with defining the challenge and setting goals. He could have done that six weeks ago when these groups first met. Instead, at that time, he urged panel members to be bold and think outside the box.

His job, it goes without saying, is to deal with the box as it is. The streamlining commission should be free to come up with creative, innovative suggestions that, if any of them worked, could save big money. But it is the governor's responsibility to meet the projected $948 million deficit when he presents the executive budget next March. It would be interesting, also comforting, to hear what specific ideas he has come up with already.

When it gets down to the reality of writing a balanced budget, Jindal has his own streamlining commission. It's called the Division of Administration. Commissioner Angele Davis, who sits on the streamlining panel, probably already has considered most of the recommendations that will come up. She gave an impressive presentation on what she's doing now to control costs throughout state agencies, such as a moratorium on buying cars. It didn't come close to $802 million, but it was a start.

That's more than the education board has accomplished. Comprised mostly of out-of-state experts with their own busy schedules, that commission has met only once, has yet to elect a chairman or set a direction for what it wants to get done.

It's unrealistic to expect the educators to make serious recommendations on cutting 15 percent of state spending for higher education. They would better serve the state by sticking to their original mission to recommend broad, even sweeping changes in how management systems are structured. Once a new plan is in place, it would be possible--more than now--to reduce costs through the merger of programs, even campuses.

The big idea, a single board, is not a new one--and Kennedy is out there running with it already. Board members and the governor's staff, especially executive counsel Tim Barfield, have been having deep discussions about what kind of new regime could replace the current five boards.

Such a far-reaching, controversial proposal--requiring constitutional change--is more effectively advanced after the vetting and seal of approval of a blue-ribbon commission of outside experts.
If the governor gets that much out of the education board, he shouldn't be disappointed if it doesn't also tell him how to balance his higher education budget. It will have served a higher purpose.

At that point, the governor can put away his poster checks and medals and travel the state with a game-changing big idea to discuss, with the stage all to himself.

Monday, September 21, 2009

Clarity Better Than Gold in Ethics Laws

An out-of-state government consultant testifying before the Streamlining Government Commission was asked what he thought of Louisiana's new ethics laws being ranked best in the country.

"It said you had the best rules," the consultant deadpanned. "It didn't say you always followed them."

Well put. Beyond bragging rights, it is hard to identify what Gov. Bobby Jindal's signature initiative, the overhaul of state ethics laws, has achieved, other than clearing out Ruth's Chris Steakhouse during legislative sessions by way of the $50 limit on what lobbyists can spend entertaining lawmakers.

In many cases, the difficulty with obeying new ethics rules has been understanding them.
For instance, current ethics cases involving two legislators and one sheriff stand to be decided not on their merits but on whether the Legislature intended for a change in the law to be retroactive or prospective, which could have been but wasn't cleared up with one sentence.
In the interest of fair play, the Legislature shortened the time period from two years to one for the Board of Ethics to bring charges after receiving a complaint.

The near mass resignation of the old board and the appointment of a new one ate up several months before the new members could get around to old cases. They eventually brought the charges within the old two-year window but beyond the new one-year deadline.
The accused officials argue that the new limit applies to them, while the Ethics Board holds that the old rules govern old cases.

Depending on how state courts eventually rule, the first dozen or so cases under the new ethics regime could be thrown out because the Legislature and the governor's lawyers screwed up the drafting of the laws.

The new procedures have other problems, which make justice needlessly elusive.
Ethics charges are no longer decided by the Board of Ethics but by panels of administrative law judges. It's been claimed that because the head of the Division of Administrative Law is appointed by the governor that she can be leaned on to protect Jindal's friends.
That's a twisted stretch.

The director, Ann Wise, first appointed by former Gov. Foster, is as ethical and independent a public servant as this state has. The administrative law judges who work for her are mostly career civil servants who hear thousands of cases each year involving employee-management disputes in state government.

