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The Senate’s budget proposal for the next two years had some significant health policy changes packed into it, namely a proposal to peel Medicaid oversight away from the N.C. Department of Health and Human Services and open the door for managed-care management of the $14 billion program.

House and Senate Republicans have spent the last few years debating what to do with Medicaid and how to address routine budget overruns from the federally-mandated program that provides health care coverage for low-income, seniors, the disabled children and some of their parents and the disabled.

House members favor keeping Medicaid within DHHS, and phasing in changes that would open up the Medicaid program to management from non-profit groups (called ACOs, or accountable care organizations).

Sen. Ralph Hise, the Republican senator from Spruce Pine who has long pushed for a managed-care solution to Medicaid, said that beginning the Medicaid reform process and moving Medicaid administration into a stand-alone division would allow the legislature to better predict and cap costs for what is the state’s largest program. (Scroll down to watch video of Hise talking about the Senate budget proposal.)

The Senate proposal does have room for ACOs, with options to have managed-care companies offer state-wide coverage while also having six regional divisions that will have slots for ACOs to work, Hise said.

Any changes to the state Medicaid program will need federal approval as well.

The Senate budget, which is expected on the floor for a vote tomorrow, would also cut ties with Community Care of North Carolina, a provider-led network that had been credited with keeping Medicaid costs down by closely managing patient cases, and pairing high-risk patients with primary care physicians. The contract with the state would end by Jan. 1. The cut will amount to a $32 million cut in the 2015-16 budget year, and savings of $65 million in the second year.

There were plenty of other note-worthy details in the budget proposal, with some re-investments in some areas of the budget, and cuts in the others. To read the 504-page budget, click here. The accompanying money report is herehere.

Among the proposed changes were proposals to:

  • Eliminate 520 slots in the state’s pre-kindergarten program, which currently offers early education offerings to 28,700 low-income children.
  • Get rid of the state’s “certificate of need” process by 2019, in which hospitals and medical centers need to make a case to state regulators for adding surgical or other specialized medical offerings, in favor of a more free-market approach that’s been a cause long championed by conservative groups in the state.
  • Extend the foster care age to 21, offering more help for children instead of cutting them off from state services at age 18.
  • Shut down the Wright School, a part-time residential facility in Durham County that provides inpatient help for children with severe disabilities and behavioral issues.
  • Get rid of the Office of Minority Health in DHHS (cut of $3.1 million). Senate Republican leaders said Monday the elimination would allow more money to flow through to actual services that affect minority populations including teen pregnancy and sickle cell programs, but Democrats argued an office dedicated to looking at overall health disparities between racial groups was important.

N.C. Health News has a great rundown as well about what’s in (and what’s not in) the budget. You can read that here.

 

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Rev. William Barber of the N.C. NAACP and Belhaven Mayor Adam O'Neal speak Monday at the U.S. Capitol

Rev. William Barber of the N.C. NAACP and Belhaven Mayor Adam O’Neal speak Monday at the U.S. Capitol

Belhaven Mayor Adam O’Neal completed a walk from his small Eastern North Carolina town to the nation’s capital today, calling on national leaders to help rural communities with sparse healthcare options.

The 283-mile walk – the second year the Republican mayor has done it –– was to bring attention to the pressures faced by the nation’s 283 rural hospitals, especially those in states like North Carolina that opted not to expand Medicaid coverage.

O’Neal reached the steps of the U.S. Capitol Monday, and was joined at a rally with other advocates and allies, including American Federation of Teachers president Randi Weingarten, Belhaven Town Council member Julian Goff and the Rev. William Barber, head of the N.C. NAACP.

Belhaven, located in Beaufort County near the Pamlico Sound, lost its local hospital in 2014, when the hosptial’s owners opted to shut down the small healthcare facility because it couldn’t afford to stay open after North Carolina lawmakers chose to not expand Medicaid coverage in the state.

Residents now have to travel to Greenville for emergency care, a trip that can take over an hour.

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The pay for presidents of public universities is rising, with the median salary for the president of a public university now $428,250.

That’s an increase of 7 percent, while two presidents in the nation (at Pennsylvania State University and Texas A&M) made more than $1 million, according to the Chronicle of Higher Education, which released its annual survey of public college presidents this week.

UNCsystemUniversity of North Carolina system President Tom Ross made $543,725 during the 2014-15 school year, according the Chronicle analysis. N.C. State University Chancellor Randy Woodson made $520,000, as did UNC-Chapel Hill Chancellor Carol Folt.

Scott Ralls, the outgoing head of the state’s community college system, made $286,954.

In an article about the Chronicle’s findings, the New York Times pointed out that not all college presidents want that higher pay.

The University of Texas’ incoming president turned down a $1 million base salary, asking instead for $750,000 out of concern of how the higher pay would be perceived by students, faculty and the state legislature.

The paycheck for the top job at UNC is likely to increase from Ross’ current salary, after the UNC Board of Governors moved in April to allow for salaries up to $1.1 million for the new president as well as increased pay for chancellors.

