Senate Medicaid cure worse than the illness

by Tom Campbell, Executive Producer and Moderator, NC SPIN, May 30, 2014.

The most common reactions to the NC Senate budget revisions have been surprise and shock. Few imagined the dramatic changes Senate leaders had in store from their closed-door deliberations. The media focused its coverage on the teacher pay and SBI move provisions but the most sweeping changes were found, beginning on page 91 of Senate Bill 744, in the most dramatic policy shifts to Medicaid since this state first established the program.

Senate leaders are obviously frustrated with what they see as too little progress being made in predicting enrollments, containing expenses and enhancing management of North Carolina’s $13 billion Medicaid program. Their disillusionment with DHHS Secretary Aldona Wos is well documented. But the Senate’s solutions are not practical and won’t work.

The Senate proposes removing Medicaid from the Department of Health and Human Services and creating a new state agency. They would dismantle Community Care North Carolina and dramatically reduce eligibility for the aged, blind, disabled and “medically needy,” cutting off medical care to some 15,000 current recipients, many of whom are in assisted living and long-term care facilities. Their actions could be painful, cost jobs and harm beneficiaries and taxpayers.

Medicaid is the most complicated federal program perhaps ever designed and no significant changes can be made without the express approval by the feds. If, and this is a big if, the Senate changes were to receive federal approval it would likely be years in coming, a long time to wait for relief. More likely, some changes would be approved, others wouldn’t and our Medicaid picture could be even murkier than exists today.

Removing Medicaid from DHHS might sound appealing and has been proposed by other legislatures and administrations but all quickly concluded such a move would create more problems than it solves. Medicaid is intricately intertwined with mental health, public health, rural health, as well as programs for the young and aged, all of which are contained in DHHS. Extricating Medicaid would only complicate and confuse lines of communication, budgeting and administration.

This measure would endanger the financial viability of many long-term care and assisted living facilities. Many would likely close, costing jobs and dumping patients out on the street. Family physicians and clinics, especially those in rural areas, that serve large numbers of Medicaid patients would see dramatic losses in revenues. Practices would close, docs would move and medical care, especially in rural areas would become even harder to access.

It is hard to understand the Senate’s end-game strategy. The House isn’t likely to concur with these drastic overhauls and further possible that even if they did Governor McCrory would veto them.

For more than 16 months a task force including legislators, doctors, hospitals, DHHS, the Governor’s office and others has been working on reforms to Medicaid that would benefit patients, the medical community and taxpayers. The Senate disregards their conclusions and strikes off in an entirely different direction. This is neither good government nor good for all involved in the process.

Yes, Medicaid needs change, better management and more predictable, containable and affordable budget parameters. But we cannot get healthy Medicaid reform behind closed doors and reforms won’t work without careful deliberation by all those affected by changes. The Senate cure promises to be worse than the illness.