McCrory takes his lumps on Medicaid

Published 12:00 am Monday, June 3, 2013

RALEIGH — Two months ago, Gov. Pat McCrory announced that he planned a major overhaul of the state’s Medicaid health insurance program for the poor that would involve private companies managing care.
In the weeks afterward, McCrory sent his top health officials, Secretary of Health and Human Service Aldona Wos and Medicaid chief Carol Steckel, on a tour to promote the idea.
Then came a pronouncement, just days before the state Senate unveiled its proposed budget, that McCrory, Senate leader Phil Berger and House Speaker Thom Tillis had “joined forces” on Medicaid reform.
The news release went on to talk about the governor’s vision for providing “care for the whole person” and improving administrative efficiency. It touted a coming Senate budget provision to push along the process.

The words omitted from the announcement were as noteworthy as those included. “Private” or “privatize” were nowhere on the page.
As for that Senate budget provision, a careful reading shows that it is no ringing endorsement of McCrory’s approach. It tells the governor and his health chiefs to come up with a plan; lays out some requirements for how the plan will be tested and implemented; requires some study on potential cost savings and risks; and then says legislators will have the final say in deciding whether to do any of it.
That’s right. Those legislative leaders who have joined forces with McCrory have told him to create “but not implement” a Medicaid reform plan.
In other words, legislators have given Pat the ol’ pat on the head and told him, “Now, you run off and be a good boy.”
Sure, they allowed him to save a little face. The budget provision, though, makes clear who will be in charge.
No one should be surprised. Most legislators never seemed real enamored with the idea of scrapping the current system in which doctors — not insurers — receive the financial incentives to generate savings.
Meanwhile, Senate budget writers have marched off on their own, hearing a different drum beat of reform for a program that most people acknowledge puts tremendous financial pressure on the rest of state government.

Among other things, Senate Republicans would create a stick to go along with Medicaid carrots. They would withhold 4 percent of payments from doctors and other health care providers and only return a portion of that if the docs could show good, cost-efficient treatment of patients.
They would also move a portion of pregnant women who currently qualify for Medicaid onto new health care exchanges, a change that critics condemn because it will mean more out-of-pocket expenses for those women.
Setting aside the Medicaid reform debate, the recent moves provide more evidence that a rookie governor without a lot of experience in state government has yet to find his footing.
He needs to find it soon. Otherwise legislative bulldogs will keep knocking him to the ground.
They will smile, help him up and dust him off. And then they will do it again, and again, and again.

Scott Mooneyham writes about state government for Capitol Press Association.