A remarkable thing happened during the recent House debate on a misnamed Medicaid “reform” plan that turns over much of the health care program for the most vulnerable people in North Carolina to out-of-state for-profit managed-care companies.
Rep. Nelson Dollar, a prominent Republican and top budget writer, not only stood and opposed the plan that he correctly said would be putting stockholders ahead of North Carolina residents, he challenged the misleading claims about the current Medicaid system made by the ideologues and special interests intent on privatizing it.
Dollar pointed out that for all the bluster about the current system being broken and out of control – two characterizations repeated incessantly by the privatizers – Medicaid claims costs have fallen in the last five years even as the program now serves 200,000 more people.
Dollar also told his colleagues that North Carolina ranks 42nd in the nation in the cost per full-time Medicaid enrollee and that the cost per patient has declined in the last four years.
That hardly sounds like a program spiraling out of control.
Dollar reminded the House that insurance company HMOs that are a key part of the reform plan have been tried before in North Carolina and failed, in hospitals in Mecklenburg County, in the state’s mental health system and in the state employee health plan in the 1980s and 1990.
It is not every day that a powerful member of the House takes the floor to argue against a carefully negotiated deal supported by the leadership of his own chamber, not to mention Senate leaders and a governor of his own political party.
But that’s exactly what Dollar did.
For the past several years, he has been considered the House expert on Medicaid and health care funding issues. His name had been floated more than once as a possible secretary of Health and Human Services.
Agree with him or not, Dollar knows what he’s talking about, and that was clear again in the recent debate. But the vote to privatize part of the Medicaid program was decided long before Dollar made the case against it.
The constant drumbeat to discredit the Medicaid program had taken its toll. The claims that Dollar refuted on the House floor had been repeated so many times by so many special interest groups with a stake in privatization, they became part of the conventional wisdom in the legislative halls.
They were repeated again this week by several House members almost by rote, even after Dollar effectively countered them.
The House and the Senate ultimately passed the Medicaid privatization plan despite the arguments against it from Dollar and many Democrats in the House who were also worried about turning over health care to for-profit managed-care companies.
Gov. Pat McCrory held a public ceremony to sign the bill into law, claiming it would transform the state Medicaid program. That’s probably true, though not in the way McCrory’s claiming.
In case there was any doubt about how the House would vote on the privatization plan, Senate leaders made sure by putting a provision into the state budget that would terminate the contract of Community Care of North Carolina in March if the Medicaid reform proposal did not pass.
CCNC is the provider-led North Carolina nonprofit managed-care group that has won national acclaim and saved the state millions of dollars according to a recent audit requested by the General Assembly.
Community Care’s role in the new Medicaid system will be greatly diminished, but Senate leaders threatened to kill it almost immediately if lawmakers didn’t approve their privatization scheme.
Despite the bullying tactics and the massive misinformation campaign, the misguided reform is hardly a done deal. The state needs waivers from the federal government to implement it.
Those could take years unless lawmakers also include a plan to expand Medicaid under the Affordable Care Act and provide coverage for 500,000 low-income people. That would certainly make the Obama administration more likely to act before Obama’s term ends at the end of 2016.
That’s the only silver lining in this week’s troubling Medicaid vote. There’s still time for lawmakers to come to their senses and stop trying to fix something that’s not broken to give insurance companies a windfall at the expense of the most vulnerable people in the state.
They need to think twice about what they’ve just done.
And they need to listen to Rep. Dollar.
Chris Fitzsimon is executive director of N.C. Policy Watch, from which this is reprinted.