June 29, 2006

The Honorable Michael O. Leavitt

Secretary of Health and Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W.

Room 615F

Washington, D.C. 20201

Dear Secretary Leavitt,

I attended a meeting at your office, at your request on March 29, 2006 where you made a skeletal presentation of a set of objectives for recovery and reorganization of the healthcare system in the New Orleans area that you hoped could be fleshed out later with my staff and other members of the Louisiana delegation. I followed up immediately after that meeting, forwarding you the name of my Chief of Staff, Aranthan Steve Jones II as my designee to work with your staff on the details. Mr. Jones is well known as a leading healthcare policy expert on Capitol Hill.

Today, despite 3 letters and at least 12 phone calls, two of which I made personally, we have received no response to our efforts from you nor any of your assistant secretaries in regard to our meeting request. Yet, I understand you have scheduled a press conference in New Orleans on July 17^th to roll out a plan or principles for such a plan for a so called “world-class-healthcare system.” We do not need a press event on this issue, but an inclusive well-thought-out plan that covers all legitimate policy concerns.

From what I remember of your presentation in March, you envisioned a “world-class-healthcare-system” that centered on private healthcare providers and clinics with an emphasis on preventative healthcare instead of public hospitals and in-patient healthcare services. This “world class healthcare system,” according to you, would be created with less money and fewer facilities.

While I share your vision of a seamless preventative healthcare system, the details have yet to be disclosed and money has yet to be committed. Thus, I am left to assume your vision of a “world class healthcare system,” is one that leaves out adequate healthcare services for poor—to—moderate income New Orleanians and  assumes very few of these people will return to the city. In fact, I raised this issue with you at the March meeting and your response contemplated a New Orleans much smaller than its pre-Katrina population and thus current healthcare dollars would go further.

However, the reality, according to a recent issue of U.S. News & World Report, is that the New Orleans area is now home to one million people, just under the pre-Katrina population of 1.3 million.  Despite this fact, the bulk of healthcare resources necessary to adequately serve that population level has not returned:  only half of the previous 4,000 hospital beds are available; there is no Level I trauma center; there are 34 nursing homes, down from 63; and 19 clinics, down from 90.  That same report describes our healthcare system as being, “unacceptably primitive,” and noted the absence of healthcare facilities, personnel, and federal guidance. Without rapid, coordinated, and effective help from the federal government, there will be disproportionate human suffering and unnecessary deaths in greater New Orleans because of a deficient healthcare system.

This is an unavoidable fact given the historically high chronic disease burden that many New Orleanians suffer and their limited amount of financial resources to be dedicated to healthcare services.  Thus, I have real doubts that any plan or principles for your “world-class-healthcare-system,” built on assumptions that do not match the current population and demographic reality, is going to work.

Prior to Hurricane Katrina our healthcare delivery system was in a chronic crisis. While I am certain that resource efficiencies can be realized through alternative practices, the amount saved is not enough to build a new healthcare system and recapture what was the best of the old one. 

There are a number of questions that the people of my district need to have answered and addressed before they would expect me to sign-off on your July 17^th plan. Some of these questions are below and do not require preemptive actions by state/local officials in order to be answered:

1.       If we use new assumptions of a rapidly returning population to pre-Katrina levels, who will be left out, or put a risk of inadequate access to services, as a result of the adoption of your plan? It is clear that certain populations will be left out, which ones?

2.       How do you propose to resolve the financial burden of bourgeoning uninsured patients?

3.       Federal government studies have repeatedly shown when public health and preventive services are disproportionately delivered through a private healthcare system access to these services is fragmented and unevenly distributed. Moreover, it has been stated that poor and moderate income patients incur access problems the most under such system. Given this well established fact in the healthcare literature why are you recommending it as the healthcare model for New Orleans?

4.       What is your department doing to address the lack of nursing homes and long-term care facilities to which hospital patients can be discharged?

5.       Why hasn’t your department requested the Federal Emergency Management Administration (FEMA) to provide emergency shelter for medical personnel to ensure staffing for both long-care facilities and hospitals? 

6.       Why haven’t you given the State of Louisiana additional flexibility and resources to address unmet needs for mental health services in the greater New Orleans region?

7.       Why hasn’t your department approved the State of Louisiana’s request to waive the federal match requirement of its AIDS Drug Assistance Program?

8.       What is the status the $100-million loan guarantee program from Health Resources and Services Administration (HRSA) which was established to construct community health centers.  Have any of these monies been given to Louisiana for that purpose?

9. Because so many people lost their jobs when they were displaced as a result of Katrina, some New Orleans residents have missed their opportunity to sign up for Medicare Part B and will incur a lifetime penalty for late enrollment because of their dislocation. Why haven’t you waived this penalty?
10. A number of Medicare beneficiaries have not paid their Medigap premiums in a timely manner and as a result risk cancellation of their Medigap coverage. Given the disruption and uncertainty in the displaced beneficiaries’ lives, an imminent concern is that policyholders will lose their current Medigap policy after a lapse in premiums payments. Why hasn’t your department stepped in to stop this from happening?
11. It is clear that many of the displaced Medicare Advantage (MA) plans members will not be returning to New Orleans and nearby areas for many months. To date, it is unknown what MA plans will offer their displaced plan members after October 2006, when the plans end their grace periods. A long-term policy, rather than month-to-month decisions, on the status of MA plan payments for out-of-area services is needed. Why haven’t you issued a policy for New Orleans citizens that are out of network?
12. Medicaid waivers for over 250,000 Katrina evacuees outside of Louisiana ends on June 30, 2006. Why have you not issued an extension?
13. The magnitude of destruction caused by Hurricane Katrina is unprecedented and obliterated the health care infrastructure in the city. By all reasonable estimates, it will take five to seven years before the system is able to return to a fully functional capacity. Given this information why did you give our Medicare Graduate Medical Education programs only 3 years to reorganize? Such an arbitrary and impractical date will inhibit our ability to ensure that healthcare residents are accurately placed and the services they provide are effectively administer to our citizens? Such a short timeline will jeopardize the viability of these training programs and the healthcare services they bring.  

It is to get answers to these and other questions that I have sought to work with you and your office, to meet with you and go over these issues.  The sad reality is that I have talked and met with President Bush on 8 different occasions about the aftermath of Katrina but only once with you. If the Leader of the Free World can find time to meet with me, surely his duly appointed Secretary can.

Again, I urge you to contact my office immediately regarding your availability to meet before July 17^th. I look forward to hearing from you in ways that will permit an engaged dialogue and discussion these issue warrant, not through a press conference.

Sincerely,

William J. Jefferson