As the General Assembly's not-so-short session grinds on, the House and Senate are raising the concept of stalemate to a high art.
Whether it's the budget, school funding or coal-ash cleanup, each branch is staking claim to sharply differing solutions. It's the kind of debate that should be reserved for the long sessions in odd-numbered years.
The division may be at its starkest in the dueling approaches to reforming Medicaid, the state and federally funded health insurance for the poor. Medicaid costs have proven unpredictable for years, and annual overruns are a leading cause of legislative heartburn.
Gov. Pat McCrory and House lawmakers have settled on a plan that continues reform already begun, the move to physician-led "accountable care organizations." The state has already taken steps in that direction, and our Medicaid administrative system has earned national praise and emulation. Care providers have incentives to keep costs down and share in cost overruns. It's a good system, the operational model the federal Medicare system is embracing - with enthusiastic participation by hospitals and other health care organizations.
The Senate has rejected that plan and is pushing its own, which would turn Medicaid administration over to private business in the managed-care industry. The Senate wants to set a flat fee each year for Medicaid administration and hire private companies to make it work. If health care for the poor is purely an accounting matter, that's the best way to go. But the plan leaves real people and their needs out of the picture. It's a throwback to the health care model of earlier days, and we're not at all convinced it will provide good health care or an adequate safety net for our poorest, and often unhealthiest, residents.
Worse, the Senate would take the program's oversight away from the governor and Department of Health and Human Services and hand it to an appointed board and new bureaucracy that would enjoy greater secrecy than should ever be given to an administrator of taxpayer funds.
The Senate plan would take effect in two years, while the House's implementation would take four to six years. We'd like to see the Senate's sense of urgency incorporated into the House plan, but would suggest shelving the rest of the Senate plan. The Senate would line corporate pockets, reduce government oversight and likely diminish the quality of care. It's a bad idea that should go away.
