Commentary

Since 1978 North Carolina’s Medicaid program has been managed by the Division of Medical Assistance, which is within the NC Department of Health and Human Services (DHHS). As the state’s Medicaid program stands today, most Medicaid enrollees are categorically needy – in other words, aged, blind, disabled or very low-income families (including pregnant women). As Medicaid enrollment has grown from under 500,000 enrollees in 1978 to over 1.5 million enrollees in 2015 so have the expenditures. Even though Medicaid spending growth between 2007 and 2012 was less than growth in private health insurance premiums, many states are reforming Medicaid to enhance budget predictability, increase quality of care, and promote long-term cost savings as enrollment increases. NC is no different as both the House and Senate have recently released their plans for Medicaid reform.

The House Medicaid reform bill was discussed in a previous post, but here is a quick recap. The House reform bill aims to build upon the system NC already uses by establishing provider led entities (PLEs). As the transition takes place, the PLEs can rely on the expertise and knowledge of Community Care of North Carolina. This model is similar to an Accountable Care Organization (ACO) approach in that networks of providers such as hospitals and doctors take responsibility for not only coordinating patient care, but for the finances. This model moves away from the current fee-for-service payment model, which rewards quantity of medical visits and/or procedures over quality of care and ultimately increases costs to providers taking a capitation payment. Capitation payment allows for providers to take on financial responsibility as they receive one risk-adjusted payment per patient. Providers in an ACO work to refer patients to other providers within the network. It is important to note that patients can select a provider outside of an ACO at no additional cost. Finally, five million dollars has been provided to reform Medicaid over a five year period in the House bill.

The Senate budget provides 10 million dollars to reform Medicaid by 2017. Like the House Medicaid reform bill, the Senate also includes the transition from a fee-for-service model to a capitation payment model. One major difference is that instead of using one type of organization to provide care and take financial responsibility, the Senate’s version of Medicaid reform uses a hybrid model. NC would contract with outside Managed Care Organizations (MCOs) who would then work with regional PLEs to provide care to Medicaid enrollees. Another significant difference between the two reform bills is that the Senate’s version of reform would remove oversight of Medicaid from DHHS to a new Health Benefits Authority, an eight member board focused on Medicaid and NC Health Choice. What is interesting is that members of the board would be appointed by the Governor, President Pro Tempore of the Senate, Speaker of the House of Representatives, and Secretary of Health and Human Services .

No matter how NC lawmakers ultimately decide to reform Medicaid, there is one action that both versions fail to do – expand Medicaid to 500,000 North Carolinians in the coverage gap. The same waiver that policymakers will submit to CMS to reform Medicaid can also be used to expand Medicaid as many other states have done.

Commentary

Budget_cleaver-150x150This past week I visited Charleston, South Carolina to lay flowers and show support to the people of Charleston and the victims of the Emanuel AME Church shootings. The place buzzed with activists, reporters, and policy makers, including the mayor and governor. Across the nation, political pundits, academics, candidates, law makers, and others have posed a question: “Why did this happen, and what policies will fix this?”

The answers to these questions are neither new nor give us the insight we truly need to begin to remove hatred such as this from our society.

In North Carolina, we are especially equipped to answer the first question. From the 1898 Wilmington coup d’état to this year’s Islamophobia inspired killings of Chapel Hill residents, we have endured many years of hate-inspired violence. We understand and have long dealt with the perverse attitudes that fuel this type of ignorance.

The second question (“What policies will fix the problem?”) does not begin to address the real issue at hand.

The better question is: “Do our laws and policies exemplify the values we want our society to stand for?” In order to combat hatred and ignorance, state legislatures must reevaluate the underlying messages their policies embody.

We do not have a policy issue. We have a values issue. Take, for example, the debate about the state budget.

