Turns out they will have to figure in a way to bribe the legislators too

At first they didn't think they'd have to.  Technically the legislature doesn't have direct authority over whether or not the sale goes through. But the way lawmakers were talking before the hearing was starting to make everybody feel back. So, back to the drawing board. For now, anyway. 

Hours before regulatory hearings in Baton Rouge were set to begin Wednesday, Blue Cross and Blue Shield of Louisiana officials said they were shelving plans for a controversial $2.5 billion sale to Elevance Health.

In a statement early Wednesday, the Louisiana Department of Insurance said, “Late yesterday evening, Blue Cross notified the LDI that it has chosen to withdraw its Plan of Reorganization. The hearing scheduled for today and tomorrow is therefore canceled."

It’s the second time in less than a year that the Baton Rouge-based nonprofit has tabled its plan to sell itself to the for-profit Elevance, one of the nation’s largest insurers, amid steep opposition from doctors, hospitals, some policyholders and state lawmakers.

I'm sure they'll be back. 

The bribes are un-subtle

We really thought Jeff Landry would have been in jail by this point in his career. But we also thought the same of Billy Nungesser and look at them both just keep chugging along.  Anyway..

The chief of staff for Gov. Jeff Landry has worked as a lobbyist for Pennington Biomedical Research Center, the institute that the governor has singled out to receive potentially millions of research dollars as part of the controversial proposed sale of Blue Cross Blue Shield of Louisiana.

Landry aide Kyle Ruckert, who also served as a campaign strategist for Landry’s gubernatorial bid last year, held the lobbying contract until late last year when his wife Lynnel took it over exclusively. The contract, which is for representation in Washington, pays $40,000 per year, according to federal filings.

The Ruckerts have represented Pennington Biomedical since 2020.

Shut up, go back to work, do not ask any questions

As we've already noted, the sale of Blue Cross Louisiana to a notorious for-profit corporation is a terrible deal. Even your also notorious Louisiana Legislature seems to understand this. 

Legislators, who came prepared with detailed questions about every aspect of the complex transaction, returned repeatedly throughout the marathon hearing to Elevance’s track record in other states. The company has racked up more than $26 million in regulatory fines for violations that included denying coverage of needed medical care, failing to cover preventive service like immunizations and breast cancer screening, and failing to pay claims in a timely manner.

Louisiana, where Elevance administers the Healthy Blue Medicaid plan, was among the seven states where the company has incurred fines.

But, because the deal also grants the new Governor and Commissioner of Insurance seats on the board of the new entity the sale will create, and sway over how some of the proceeds are spent, it will likely gain the approval of both. The Governor, in fact, has already made a public endorsement.  

There appears to be public momentum gathering against the sale. Note the skeptical legislators above and, here, even our reactionary Treasury Secretary John Fleming is militating against it today.  In the meantime, though, let's look at Jeff Landry's stated reasons for accepting his bribe lending his support. To begin with, he says it's a good excuse to boot people off of Medicaid.

Landry’s strongest comments in favor of the Blue Cross sale centered on the nonprofit foundation, Accelerate Louisiana Initiative, that will funded with the bulk of sale proceeds and surplus Blue Cross reserves, for a total of more than $3 billion.

The foundation will seek to operate as a nonprofit public-private trust, a designation that will require a change of state law. It is to have four focus areas, all centered on poverty and health outcomes. Landry praised the first pillar, which supposedly would move people from dependence to independence.

“In other words, we’re going to be able to have an organization that is going to work towards trying to move those people off of Medicaid,” the Republican governor said.

It used to be, you had to just pull the inference out of the policy choice itself and explain how hostile the intent was.  Nowadays, they just come out and say what they are doing.  

The other thing they've given up on pretending to anymore is the notion that there are fiscally "conservative principles" at work here. It's about being cruel for the sake of being cruel.

That federal government-sponsored health insurance program for poor people was dramatically expanded under Landry’s predecessor, Democrat John Bel Edwards. Almost half the state’s population is now on Medicaid, most of which is paid for by the federal government.

Landry said Accelerate money will also be used to help get the state’s “safety net programs” working in sync. He used the example of a hypothetical patient with Type II diabetes, a chronic health condition that leads to other health problems. Landry said the patient might receive a “shiny brochure” from her doctor telling her to eat healthy and lose weight to help her condition.

“Then, she puts it in her purse, goes to Piggly Wiggly and goes down the aisle to the soda, chips, cookies, and then she goes to the cash register with her Louisiana Purchase card,” said Landry, using an old trope that criticizes welfare recipients. “How about if we had an organization that helps the government start to integrate the food stamp program with the Department of Health, so instead of getting a fancy brochure we could give her $100” if she engages in healthy lifestyle choices,” he said.

“When else are we going to get that opportunity again?” he said. “Those are the things we will do.”

Poor people deserve to be bullied and shamed by the state.  It's the only way to keep the help in line.  And that is, in fact, all they are good for. Landry is saying that out loud as well. 

The plans for the foundation, which were changed late last year as Blue Cross sought approval from state regulators for the deal for a second time, now specifically prohibit research money for health outcomes from going to higher educational institutions — except for the LSU-affiliated Pennington Biomedical Research Center in Baton Rouge.