They are as fair and capable as the governor's ethics board appointees in deciding cases. But that doesn't mean they should be doing so.

Legislators came up with using the ALJs in order to get away from having the ethics board act as prosecutor, judge and jury. But they should have thought that through more. Under the new law, the ethics board acts as kind of a grand jury in charging defendants, but once the ALJ renders a decision, the board is required to ratify the ruling, even if members don't agree with it.

Board chairman Frank Simoneaux intends to ask the Legislature to return decision-making to the board, but to have a separate department within the agency investigate and prosecute cases. That would clear up conflicts while restoring the board to its proper adjudicatory role instead of that of a ceremonial bystander.

Also, should the governor and Legislature revisit ethics, they might as well change those three troublesome words, "clear and convincing," that make the new process anything but.
The words were inserted into legislation to set a new standard of proof, meant to fall somewhere between "preponderance of evidence" in civil cases and "beyond reasonable doubt" in criminal cases. Trouble is, no one is quite sure where that somewhere is.

The standard-of-proof wording does not, as some critics claim, make ethics laws unenforceable, but neither does it make them clear. In most cases, the facts are not in dispute so much as is the interpretation of the law. So returning to "preponderance of evidence" would not change outcomes as much as it would re-instill some confidence in the system.

The governor need not worry that clarifying ethics laws would tarnish the gold standard he professes for them. But it sure would help make our best-ranked rules easier to follow.

Thursday, September 3, 2009

Panels Brainstorming Smaller Government

One could sense the collective yawn and rolling of the eyes when Gov. Bobby Jindal urged two separate commissions on down-sizing state government and higher education to be bold, to think big and to come up with recommendations that won't just gather dust on a shelf, as has happened in the past.

Skepticism abounds, for these advisory panels, like those before, can think outside their boxes all they want, but it's the governor and the Legislature who have to follow through to make government institutions any smaller, as has not happened in the past.

This time, however, with state revenues in steep decline for years to come, change is going to happen, the only question being if and how government and higher education will work when it is all done.

One would think Jindal, with his big-picture vision and laser-like focus, would not need a couple of blue-ribbon commissions to tell him what needs to be done. Nor is the Legislature clueless.
What they both need is outside validation and broad-based public support for the hard political choices to curtail government services and shrink universities.

For that, the Commission on Streamlining State Government and the Postsecondary Education Review Commission could prove useful, not to mention quick and cheap for government work.
With only four months to report back, the streamlining commission is taking a broad look at state government instead of drilling down into each agency. "We want to make sweeping recommendations," said its chairman, Sen. Jack Donahue, R-Mandeville, with the aim of saving hundreds of millions of dollars.

Off the top of his head, he suggests centralizing human resources and technology support instead of every agency having its own staffs for those functions. The governor urged the streamliners to look at merging some state agencies and privatizing and outsourcing the work of others.

Comprised mostly of state officials and with minimal operating expenses, if the streamliners come up with one $10 million idea that the Legislature buys, the effort won't be wasted.
The higher education commission, however, needs to do better than that, given the serious and growing shortfalls for college budgets. There are those who won't be satisfied with anything less than the closure of three or four of the state's 14 four-year universities. That's not going to happen.

According to a web site that tracks universities that have closed, since 1945, the number of public four-year colleges in the country to shut down is three: in South Dakota, North Dakota and Minnesota. More four-year colleges have become two-year schools, but as major economic engines of any community, they don't just go away.

Instead, the governor asked the commission, comprised mainly of out-of-state experts and Louisiana private citizens, to look at right-sizing the schools we have. In Louisiana, 75 percent of college students attend four-year universities and only 25 percent go to community colleges, while nationwide, it's closer to 50-50.

The governor proposed a solution straight out of Economics 101: raise admission requirements at four-year schools in order to divert more marginal, less-prepared students to community colleges, where the cost per credit hour is far cheaper, both for the state and the student.

