Medicaid match
Published July 23, 2014
Editorial by Greensboro News-Record, July 23, 2014.
In his first year as governor, Pat McCrory often said he was stepping on toes of both Democrats and Republicans.
Few Republican toes seemed to be bruised.
And now, in the GOP governor’s second year? The same thing, he said in a News & Record interview Monday. Just more publicly.
Only he’s aiming higher. McCrory is kicking the shins of Republican Senate leaders, whom he’s compared to such Democratic predecessors as Marc Basnight and Tony Rand for their propensity to exert rigid control over the Senate. Last week, he threatened to veto the Senate’s version of the budget if it’s enacted. Monday, he stepped up on his bully pulpit to appeal for public support of his Medicaid reform plan. Tuesday, he met with all Senate Republicans to ask them to back away from their plan. Tuesday afternoon, they postponed a vote until today, following possible changes.
Senate leaders complained that McCrory is meddling in legislative affairs. But intervention is hardly novel for a governor, as anyone who remembers Jim Hunt can attest. Hunt lobbied legislators hard to back his agenda. If McCrory is trying to channel Hunt, it’s an improvement from his timid first year. It may encourage him to recall that Hunt was elected four times.
The Senate Medicaid plan sets up dual managed-care and provider-run systems that allot prescribed amounts of money for patient care and make managers responsible for additional costs. Care would be administered by a new Department of Medical Benefits governed by an independent board of directors.
McCrory initially supported a managed-care option, which is run by private companies, but backed away after further study. He strongly opposes creation of a new agency, insisting Medicaid should be run by the Department of Health and Human Services, which reports to the governor.
He’s right about that. The governor should be accountable for Medicaid administration, not an unelected independent board whose members would be virtually unknown to the public.
McCrory’s own approach was contained in the original Medicaid reform bill approved unanimously by the House July 2. It builds on an accountable care model where patients use a single portal to access a variety of services. It gradually moves to a financial structure where providers take full responsibility for costs by 2020. In that way, it builds on strategies that are already successful and allows for a reasonable transition to a more predictable cost structure.
The plan complements the current system, was developed by professionals “on the front lines” and allows regional flexibility, McCrory said. It’s also less risky than throwing out a familiar structure for a system that is untested in North Carolina.
Senate leaders rarely have yielded to the governor or failed to hold their followers in line. They won’t win this time. Because of his public opposition, McCrory can’t afford to give in to the Senate. But if the Senate won’t accept the House plan, Medicaid reform will be dead for another year, shin-kicking or not.
