Monday night this week we had a great educational forum in Marion, NC on giving details of the Affordable Care Act in NC and the opportunity for expanding Medicaid to fill the coverage gap for low income people in our state. Big thanks to City Councilman Billy Martin who helped coordinate the event and got us into the wonderful community building constructed by the Civilian Conservation Corps nearly a century ago. Below Nicole Dozier gives the lowdown on the ACA and you can read the article advertising our meeting here. We are heading down east to Beaufort County next and will be back up in the foothills and all over the state in the coming months.
No, I’m not overstating the case. This year, the NC Department of Health and Human Services has hired a $250/hr Medicaid consultant, paid a $210,000 annual salary to a former Louisiana Medicaid director who stayed in NC less than a year, and hired a guy a year out of college for $85,000 a year to be chief spokesperson. Governor McCrory, DHHS Secretary Wos – I have a message for you: Save our taxpayers some serious money and look a little closer to home for your expertise. For instance, take the graduate programs in public policy at Duke and UNC-Chapel Hill.
This week students on the Duke-UNC Student Medicaid Reform Team released a comprehensive, detailed, thoughtful, realistic and highly impressive report on Medicaid Reform in North Carolina. Titled “A New Health Reform Framework For North Carolina” the 66 page document sets out a plan for NC Medicaid that uses both private health insurers and the current public program to expand coverage, recommends concrete ways to better integrate mental health services and contains detailed estimates of costs and benefits of the proposed changes. It short, the student team directly and comprehensively responds to the charge given to the DHHS Medicaid Reform Commission.
Governor, Secretary Wos, I have to tell you. Hiring these students could really help North Carolina in general and the Department of Health and Human Services in particular. Especially when you consider what all the highly paid consultants, high profile meetings, and extensive public relations blitz produced at your final Medicaid Reform Commission meeting this week. The sole document given out at the meeting this week where your big, new revolutionary reform plan was to be presented consisted of a two-page overview of what how you hope to use different payment mechanisms for doctors and hospitals in NC’s current Medicaid program. Two pages! And after all that work and money spent. I would advise a call to the Duke and UNC public policy schools very quickly and see if you can get some of these students to commit to their home state before they get snapped up by other employers.
Yesterday, Governor Pat McCrory’s DHHS Secretary, Aldona Wos, unveiled the administration’s long-awaited reform plan for Medicaid. One of McCrory’s favorite talking points on Medicaid has been how “broken” the system is and how he’s going to “fix” it. Setting aside the past year of missteps in which McCrory and Wos did more than any Governor and Secretary in history to discredit and cause problems for NC’s award-winning Medicaid program, what does the administration’s plan yesterday tell us about the future prospects of Medicaid and health care for the poor in NC? Here’s my take:
1. Surrender: The Governor completely surrendered by backing down from his former big plans to sell off substantial parts of the Medicaid program to private, out-of-state insurance companies. The proposal yesterday to use “Accountable Care Organizations” or ACOs is simply, at its core, a new way to pay existing or new networks of doctors, hospitals and other health care providers. Paying health providers as a group for each illness a patient gets rather than piecemeal for every test and procedure is supposed to get providers focused on quality and efficiency, especially when payments go up if patients are healthier. ACOs represent gradual evolution in health care and not “major reform.”
2. Missing the boat on Medicaid expansion: The Governor also made it clear that he has no intention of solving the coverage gap for the 500,000 poor North Carolina citizens who would be eligible for Medicaid coverage if he led the charge to expand Medicaid using the billions of dollars in federal money available to our state. Conservative governors and legislators around the country – whether in New Hampshire or Utah – are coming up with innovative solutions to cover their citizens with all the new federal money available. By leaving an expansion proposal out of his plans to change Medicaid, our Governor is renouncing any claim to national moderate leadership on this issue, leaving billions of federal tax dollars collected from North Carolinians to go to states that do expand and hurting hundreds of thousands of his own constituents.
This week state executives from around the country trooped to the White House to discuss a variety of topics with the President including expanding Medicaid under the Affordable Care Act. Two GOP Governors – our own Pat McCrory and Utah’s Gary Herbert – had very different takes on what was said about Medicaid expansion. I’ve added the emphasis in the quotes below, but what is clear to me is McCrory simply ignored what the President said and the plain facts on the ground regarding Medicaid expansion.
“Regardless of how you feel about the policy, the dilemma is the execution is being put on the states with absolutely no flexibility to the 50 states’ unique needs,” he said…He said that some states were receiving Medicaid waivers, allowing them to devise their own plans, but that there was too much red tape to get them.
Then Utah’s Governor Herbert:
Gov. Gary Herbert said Monday he was encouraged after hearing President Barack Obama pledge to work with states on Medicaid expansion during a meeting with the nation’s governors in the White House….. “None of us like just being dictated to by Washington, D.C.,” the governor said in a telephone interview on his way to the airport. “So I’m encouraged by the rhetoric. Let’s hope the actions prove to be commensurate with what the tone and talk was today.”
And here’s what the President actually said:
The president promised his administration would work with governors to tailor Medicaid expansion programs in his remarks to members of the National Governors Association earlier Monday, according to a transcript released by the White House.
“States that don’t expand Medicaid are going to be leaving up to 5.4 million Americans uninsured. And that doesn’t have to happen. Work with us to get this done. We can provide a lot of flexibility,” Obama said.
States like Arkansas have shown the enormous flexibility the Obama Administration is willing to give states that decide to expand Medicaid. Arkansas is expanding Medicaid 100% through private health insurance plans! To pretend that flexibility from the federal government on Medicaid expansion is not available and extensive given examples like this flies in the face of reality. The simple truth is that conservative governors like Herbert who want to tailor a Medicaid expansion to their state will very likely be able to do so while conservative governors like McCrory will simply look even more ideological in their opposition to expanding health care for the poorest citizens in their state.
You would think the Governor would be smarter than to keep blaming Medicaid for his budget problems every time he gets asked about why he isn’t giving all teachers a much-needed raise. After all, this is the Governor whose Department of Health and Human Services has done its best to run our Medicaid program into the ground over the last year with actions like failing to pay hospitals and doctors and giving mysterious $37,000 “severance” packages (a higher amount than McCrory’s proposal for first-year teacher’s annual salaries) to political cronies who who work at DHHS for one month. See a full list here of McCrory’s year of missteps on DHHS and Medicaid.
At what point is the Governor embarrassed with this line? In today’s version he blames the Affordable Care Act for adding people to NC Medicaid. Sorry, Governor. Those people were already eligible in NC for Medicaid. We didn’t expand coverage in NC to anyone – these are just people that were already eligible for coverage who are now, thanks to the Affordable Care Act, actually finding out that they could get help with health care, unlike the hundreds of thousands you told won’t be getting Medicaid coverage.
Governor, the problem with finding money for teacher salaries isn’t with the Medicaid program you are so busy breaking. What is? That half a billion dollars in tax cuts aimed largely at the wealthy in our state you signed into law last year. It may be easier for you to blame low-income people who need Medicaid for your problems, but look to put your own house in order before you pull out your tired, old and increasingly discredited arguments about Medicaid yet again.