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Today’s Fayetteville Observer hits the nail on the head with this editorial condemning the state Senate’s plan to turn North Carolina’s Medicaid program over to giant, for-profit insurance corporations:

“The N.C. Senate’s drive to restructure the Medicaid program is making less sense all the time.

We understand lawmakers sometimes succumb to the urge to fix what’s not broken. But when they, and the voters, see mayhem coming, they usually back away.

We hope that’s happening this week, as members of the General Assembly get more evidence that our Medicaid management model is anything but broken.

According to just-released long-term review by the State Auditor’s office, the agency that administers the Medicaid program here is saving taxpayers a bundle – and providing improved medical outcomes at the same time.

The audit measured results achieved by Community Care of North Carolina from 2003 through 2012. The physician-led program has won national acclaim for its effectiveness in running the health-insurance program for the poor and disabled. Other states are copying the system, which has produced budget surpluses for the past two fiscal years.

Medicaid, funded jointly by the state and federal governments, covers about 1.4 million North Carolina residents. According to the audit, Community Care succeeded in managing medical conditions and keeping patients out of the hospital. That resulted in savings of about $78 per user per quarter, which adds up to saving state and federal taxpayers something approaching half a billion dollars a year.

Most lawmakers would likely agree that we’re talking real money there, yet the drive for privatization still has its hooks in the Senate, our legislative branch most driven by ideologues. Read More

News

Community Care of North Carolina saves the state’s Medicaid program money, by about $309 per patient, according to an audit released today by the State Auditor’ s Office.

The audit was conducted at the behest of the legislature, which asked for it in 2013 to see if the state was saving money by using CCNC, a provider-led entity that manages the health care of approximately 1.2 million of the state’s 1.5 million Medicaid recipients. Medicaid is a federally-mandated program that provides health care to low-income children, elderly and disabled people.

North Carolina lawmakers have opted not to expand Medicaid, which would offer health insurance to additional low-income adults not eligible for health insurance subsidies on the open market.

The State Auditor’s office, headed by Democrat Beth Wood, contracted with an outside medical research $279,457 to conduct the audit. Major findings included the $309 annual savings per patient (based on 2003 to 2012 data), as well as what were seen as improved health outcomes, a 20 percent increase in physician’s services (which is believed to prevent more expensive future care) and a 25 percent drop in inpatient admissions. The researcher saw no statistical difference in emergency room visits.

Click here to read the entire audit.

CCNC works by pairing Medicaid patients with a primary care doctor or office, which for an additional fee then helps manage individual patient’s care with the intention of cutting down on unneeded medical expenses and providing better care.

CCNC’s future in the state is murky, with the Republican-led House and Senate chambers currently trying to decide how the $14 billion Medicaid program should be managed, and whether it should be privatized. House members have been more open to keeping CCNC, while the Senate has proposed doing away with the state’s contract with CCNC and instead turning to managed-care health companies to take over the bulk of the state’s Medicaid cases.

There’s also been considerable turnover in CCNC itself. Several top leaders left the non-profit entity recently, for what CCNC described as a “downsizing.”

Commentary

Pat McCrory 4Sometimes, you have to wonder how Governor Pat McCrory prioritizes the issues to which he will devote his attention.

Right now, the General Assembly is in the midst of one of the most momentous — and potentially damaging — stretches in recent state history. An interminable and increasingly destructive budget impasse, the serious consideration of a radical series of constitutional amendments, a plan to sell off the state’s award-winning publicly-controlled system for delivering health insurance for people in need to Wall Street corporations and a proposal to expedite the privatization of public schools are all on the front burner on Jones Street. Add to this that the legislative session is about to go into double/triple overtime and one might reasonably conclude that now is THE time for the Governor to be exerting leadership and driving the agenda.

Unfortunately, this is not the case. Instead, here is what the Guv has apparently made his top priority, according to Raleigh’s News & Observer:

“Gov. Pat McCrory on Wednesday called on the state Senate to pass a historic tax credit plan that has languished in the legislature since March.

House Bill 152 would create a scaled-back version of the tax credit, which expired at the beginning of the year as part of a Republican-led tax reform effort. The new credits would pay property owners less than the original program, with an expected annual cost to the state of $8 million. The available credit would be larger in the state’s poorest counties.

The House passed the bill in a 98-15 vote on March 26, but the Senate referred it to the Ways and Means Committee, which never meets.

‘I’m getting impatient, that’s why I took off my tie,’ McCrory told a group of about 100 tax credit supporters. ‘We shouldn’t even have a fight about it. … We need action today. Go to the legislature!’