Fiscal policy is about more than meeting revenue goals and growing the economy, it’s about creating a just and moral society; a society in which the leadership sets the example of how we value and treat individuals. When we refuse to provide all children with access to quality pre-K, when we fail to create equitable education experiences, when we cripple the state’s higher education system, when we fail to support families, when we ignore out-of-work North Carolinians, when we prioritize corporations and neglect individuals, we send a clear message. Read More

Commentary

Climate change - droughtLike their intellectual predecessors who for so long denied the dangers of tobacco smoke, the creativity of climate change deniers in manufacturing excuses and red herring-filled critiques of common sense public regulations knows few bounds. At some point, however, the evidence simply becomes so overwhelming that reasonable people simply stop listening to the denials.

Let’s hope that a new federal EPA report hastens the arrival of that day. This is from a Washington Post article that was reprinted in this morning’s edition of Raleigh’s News & Observer:

“A global agreement to curb greenhouse gas emissions would prevent nearly 70,000 premature American deaths annually by the end of the century while sparing the country hundreds of billions of dollars’ worth of economic losses, according to a major government study on the cost of climate change.

Slowing the carbon build-up in the atmosphere would also prevent severe damage to a wide range of critical ecosystems, from Hawaiian coral reefs that support tourism to shellfish beds off the East Coast, said the report released by the White House on Monday.

The report, a five-year, peer-reviewed analysis that assesses the benefits of alternative strategies for dealing with climate change, concludes that every region of the country could be spared severe economic disruptions that would result if greenhouse gas concentrations continue to soar.”

The article goes on to explain some of the myriad ways in which human health and overall well-being could be enhanced if we would simply stop poisoning the planet so aggressively.

Click here to explore and download the entire EPA report – “Climate Change in the United State: Benefits of Global Action.”

News

Two charter schools hoping to open up shop in North Carolina in 2016 have abandoned partnering with a troubled management company that had planned to operate the schools, according to the News & Observer.

The questions surrounding Newpoint Education Partners [a Florida-based education management company] caused the State Board of Education earlier this month to refer Pine Springs Preparatory Academy in Wake County and Cape Fear Preparatory Academy in New Hanover County to an advisory board for further review. Both schools have since submitted letters announcing they’re severing relations with Newpoint, according to Adam Levinson, interim head of the state Office of Charter Schools.

At a meeting of the State Board of Education earlier this month, the applications of Cape Fear Preparatory (New Hanover) and Pine Springs Preparatory (Wake) were kicked back to the state advisory board that reviews charter school applications so that they could further investigate allegations and charges of grade tampering and other abuses at some of Newpoint’s Florida charter schools.

A formal investigation by the Florida State’s Attorney into these allegations resulted in criminal charges handed down in early June—just as the charter school management company had hoped to nose its way into doing business in North Carolina (for more background, click here).

Other findings of the school district’s own investigation included students not completing curricular requirements; numerous missing or incomplete academic records for the schools’ students; allowing the employment of an individual who had not passed a background check; and teachers drinking alcohol with students on a senior trip/cruise, according to the Pensacola News Journal.

See Cape Fear Preparatory’s letter explaining their intention to cut ties with Newpoint here, which outlines how the board plans to operate the school without the aid of an education management organization.

Commentary

Governor Pat McCrory continues to struggle to earn the respect of state legislative leaders. The latest evidence that the folks on Jones Street aren’t too worried about what the governor thinks comes from House Majority Leader Mike Hager in an AP story about why McCrory’s bond proposals are floundering in the House and Senate.

“With the budget we’ve got going on we really haven’t got a lot of time to discuss it,” said House Majority Leader Mike Hager, R-Rutherford.

No time to discuss it? McCrory proposed the bonds in his State of the State speech to the General Assembly on February 4th, more than four months ago, and he has spent the last several weeks touring the state to build support for the bonds.

House leaders have had plenty of time to discuss it. They simply don’t respect McCrory enough to make it a priority and he still hasn’t figured out how to use the power of his office to make them.