The latest salary scandal this week has Governor McCrory endorsing his DHHS Secretary’s latest decision to hire another clearly unqualified politically-connected person and pay her close to $100,000 a year for one more dubious advising or consulting job. This follows a string of similar missteps hilariously recounted here . As a political farce, the debacle at DHHS is becoming a classic. Not so amusing however is the fact that the agency has some pretty serious work to do that isn’t getting done while Rome burns:
1. On October 1, over 1,000,000 North Carolinians become eligible for substantial tax credits and can then use these to buy comprehensive health care plans on the new federal health marketplace created by the Affordable Care Act. Many of these folks are in rural North Carolina, never have had health insurance before, and will be looking to divisions of the state DHHS for help in applying. So far as I can tell, there is zero direction or planning from leadership across state DHHS divisions to prepare for this.
Luckily, private organizations from Legal Services to Community Health Centers are working hard to prepare for October 1 and in many counties are quietly working with the various local health and social services departments of the state DHHS as they have always done to help people in their communities. But not having any direction from the DHHS top leadership is hampering NC’s proud and successful tradition of local cooperation.
2. Health care providers continue to provide health services to people on Medicaid – run by DHHS – and fail to be paid. I talked to a local physician in Franklin County this week who said he was about to have to take out a loan to make the payroll in his office. I hear from pediatricians that they are not getting paid for providing simple things like vaccines. And I see that big hospitals like Wake Med are not only not getting paid, but the money involved is so much that it has a ripple effect for such institutions. To cover expenses, apparently some hospitals have to take reserve money out of interest earning accounts. At the amounts involved, DHHS delays in payment end up costing these institutions large amounts of lost interest income as well.
3. Then there is “reforming Medicaid.” Is Governor Pat McCrory really serious when he says he still wants to radically change NC’s Medicaid program? He’s referred as “broken” again and again a NC Medicaid program given a national award  for leading in cost savings and quality this year by US Senator Richard Burr. But by hiring people who can’t get the bills paid  under the current program, are clearly unqualified to provide any rational sort of policy advice or planning, or wasting money on “branding,” McCrory’s DHHS Secretary – who he continues to defend – is apparently doing the best job she can to break the program herself. Major change in Medicaid – if it is even really necessary – will require the confidence of health care providers across the spectrum and political credibility even in the view of people who disagree with the Governor’s policy aims. At this point the Governor has neither and is quickly losing what little confidence and credibility he has left. Why would any provider, consumer representative, genuine health policy expert, or insurance company sit down and negotiate at a table containing McCrory? You couldn’t be sure the people he has in place to carry out what he says he wants to do can actually perform and you have already had hard evidence of the incompetence of people at the top.