McCrory’s cultural resources secretary, Susan Kluttz, said she’s made 73 trips to 52 towns across the state to solicit support for the tax credits.”

You got that? At a time of great upheaval in which fundamental decisions are being made about the future of North Carolina, the Governor is spending vast amounts of his time campaigning for what is, at best, a tiny side issue. This isn’t to say that restoring the historic tax credits wouldn’t be a nice thing to do, but good grief! Seventy-three trips for a tax credit that amounts to spare change in a $21 billion budget?

C’mon Governor. We know General Assembly leaders frequently opine that you are all but irrelevant, but you could at least try to insert yourself into the debates that really matter. The historic tax credit campaign at a time like this is simply embarrassing.

Commentary

well-timed tissueGov. McCrory may have shed a few tears yesterday over the departure of his Secretary of Health and Human Services, Aldona Wos, but the chief reaction across the state — both within government and without — was relief and a strong feeling of “what took so you long? This morning’s editorial pages tell the story:

Here’s Wos’ hometown Greensboro News & Record in an editorial called “Good heart, bad fit”:

“As for tangible results, well, that was another matter. Despite her background as a physician and former U.S. ambassador— and her famous, sunrise-to-late-night work ethic — the sheer weight of the DHHS bureaucracy seemed to overwhelm Wos.

In time, critics on both sides of the partisan aisle began to wonder out loud if they were getting their money’s worth.

Now, after two and half years at the post, Wos is leaving, Gov. Pat McCrory announced at a Wednesday news conference in Raleigh. Standing at his side, Wos noted it was ‘time to go home.’ Although the governor tearfully praised Wos’ job performance and commitment — as he has all along — her tenure has been wracked by a series of missteps and crises, large and small…”

The N&R then goes on to list a half dozen HHS disasters under Wos’ leadership.

Raleigh’s N&O put it this way in a piece entitled “Don’t cry for me North Carolina”:

“Some Republican lawmakers were annoyed by the turmoil in the department and Wos’ inability to provide reliable numbers on the cost of Medicaid. Senate Republicans even proposed that their version of Medicaid reform would remove the program entirely from DHHS and place its management under the control of a new agency. Indeed, lawmakers doubts about Wos may well have played a role in her resignation.”

The Winston-Salem Journal called for the department to be put back on track:

“The resignation Wednesday of Dr. Aldona Wos, the embattled secretary of the state Department of Health and Human Services, was as overdue as it was unsurprising.…During the two-and-a-half years she has served as secretary, legislators of both parties, advocates and state audits have repeatedly pointed out flaws in the department’s delivery of service to some of our most vulnerable citizens.”

Charlotte Observer cartoonist Kevin Siers compares the department Wos leaves behind to the Statue of Liberty — the torch section.

Meanwhile, the Fayeteville Observer took a different approach, noting that Wos’ departure provides a perfect time to expand Medicaid:

“When he explained why he declined to adopt Obamacare’s expanded Medicaid coverage two years ago, Gov. Pat McCrory said he couldn’t do it because the system was broken. Two consecutive years into positive fund balances, it doesn’t look broken anymore, does it? Where, then, is the expansion initiative, which would bring billions of federal dollars to North Carolina, insure hundreds of thousands of residents without coverage and likely save some rural hospitals from shutting down?”

Commentary

Medicaid expansionFor years now, poor and working North Carolinians who would benefit greatly from Medicaid expansion under the Affordable Care Act have been held hostage as Governor McCrory procrastinated and offered excuses. First, the Guv claimed that the Medicaid system itself was “broken” and in need of repair before it could be expanded. Then, he claimed that it would be inappropriate to act until the U.S. Supreme Court ruled on the constitutionality of the ACA itself.

Today, McCrory is running out of excuses. The Supreme Court took care of the constitutionality question a few weeks ago and yesterday, McCrory himself laid Excuse #1 to rest.

According to a statement from the Governor’s office, Medicaid is now in the black:

“The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.”

What’s more, that surplus is more than enough to cover state costs of implementing expansion. As a December 2014 study from health policy wonks at the Milken Institute School of Public Health at George Washington University reported (see page 15), expansion will actually save the state more than $300 million over the next five years. In 2020, however, there will be a modest net cost to the state of $91.7 million.

The obvious takeaway? Even if the state flushed away the savings that expansion will bring between now and 2020, it can easily cover the modest bump in costs in 2020 merely by socking away the current surplus.

Not surprisingly, however, the Guv is already moving the goalposts. Read More