The board is in the midst of its search for a new president of the 16-campus system, after Ross was pushed out in January by the politically-appointed board for reasons that have still not been explained. Ross will stay in his position until January.

Pay, and the ability to offer more money to job candidates, has been mentioned by some board members as a necessary tool to recruit UNC’s next leader.

The decision to allow for more pay for top executives in the university systems comes after several years of deep cuts handed down to the university system by the state legislature, and as faculty and staff have seen little change in their salaries during the course of the recession.

There may be some salary increases for UNC employees, however. The House version of next year’s budget has a 2 percent raise proposed for university system staff and faculty.

The Senate is expected to release its version of the budget in coming days, though Senate leaders have said to expect a significantly smaller budget than what their colleagues in the House prepared.

So, what do you think? Should North Carolina be paying its top university leaders what it does? How much does salary matter when it comes to recruiting for top university jobs?

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The Nation became the latest national media group to offer its thoughts on the changing direction of the University of North Carolina’s Board of Governors, with the publication today of “How A Right-Wing Political Machine is Dismantling Higher Education in North Carolina.”

The progressive magazine took aim at recent decisions like the firing of UNC president Tom Ross and the controversial closure of three academic centers, as well as recent pledges to look at “right-sizing” the entire public university system.

From the article:

But just as pertinent as the question of what should be taught at UNC is the question of whom. Since its founding in 1789 as America’s first public university, UNC has fought to preserve the “public” part of its mission; high-quality education plus low tuition has kept more students in-state in North Carolina than anywhere else in the country. Now the board appears to be dismantling the system’s ability to fulfill that goal.

In response to deep cuts to state funding, the board has approved a series of tuition hikes—in-state students will pay 4.3 percent more next year on average—while imposing a cap on financial aid that may impact nearly 22,000 low-income students next year. Governor McCrory has suggested that schools compensate by limiting enrollment to “those who are ready for college,” a distinction that smacks of euphemism. Despite these austere times, the board voted in April to boost the salaries of top administrators to as much as $1 million a year.

The goal, apparently, is not only to put Ayn Rand into the hands of students but also to force UNC into the sort of economic order she envisioned. It matches the agenda that the legislature and McCrory have advanced throughout the state with the backing of the Pope network: cut taxes for corporations and the wealthy, and use the resulting revenue gap to justify the evisceration of safety net programs like unemployment insurance, and public institutions like schools. “You can’t separate what’s happening at the Board of Governors from what’s happening in the legislature,” Gene Nichol said over the phone in March. “They govern for the white, wealthy, straight Christians, mostly for the males, and all the rest be damned.”

“We’re capitalists,” explained Steven Long, a former Civitas board member who now sits on the Board of Governors, after the body voted in May to cut dozens of academic programs across the system. “We have to look at what the demand is, and we have to respond to the demand.”

You can read the entire piece here.

 

Commentary

Carol Ann and Thomas Person were planning to be married when they went to a Forsyth County magistrate’s office in 1976.

Carol Ann and Thomas Person (Source: N&O/Person family)

Carol Ann and Thomas Person (Source: N&O/Person family)

To their suprise, they was turned away because two magistrates, citing their own religious beliefs, refused to marry an interracial couple.

The couple now lives in Moore County and have been married for 40 years.

Carol Ann wrote about the experience of being turned away by the county magistrates in this poignant editorial published in the News & Observer, to emphasize their opposition to Senate Bill 2, which would allow magistrates to refuse to marry same-sex couples.

“Whether gay or straight, black or white, Jew or Gentile, nobody has a right to tell anyone who they can love or marry,” she wrote.

The N.C. House of Representatives is expected to consider whether to override Gov. Pat McCrory’s veto later today.

From Person’s column:

 

I met the love of my life more than 40 years ago in Raleigh. Thomas is a lifelong North Carolinian. I was a recent transplant from Vermont. We are both legally blind, and soon after we met, we moved to Winston-Salem to work for the Industries of the Blind. Our friendship blossomed into love, and in 1976, Thomas proposed. I very happily said yes.

Soon after, we went to our local courthouse to receive a civil marriage license from one of the magistrates there, so we could commit our lives to each through a legal union. I was so excited. People always say your wedding day is supposed to be one of the happiest days of your life, and I was expecting mine to be exactly that.

But when we walked into that government office together, we were told that the magistrate on duty wouldn’t give us a marriage license. I was flabbergasted. We had planned everything, we had all our paperwork and we were legally eligible to get married.

So why wouldn’t he marry us? The reason, it turned out, was because Thomas is African-American, and I am white. The magistrate told us that marrying an interracial couple went against his religious beliefs. Our happy day quickly turned into a nightmare.

I was so surprised that a government official was using his own personal religious beliefs to deny us a civil marriage license that I didn’t know what to say. There was a second magistrate on duty, but he, too, said he wouldn’t marry us, because doing so would violate his religious beliefs. One of them took out a Bible and began to lecture us about their religious views and why Thomas and I should not be together. We eventually went down the street to the local Legal Aid office and returned with a lawyer, but the magistrates still refused. It was so upsetting.

The entire piece, which is well worth reading, can be found here.