The economic impact of the poor graduation rates of Louisiana universities is seen in students who flunk out or quit after a few semesters, but are saddled with their student loans for years. If the same students start at community colleges, they would borrow less with far greater chances of earning associate degrees, which lead to better jobs or admission to four-year schools.

Enticing unprepared students to take out loans to go to universities where they will fail morally equates to the worst practices of the sub-prime mortgage industry.

The idea of raising admission requirements is not new, but neither has it been embraced by university leaders and their local legislators, who fear losing enrollment on which funding and jobs are based. Fortunately, the colleges have a voice but not a vote on the college commission.

That will make it easier, or at least possible, for the panel to make and validate the kind of bold recommendations the governor will need to build public support around. It's going to take a lot.

Tuesday, August 18, 2009

Panels Brainstorming Smaller Government

One could sense the collective yawn and rolling of the eyes when Gov. Bobby Jindal urged two separate commissions on down-sizing state government and higher education to be bold, to think big and to come up with recommendations that won't just gather dust on a shelf, as has happened in the past.

Skepticism abounds, for these advisory panels, like those before, can think outside their boxes all they want, but it's the governor and the Legislature who have to follow through to make government institutions any smaller, as has not happened in the past.

This time, however, with state revenues in steep decline for years to come, change is going to happen, the only question being if and how government and higher education will work when it is all done.

One would think Jindal, with his big-picture vision and laser-like focus, would not need a couple of blue-ribbon commissions to tell him what needs to be done. Nor is the Legislature clueless.

What they both need is outside validation and broad-based public support for the hard political choices to curtail government services and shrink universities.

For that, the Commission on Streamlining State Government and the Postsecondary Education Review Commission could prove useful, not to mention quick and cheap for government work.

With only four months to report back, the streamlining commission is taking a broad look at state government instead of drilling down into each agency. "We want to make sweeping recommendations," said its chairman, Sen. Jack Donahue, R-Mandeville, with the aim of saving of hundreds of millions of dollars.

Off the top of his head, he suggests centralizing human resources and technology support instead of every agency having its own staffs for those functions. The governor urged the streamliners to look at merging some state agencies and privatizing and outsourcing the work of others.

Comprised mostly of state officials and with minimal operating expenses, if the streamliners come up with one $10 million idea that the Legislature buys, the effort won't be wasted.

The higher education commission, however, needs to do better than that, given the serious and growing shortfalls for college budgets. There are those who won't be satisfied with anything less than the closure of three or four of the state's 14 four-year universities. That's not going to happen.

According to a web site that tracks universities that have closed, since 1945, the number of public four-year colleges in the country to shut down is three: in South Dakota, North Dakota and Minnesota. More four-year colleges have become two-year schools, but as major economic engines of any community, they don't just go away.

Instead, the governor asked the commission, comprised mainly of out-of-state experts and Louisiana private citizens, to look at right-sizing the schools we have. In Louisiana, 75 percent of college students attend four-year universities and only 25 percent go to community colleges, while nationwide, it's closer to 50-50.

The governor proposed a solution straight out of Economics 101: raise admission requirements at four-year schools in order to divert more marginal, less-prepared students to community colleges, where the cost per credit hour is far cheaper, both for the state and the student.

The economic impact of the poor graduation rates of Louisiana universities is seen in students who flunk out or quit after a few semesters, but are saddled with their student loans for years. If the same students start at community colleges, they would borrow less with far greater chances of earning associate degrees, which lead to better jobs or admission to four-year schools.

Enticing unprepared students to take out loans to go to universities where they will fail morally equates to the worst practices of the sub-prime mortgage industry.

The idea of raising admission requirements is not new, but neither has it been embraced by university leaders and their local legislators, who fear losing enrollment on which funding and jobs are based. Fortunately, the colleges have a voice but not a vote on the college commission. That will make it easier, or at least possible, for the panel to make and validate the kind of bold recommendations the governor will need to build public support around. It's going to take a lot.