After the shock health care officials and advocates received when they saw the Senate budget, the House version presented yesterday was a welcome relief.
By Rose Hoban
In a document that reads as a sharp rebuke to the budget approved by the North Carolina Senate last month, the House of Representatives presented a budget for the upcoming fiscal year Tuesday that restores deep eligibility cuts made to Medicaid and keeps other programs and services intact that the Senate has left on the chopping block.
“We’re not coming out with a new budget, we’re coming out with adjustments to the foundation we created last year,” said House Speaker Thom Tillis during a Tuesday morning press conference to announce the budget. “Many of the provisions that are in the budget are really the budget that we passed last year.”
The House version gives teachers a much lower raise of 5 percent, compared to the 11 percent raise proposed by the Senate and leaves more room for retaining programs and services.
Also in contrast to the Senate’s budget presentation, members of the House held hours-long appropriations subcommittee meetings to present individual sections of the budget. Two weeks ago, the Senate held a single appropriations meeting before moving the bill onto the Senate floor for votes.
“I like this budget better” than the Senate version, Rep. Beverly Earle (D-Charlotte) told the Appropriations Subcommittee on Health and Human Services. Rep. Verla Insko (D-Chapel Hill), who chaired the health and human services subcommittee when Democrats were in power, also voiced her appreciation of the budget.
Medicaid
The House budget moves forward with a Medicaid reform plan favored by Gov. Pat McCrory that moves the program away from a traditional fee-for-service plan to one that favors accountable care organizations – networks in which doctors and hospitals can share in savings for cost-effective care or face financial penalties if outcomes and quality are poor.
Instead of putting provisions for Medicaid reform in the budget bill as the Senate version does, House lawmakers have created a separate bill to move through committee and be passed separately.
“We feel that needs to be an open process with stakeholders seeing and working that legislation through the committee process,” said Rep Nelson Dollar (R-Cary).
Kevin Howell, a spokesman for the Department of Health and Human Services, expressed pleasure that the House budget “moves Medicaid reform forward.”
“It’s not an ideological budget,” said Julia Adams of The Arc of North Carolina, a group that advocates and provides services for people with intellectual and developmental disabilities.
“The House is standing by the idea that it truly believes that Medicaid is not broken in the state,” she said.
Adams pointed out that Health and Human Services Appropriations chair Dollar has reiterated that Medicaid has slowly been brought under control over the past few years.
“I also think that the House also believes that when it came to the Medicaid Reform Advisory Group, everyone really came to the table and the reform process was done in good faith and transparency,” she said.
Dollar said the DHHS budget would also create a $117.7 million risk reserve for Medicaid. The House estimates the current Medicaid shortfall at $75.2 million, roughly in line with the shortfall estimated in the governor’s budget by the Office of State Budget and Management.
Rep. Marilyn Avila (R-Raleigh), co-chair of the Appropriations Subcommittee on Health and Human Services, made the point that the House budget restored the Senate’s eligibility cuts for elderly, disabled and blind Medicaid recipients.
“We saw cases where some of these cuts would do significant damage to some of the most frail in our society,” said Avila, who was a leader in the budget process for health and human services on the House side.
If you have a goal to achieve, she said, “are you going to achieve it overnight at the risk of endangering people’s lives, or do you take a much more moderated approach and move things incrementally to where you want to go.”
Mental health
In keeping with. McCrory’s emphasis on mental health crisis intervention, the House budget adds $5 million to create community crisis services. A special provision in the budget also instructs DHHS to study what it would take to make it easier for ambulances to deliver people in mental health crisis to facilities such as Wake County’s WakeBrook crisis center and train more paramedics to recognize mental health crises.
The House budget retains the Wright School, an educational and treatment program in Durham that caters to emotionally disturbed children. The Senate budget eliminated the school’s $2.7 million budget.
When asked about the Wright School at a budget press conference Tuesday morning, Dollar paused and gave one of his most emphatic statements of the day.
“That is one of the most impressive treatment programs operated anywhere in the state for incredibly challenging behavioral issues with children and their families,” he said.
Dollar added that he would like to see the school expanded in the future.
Some legislative watchers have commented that the Senate’s elimination of the Wright School was aimed at Dollar, who is known to support the school and is one of the House’s key budget negotiators.
“It came up last time, and it’s come up again,” said Rep. Jean Farmer-Butterfield (D-Wilson), who was on the budget conference committee when Democrats were in control. “I think it sends a message to him. It’s trading power, bargaining power to hold over your head because there’s certain things I need you to do.”
For the most part, House budget writers kept mental health funding intact, trimming away a $6.1 million reserve that was intended to backstop mental health management entities that might have overruns. The budget also reclaims $16 million in reserve for outfitting the renovated Broughton Hospital, citing delays in opening that facility until 2016.
Horse trading
Another difference between the House and Senate budgets is likely to be how well accepted they are across the political divide. In the House health and human services subcommittee meeting, only two amendments were offered, in contrast to a contentious and at times tense amendment process during the full Senate budget appropriations meeting.
Democrats in the health and human services committee meeting were not only complimentary of the Republican budget but thanked the chairs for the document.
“I made my desires known, and I felt like I was heard in some instances, and representatives [co-chair Mark] Hollo and Avila were attentive when I talked with them,” said Farmer-Butterfield. “They listened, and I see some results.”
Both Tillis and Dollar demurred when asked how they thought the Senate would respond to the House proposal. But Farmer-Butterfield said she thought the budget compromise could be a tough fight.
“They’re going to hold steadfast to their views, and we’ll hold steadfast to ours. So the conference committee might drag out longer than I had hoped,” she said.
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