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NC HHS Sec. Aldona Wos

NC HHS Sec. Aldona Wos

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.

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There have been a lot of interesting — even amusing — reactions over on Right-Wing Avenue to last Friday’s judicial order halting the state’s unconstitutional school voucher program. House Majority Leader Paul Stam, for instance, wishfully and inaccurately dismissed the court’s action as a trifling matter that can easily be evaded with just a tiny tweak during the upcoming short session.  Meanwhile, the chief voice of the Koch Brothers in North Carolina, Americans for Prosperity, laughably termed the lawsuits brought by an array of concerned citizens and local Boards of Education as “demagoguery from a special interest group.”

But perhaps the most amazing response (and best example of unintended irony) thus far comes from the Pope-Civitas Institute, where a staffer wrote the following in response to the lawsuits and the Judge Hobgood’s preliminary injunction:

“When you can’t win at the ballot box,  enforce your will through the courts.  That’a (sic) well-known tactic of the left and that’s exactly the strategy on display in North Carolina.” Read More

Dean BakerIf you don’t follow economist Dean Baker on Twitter or the blogosphere, you should. This week, Baker has, among other things, dissected the bombs being lobbed at the Affordable Care Act because of the finding that it might lead to lowering of employment numbers.

As Baker notes here:

“Apparently a lot of media folks have made such a habit of repeating Republican talking points that they can’t see what is right in front of their eyes. The Republicans are touting the fact that the Congressional Budget Office (CBO) expects the Affordable Care Act (ACA) to reduce the number of people working.

Guess what? This was one of the motivations for the ACA. It is a feature, not a bug. Read More

Medicaid expansionThe drumbeat calling on state leaders to reverse course and accept federal Medicaid dollars in order to provide health insurance to hundreds of thousands of poor North Carolinians continues to grow louder and louder.

As this morning’s Greensboro News & Record editorial argues (after citing a new report by the accounting firm Jackson-Hewitt that the failure to expand will lead to tens of millions of dollars in tax penalties for North Carolina businesses):

“A society and an economy are stronger when people are healthier. Expanding Medicaid coverage could help North Carolina achieve that goal. If that could spare employers tens of millions of dollars in tax penalties at the same time, our pro-business governor should explore that opportunity.”

Meanwhile, be sure to check out this essay by Duke writer and doctor Laura Musselwhite in  Raleigh’s News & Observer in which she points out: Read More

Sen. Richard Burr has an idea: maybe it’s time to reform our health insurance system. We could set up state-based marketplaces, give tax credits to purchase private insurance, and create some new protections for people with pre-existing conditions. But first we need to repeal the Affordable Care Act because it sets up state-based marketplaces, gives tax credits to purchase private insurance, and creates some new protections for people with pre-existing conditions.

The fact that Sen. Burr’s proposal is a watered down version of Obamacare is not its most entertaining feature. Partisan opponents of the Affordable Care Act have spent several years introducing alternatives to health reform that are just less workable variations of the law the nation has spent the past three years implementing.

What is most entertaining about Sen. Burr’s new proposal is what it says about prevention. Although the Affordable Care Act is one of the largest, most comprehensive investments ever made in prevention, it was not enough for Sen. Burr. In debates and news interviews he constantly harped on the lack of investment in prevention as the primary driver of his opposition to the ACA. In fact, he introduced an ACA alternative in 2009 called the Patients’ Choice Act. Title I of that act is “Investing in Prevention”. Prevention, after all, is the key.

What, then, does this new proposal, called “The Patient Choice, Affordability, Responsibility, and Empowerment Act,” have to say about prevention? Nothing, nothing at all. In the detailed summary of the bill there is no mention of prevention. So, Sen. Burr is now proposing that we throw away a unprecedented, large-scale prevention effort currently underway and replace it with nothing.

It’s easy enough to laugh off these public relations stunts. Even Sen. Burr has admitted that repeal is unlikely. It’s even less likely now that millions of people are enrolled in ACA plans and are receiving tax credits. But it’s sad that this is what passes for legislating nowadays. There are things that need fixing in health reform. Legislators should get to work and stop trying to strip away protections for American consumers.