Most everyone agrees North Carolina’s Medicaid program is broken, but fixing Medicaid hasn’t been a high priority for previous governors or legislators. Now might be the right time and Gov. Pat McCrory might be assembling the right team to make Medicaid operate more efficiently and effectively.
Medicaid is expensive, complicated and a large number of hands are involved in its administration and service delivery. Our Medicaid program costs about $13 billion per year, about $3 billion of which comes from the state. There are approximately 1.5 million people in our state covered by Medicaid, which has 15 mandated and about the same number of optional services, most all involving federal regulations and oversight, state laws and regulations, state agency management, local and regional partnerships and private sector service providers. That does not excuse poor execution and administration but it helps us understand the complexity of Medicaid.
We understand that legislators are frustrated at years of reported mismanagement, cost overruns involving new computer processing systems and repeated waste and fraud. In comparison with other states our program offers more benefits and needs reform. We even understand that our Republican controlled legislature doesn’t care for Barack Obama or for the Affordable Care Act Congress passed with added Medicaid mandates, but that doesn’t justify the hasty and arbitrary passage of Senate Bill 4.
The Affordable Care Act mandates that all states set up health insurance exchanges and provides we choose between three options: state operated, a state-federal partnership or a federally controlled and operated exchange. When our legislature didn’t act in a timely manner Governor Perdue opted for the state-federal partnership. In what seemed an arrogant power play Senate leaders stated these were not the governor’s decisions to make, they were legislative decisions.
Senate Bill 4 overturns Perdue’s decision. Curiously, Republicans who constantly complain about big government want to relinquish total control of our state’s health insurance exchanges to that government. SB4 also declares North Carolina will not opt to expand Medicaid to some 500,000 new recipients because Senators are rightfully skeptical about potential unfunded mandates beyond the first few years, when the federal government promises to pay all or virtually all the costs.
Senate leaders attempted to justify their speedy action by citing a Feb. 15, federal declaration deadline. That dog won’t hunt. They weren’t concerned enough to respond to federal deadlines last summer or in December, saying there was plenty of time to make decisions. But the exchanges are supposed to begin operation in October and Insurance Commissioner Wayne Goodwin has already received five million dollars in federal planning money toward their implementation.
These are important decisions that demand our best and brightest minds to find solutions and need to include Governor McCrory, our Insurance Commissioner and we the public need to be heard, since Medicaid impacts every citizen directly or indirectly. We deserve full disclosure and sound reasoning behind decision-making.
Senate Bill 4 is wrong on many levels. It was arbitrary, didn’t include all the needed stakeholders, was designed and passed without sufficient discussion and leaves far too many questions unanswered. North Carolinians gave legislative control to Republicans who promised honest, transparent and more accountable government. The Senate hasn’t lived up to that promise with Senate Bill 4. We deserve better.
Campbell is the creator and host of NC Spin, a weekly panel discussion on state issues that air on public television. He is also a former assistant state treasurer.