HHS Secretary Mike Leavitt visited Louisiana on Wednesday to promote a plan to reduce the number of uninsured residents in the state that he developed last year with the Louisiana Health Care Redesign Collaborative, the New Orleans Times-Picayune reports. The plan over five years would redirect $770 million from the state's Charity Hospital system, which provides care for low-income, uninsured residents, to provide private insurance coverage for 319,000 adults with annual family incomes below 200% of the federal poverty level. Leavitt said the plan would provide coverage for about 90% of low-income uninsured adults in the state once the program is fully implemented. About $280 million in funding would remain for the state's hospitals, psychiatric hospitals, rural hospitals and medical education programs at the end of the five-year phase-in period. Leavitt said that there would be no additional federal funding for the plan. He said Louisiana should start planning for ways to restructure the current health system because there is no guarantee that federal funding for charity care will continue in the future (Moller, New Orleans Times-Picayune, 2/1). "It's important that Louisiana and every other state have a safety net to be used to break the fall of 5% or 7% (of the uninsured), not 25% or 30%," Leavitt said, adding, "This is not about eliminating a system of charity care. It's about reducing the number of people who depend on it."

Reaction
State Democratic and Republican leaders said they likely will oppose the plan because it includes no additional federal funding (Shuler, Baton Rouge Advocate, 2/1). "Even longtime proponents of moving away from the charity model said the financing plan presented by Leavitt is unworkable," the Times-Picayune reports. State officials say that Leavitt's plan still would leave at least 400,000 residents without health coverage and that, without the charity system, the uninsured would be forced to seek care through hospital emergency departments in private hospitals. State Senate President Donald Hines (D) said, "My impression is we're being presented with an unworkable plan that we're not going to be able to implement." State Department of Health and Hospitals Secretary Fred Cerise said, "When the trade-off is (to) close (outpatient clinics and preventive services) to insure 40% of the people, that's a tough trade-off." Louisiana Gov. Kathleen Blanco (D) and legislative leaders recently have indicated that they are planning to seek health care system changes that do not require federal approval (New Orleans Times-Picayune, 2/1).

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