The waiting room is full, physicians and nurses are busy, and it doesn't look like the Martin Luther King Health Center in Shreveport will empty out any time soon.
"We have younger and younger people being diagnosed with primary care chronic illness - diabetes, hypertension, heart problems," explains M.L.K. Health Center Executive Director Janet Mentesane.
She says the bulk of their patients can't find a doctor that will accept Medicaid because of low reimbursements.
Her free clinic allows them to seek primary health care, without turning to costly emergency room visits for routine health issues.
"There's not enough primary care - what I call 'gateway providers' - for the initial primary care," she says.
Louisiana's history of hurricanes has meant extra Medicaid funding for the state, but that funding will be eliminated in October, leaving a deficit of $860 million.
"We shouldn't make across the board cuts. That punishes the good with the bad," says State Treasurer John Kennedy.
One of the "good" facilities Kennedy is referring to is LSU Health Shreveport. He describes it as one of the best-run state hospitals in Louisiana.
He adds that state leaders knew this day of budgets slashes was coming and says we should have had solutions in place to weather the storm.
"We have to live within our means. We can't spend more than we take in. When you do, you run into a deficit. It's really simple."
Among his solutions, is a modest co-pay of $2 to $5 from all Medicaid patients.
"It generates a little revenue. It gives everybody some skin in the game. It'll eliminate unnecessary treatments, not completely, but substantially."
He also says eliminating Medicaid re-imbursement for costly emergency room visits for routine health care issues would help save millions of dollars, similar to a system Washington State has in place.
"Washington State has said we will no longer spend Medicaid money to pay for emergency room visits to pay for things like pregnancy tests, diaper rash, acne, sunburn. We'll pay for your treatment but you have to go to a private clinic," Kennedy says.
He also lists reforming the state Medicaid preferred pharmaceutical drug list to include the most effective drugs at the lowest price for each illness.
Complicating Louisiana's situation, is the refusal of Governor Bobby Jindal -- along with southern Republican governors from Texas to Florida -- to participate in the Medicaid expansion stipulated under Obamacare.
John Kennedy's additional soutions to easing the pain of the Medicaid cuts are as follows:
- Implement Louisiana law (LRS 22:1065, LaHIPP) that allows the state to purchase private insurance offered by the employers of low-income citizens when it's cheaper than covering them through Medicaid. The state needs to do more than hiring an out-of-state vendor to make robocalls and leave messages for potential enrollees.
- Review all Medicaid hospitalizations for medical necessity. In 2009, 80 percent of the 218,784 Medicaid hospitalizations, costing $900 million, were not reviewed for medical necessity, according to the Legislative Auditor.
- Reduce the size of the new $1.1 billion charity hospital currently being built in New Orleans. According to its own business plan, the hospital, at 424 beds, won't have cash flow now that we are reducing the size of the Medicaid program.
- Eliminate the $148,500 a year position created by DHH to advise on implementation of the ACA, given the Governor's decision to opt out.
- Demand a 5 percent discount on all DHH and Charity Hospital consulting contracts that do not directly involve the delivery of health care.
- With legislative action, return $300 million of prior years' surpluses in the capital outlay (building) account to the general fund, use it to pay state debt, free up money for health care, and replenish the building account with the proceeds of a future bond issue.
- Spend the money budgeted to implement the state's new computer "upgrade" on health care.
- Expedite implementation of the Legislature's decision to sell the uncollectible portion of the state's $1.3 billion accounts receivable, use the proceeds to pay state debt, and free up money for health care.
- Assign medical supplies procurement for all 10 charity hospitals to a single inventory manager that uses a "just-in-time" inventory system.
- Don't close the Southeast Louisiana Mental Hospital. These patients will end up in jail or emergency rooms, which will cost more money in the long run.
- Let the Legislature make all final policy decisions after a public debate.