Landry said that giving the money to other Louisiana research institutions, a list that would include LSU and Tulane University, would be wasteful.

“I don’t want money going to higher education. I want the money used in our workforce because everywhere I go, people are telling me they don’t have skilled labor. And I’ve seen these deals around the country and all the money gets sucked up by the universities and we got nothing,” Landry said.

When we consider this is how the Governor view his people; not so much as humans with human appetites for joy and knowledge and experience to be nurtured, but only as a "workforce" to be disciplined; then it's easier to understand why he's keen to sell their health care off to capitalist vultures at the nearest opportunity. It's an extremely efficient way of liquidating lives into profits.  

It's called a bribe

Appreciate the legislators asking very good questions about all of this. But, at the end of the day, it will be Tim Temple and, to a lesser extent, Jeff Landry (via bully pulpit agenda setting) who will make the decision.*  So... the deal guarantees Temple a seat on the board of the new entity created by the sale.  And Landry gets this.

They called special attention to a curious provision in the plan to create Accelerate Louisiana, which will be a $3 billion foundation focused on addressing poverty and health inequity in the state. The provision prohibits the foundation from giving money for health research purposes to any higher education institution in the state except the Pennington Biomedical Research in Baton Rouge.

“You have $3.1 billion and the only institution that can receive funding is Pennington?” asked Sen. Adam Bass, R-Bossier City. “Why is that?”

Tim Barfield, a former Blue Cross member who is now board chair of the Accelerate Louisiana Initiative, said the stipulation was a condition imposed by Gov. Jeff Landry and his staff.

“That was a requirement of the attorney general, now governor,” Barfield said.

*Blue Cross policy holders also have to vote on the sale but that may be, in the bag, so to speak.  

Lawmakers also grilled Blue Cross about potential irregularities in the voting process and the way proxies are being collected. Under questioning, Blue Cross officials acknowledged that the same outside firm tabulating proxy votes is also soliciting members by phone to make sure they vote.

“The same group that can take a proxy vote over the phone is the same group calling to say, ‘Did you get your ballot?’” said Republican Sen. Thomas Pressly of Shreveport. “I am blown away.”

The bribes have been negotiated and they are surprisingly small

I think I said this around this time last year, but I really have got to get back to posting here (or writing longer form in some other way) more often. It's the only way I'm going to be able to keep track of the things that happen and hold them in my mind for any longer than it takes to flush them down Elon's Twitter toilet. 

For example, yesterday when I read this story about the deal Elevance and Blue Cross are offering Jeff Landry and Tim Temple so that they will bless the non-profit insurer's sale to the for-profit company, I thought, oh look, all it took was a just a couple of little bribes. They really bought them off cheap.

Many of the major elements of the proposed acquisition are largely unchanged from the original proposal announced in January. The sale price remains the same, as does the percentage of the sale's proceeds that will go to Blue Cross' 92,000 official policyholders.

But the new deal includes changes to the nonprofit foundation that will be formed as part of the transaction and is set to receive 91% of the sale's proceeds. The Accelerate Louisiana Initiative will now have an expanded board of directors that includes an appointee of Gov.-elect Jeff Landry. It will also include a nonvoting "observer" appointed by newly elected Insurance Commissioner Tim Temple.

But it took me a while to be reminded that I'd already flagged this in September when the writing was on the wall about Landry and Temple's intentions prior to the election.  This happens to me all the time now. If I don't deliberately stop and write about something, I'm liable to lose it. I try to keep little notes in draft but it's not the same. There's something about completing the thought here that makes it stick. There's just been less time lately to finish thoughts. That can't be good.

Anyway, this isn't supposed to be a post about me. Elevance is about to take over the state's largest insurer in a deal that will make some very wealthy administrators even wealthier. Meanwhile, Blue Cross policyholders are facing a precarious future. But hey, I'm sure that $3,000 will make up for it. 

Blue Cross first announced the deal with Elevance nearly a year ago. But as the deal came under closer scrutiny before its approval by regulators, critics expressed concerns about the effect of the sale on customers and questioned the structure of the foundation.

Two reports by independent consultants prepared for state regulators raised questions about some of the deal assumptions. More recently, a Metairie attorney has filed a suit in federal court seeking class action status on behalf of the 92,000 policyholders, arguing that as members of the mutual indemnity company who have paid into it over the years, they, not the foundation, are entitled to the sale proceeds.

Under the terms of the current deal, policyholders will split some $276 million, receiving approximately $3,000 each.

All clear for profit taking

 Election's over. No longer any reason to pretend anyone will stand in the way of Elevance. 

Baton Rouge-based Blue Cross officials notified the Louisiana Department of Insurance in late September it was withdrawing its application for the necessary state approval of the deal. The pause came amid growing concerns from policyholders, local politicians and Louisiana Attorney General Jeff Landry, who is now governor-elect.

At the time, the company said it would refile its application with the state later this year or in early 2024.

Landry had expressed concerns about whether the deal was in the best interest of the policyholders and had said he thought the incoming Commissioner of Insurance, Tim Temple, a new governor and a new crop of state legislators should be in office before a deal of such magnitude is approved.

More than 1.9 million people in Louisiana have some form of Blue Cross health insurance. Of those, some 92,000 are policyholders.

Good luck, everybody!