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Mary Landrieu gets $100 million from health-care reform bill she doesn't yet support

It's nice to be an undecided senator in a 60-vote Senate:

Sen. Mary Landrieu's state of Louisiana is still ailing years after Hurricane Katrina devastated its largest city. So Senate Majority Leader Harry Reid could be killing two birds with one stone by including in his health care bill $100 million in federal Medicaid aid for any states (aka, Louisiana) that have suffered a natural disaster in the last seven years. That's much needed help for the poor in Louisiana, and also a sweetener for Landrieu, whose support for health care reform has never been terribly certain.

Cynical question: How does this get Landrieu votes? The folks helped by $100 million for Medicaid are largely poor people who either don't vote or already vote Democratic, and Gov. Bobby Jindal, who isn't going to help Landrieu win reelection no matter how much she does to help him balance his budget. It's obviously a good thing for Landrieu's state, and even strikes me as good policy, but I've never been clear on how the assumed electoral benefits of this sort of thing actually work.

By Ezra Klein  |  November 20, 2009; 2:05 PM ET
 
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Comments

Medicaid helps the health care providers who work with eligible aid recipients. An increase in Medicaid funding is a nearly-direct pipeline of money to the Louisiana health care industry.

Posted by: nolo93 | November 20, 2009 2:18 PM | Report abuse

The vote to evict Jindal from office could be a decisive matter. Where is ACORN when needed?

Posted by: rmgregory | November 20, 2009 2:32 PM | Report abuse

i had seen this yesterday too but what is to stop ANY state who has had a natural disaster and is the potential maximum cost factored in the bill?

California??

Florida?? (any hurrianes that hit them?)

Texas??

Wait, didn't NJ have floods a couple years back that were considered a national disaster? If so, GOOD. We could use it with a $8 BIllion shortfall this coming year.

Any other states applicable??

Posted by: visionbrkr | November 20, 2009 2:40 PM | Report abuse

Anything that helps's the overall budget situation of the state is a positive spin for her; much better to get other people to pay your bills than to have to tax yourself to pay them.

Posted by: exgovgirl | November 20, 2009 2:40 PM | Report abuse

nolo93 is right, Ezra. Follow the money. Kaiser's State Health Facts is a great help here.

Consider the path Medicaid spending by the feds follows when it leaves Washington: it is deposited in a dedicated state fund -- not the general fund, usually -- so it won't help Jindahl balance the budget anyhow (unless there's a shortfall in Medicaid, though shortfalls are always utilization-driven).

Then, it gets added to the $5.5 billion Louisiana already spends on Medicaid. About 31 percent of that money goes directly to providers to pay for services used by patients in Medicaid's fee-for-service population -- mostly folks in nursing homes and the disabled.

The remaining 69 percent goes to primary-care case management operations, which are generally privatized, blended-payment organizations that can be run by doctors, hospitals or insurers, and covers mostly pregnant moms and kids. Everyone skims off 15-20 percent for their admin and profit. The 80 to 85 percent that's left goes to providers, who also take a share for admin and profit (except for the ones that are losing money.

None of this means a darn thing to the patient (Medicaid beneficiary). All that person knows is they got to visit the doctor or hospital and the bill got paid. I don't think they either know or care whether Landrieau or Reid had anything to do with it, and even if they did, po' folks don't vote as much as other demographics.

Posted by: Rick00 | November 20, 2009 2:44 PM | Report abuse

http://voices.washingtonpost.com/capitol-briefing/2009/11/nebs_nelson_agrees_to_health_d.html

Lieberman and Nelson, etc.... I suppose it is likely to come to the floor after all.

That's pretty much the same as saying health care reform, mostly as it has been made so far, will happen.

The only part left is key little pieces like whether the payout ratios will be 85% instead of 80%, and whether the pilot programs will have teeth (specific timeline goals and requirements to widely implement successful programs).

Posted by: HalHorvath | November 20, 2009 4:03 PM | Report abuse

Hal,

no its not. From what i can tell Lieberman still hasn't backed off the death of the public option. To say that it's a "done deal" is absolutely wrong.


Again I've argued before that a public option trigger with medicare rates would do much more than this crappy opt out. The PO is what insurers fear and if the trigger is structured right it could absolutely force them to get tough with providers and hospitals and actually work to save money all while not having to put in an expensive public option that will cost a lot to start, even more to bail out when insurers already have their systems in place.

I'd love to see that option scored.

Posted by: visionbrkr | November 20, 2009 4:20 PM | Report abuse

"even strikes me as good policy"
Buying votes strikes you as good policy? How so?
This is going to get a lot of bad publicity.

Posted by: staticvars | November 20, 2009 4:40 PM | Report abuse

vb -- that does seem like a plausible option. I suppose the "medicare rates" would be +5%. If not, I'd be impressed.

One of the things not many people think about is the whole question of how much insurers/patients/medicare/self-insured companies, etc., will pay for medical care.

In the past, it was price no object, and now the credit bubble has popped....

Posted by: HalHorvath | November 20, 2009 4:52 PM | Report abuse

"Cynical question: How does this get Landrieu votes?"

Ezra is still assuming that people are rational actors responding to policy according to how it benefits them personally. I don't think that is how pork barrel works. If only the votes of those who directly benefit from a given pork barrel were affected, the whole pork barrel system would be irrelevant because let's face it, pork barrel money, outrageous as it is in many cases, is small fish in the grand scheme of things.

Posted by: carbonneutral | November 20, 2009 5:39 PM | Report abuse

That's ok. Senators aren't clear on it either. They just believe in it with all their frozen hearts.

Posted by: pj_camp | November 20, 2009 9:35 PM | Report abuse

$100 million is nothing when you consider Cardoza got half a billion for two new medical schools in California. But it helps give Landrieu cover to vote for the bill.

Posted by: bmull | November 20, 2009 10:51 PM | Report abuse

Oh please, part or a great part of the "Louisiana purchase", as this event is coming to be known, will find its way into her war chest. And she was probably promised other things that you don't know of. As well as threatened if she didn't come through.

Posted by: truck1 | November 21, 2009 1:02 PM | Report abuse

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