Senate Bill 4 is Wrong on Many Levels

Published February 7, 2013

By Tom Campbell

by Tom Campbell

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 Governor 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 dollars 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 February 15th 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.

February 10, 2013 at 9:48 am
dj anderson says:

The comment about being for or against "Big Government" regarding Medicaid is moot, I think, since it is big government either way, if the Federal or the State takes control.

February 10, 2013 at 10:21 am
dj anderson says:

I viewed the Senate action as a "restart" or "reboot" on the issue that was kicked along by the former governor & last legislature for years without decision. The Senate acted and now awaits reaction from the governor, whom they are going to put in his place, and from the loyal opposition party which will have to state flatly what they want, and why. There would be the needed public debate, with little time to do it.

February 10, 2013 at 10:34 am
dj anderson says:

With sequestration looming over DC, I understand the Legislature's lack of confidence in the Feds finger-crossed promises of 100% for 3 years, then 90% afterward. I don't see how the nation can afford it.

From that view, this ordinary citizen leans to let the federal government handle medicaid expansion, but no choice is financially safe. The panel did not address what would happen to NC's possible cost if DC has bitten off more than it can chew (pay for) and one day decides to hand Medicaid back to the state? Would NC have to raid education to get funds for health care?

The panel didn't address the different effects on current care providers, except a one-liner by the Libertarian saying private insurance could be hurt, and I can see where large Duke/UNC hospitals will thrive with the state taking control, but I'm unclear on how Medicaid payments to small county hospitals might become restrictive. Federal money is often double edged. What are the facts?

February 11, 2013 at 8:00 pm
larry wood says:

Are your numbers accurate? Is there really 13 BILLION dollars spent in NC on 1.5 MILLION people. Do the math. The state should take the money and buy a Cadillac insurance policy for each Medicaid recipient. I would wager that virtually no one pays an annual premium of nearly $100,000 for health insurance. No wonder we are broke! Publish the actual amount spent per person and see what reaction you get.

February 12, 2013 at 8:17 am
TomC says:

These are the generally reported numbers for Medicaid. 10 billion comes from the feds and 3 from the state. On a per capita basis we would be better off just writing these people a check but sadly the dollars filter through many hands. See why so many say this program is broke and broken?

February 15, 2013 at 5:48 pm
Art Wilson says:

Our legislature cannot pass a "good bill" pertaining to the ACT. This albatross was hung around our neck and the less we commit to it the better. The Obama administration sired this horse, let them ride it. When a can is empty it does not matter whether you kick it down the road or no. At some point in time even the dumbest social engineers will have to realize health care is a commodity not a right. There is no government that can subsidize total health care indefinitely.