By Rose Hoban
Although Medicaid comprises close to $4 billion of North Carolina’s $21 billion budget, Gov. Pat McCrory mentioned the program that covers more than 1.7 million low-income children, their parents, seniors and people with disabilities only once during his 80-minute State of the State speech on Wednesday evening at the General Assembly.
And while debate over the idea of expanding the Medicaid program as allowed for under the Affordable Care Act is increasingly being embraced by other Republican governors around the country, McCrory sidestepped the topic, only talking about expansion in veiled terms.
“As we continue to review health care options for the uninsured, we are exploring North Carolina-based options that will help those who can help themselves while also encouraging those who can’t,” said McCrory.
The governor repeated his talking point that any solution for covering uninsured people who fall into the income gap between qualifying for Medicaid and making enough to qualify for federal tax subsidies to help pay for health insurance must be a “North Carolina plan, not a Washington plan.”
“If we … come up with a proposal and determine that the proposal is best for North Carolina to cover the uninsured, it must protect North Carolina taxpayers,” he continued. “And any plan must require personal and financial responsibility for those who would be covered.”
McCrory spent more time talking about Medicaid reform, a plan his administration calls the Healthy NC Initiative.
“Last session, we came close to passing Medicaid reform, but progress stalled on the 1-yard-line,” said McCrory, referring to the fact that disagreements between the House and Senate over the shape and scope of Medicaid reform delayed the end of last summer’s legislative session.
At the close of the session, legislators decided to put off moving forward on Medicaid reform. A committee process this past fall also failed to reach compromise between the two legislative chambers on how Medicaid will look in the future.
Reform remains contentious
McCrory came into office in early 2013 proclaiming Medicaid a “broken” system that needed restructuring. He and Health and Human Services Sec. Aldona Wos also argued that North Carolina would be unable to expand Medicaid until the program was “fixed.”
An initial reform plan seemed to favor using commercial managed care organizations to run the program but met with fierce opposition from the health care community. This approach to Medicaid reform continues to have support in the Senate. But in February 2014, Wos presented a reform plan to lawmakers that favors creating provider-led accountable care organizations to deliver Medicaid services. This approach has found favor in the House.
McCrory reiterated his support for Wos’ plan and said reform should be driven by physicians.
“Health care providers, including physicians, will share in the responsibility for reducing costs by avoiding unnecessary services and working to keep people healthy and out of the emergency room, which is very costly,” McCrory said in his speech.
But McCrory’s support for reform didn’t seem to soften members of the Senate.
“We’ve been clear where we are and we think it’s time to move and not restate the same positions that we’ve had,” said Sen. Ralph Hise (R-Spruce Pine), who chairs the Senate Health Care Committee and oversees appropriations on health care for the Senate.
When asked if the Senate leadership is interested in moving closer to McCrory’s position on reform, Hise equivocated.
“I think we have a lot of areas out there: the role of [managed care organizations], how the department should be structured,” he said. “We’re open to discussion on any of them, but ultimately we’ll have to come to a deal for this state that will control the cost of Medicaid.”
“The governor presented very well … the need to get over the finish line with Medicaid reform,” said Wos after the speech. “We’ve been more than 18 months working on this project. We have to get over the finish line so we can finally implement it for the citizens of the state to be able to move foreword in a patient-centric, provider-driven Medicaid reform system.”
Dancing around expansion
When discussing the possibility of expanding the state’s Medicaid program, McCrory didn’t use the word “Medicaid,” instead referring to “health care options for the uninsured.”
Wos defended the governor’s language, saying it was not a play on words.
“It’s not exactly Medicaid expansion,” she said, in the sense of providing coverage to more people under the system as it operates today. “It’s providing health care for the uninsured.”
Wos did clarify that any growth would be through the Medicaid program using federal Medicaid dollars.
Earlier in the day, Democratic lawmakers called for Medicaid expansion.
“I spoke with [McCrory] earlier this week … and he has indicated that he would like to try to do something” about Medicaid expansion, House minority leader Larry Hall (D-Durham) said. “We believe there should be something worked out with the federal government as soon as possible. We don’t think there should be a political issue where we make token efforts.”
But Sen. Mike Woodard (D-Durham) said he didn’t see how expansion would be possible.
“I really wish he had thrown the weight of his administration fully behind it and use those words and double down, but he did not do that,” Woodard said after the speech.
He also said the Senate leadership has made no commitment to expanding Medicaid. “That’s where it stalled before and I’m confident that’s where it’s going to stall again.”
Support for mental health services
The governor also advocated for the creation of several more veterans’ treatment courts, an initiative that focuses on helping veterans who have run afoul of the law.
“We have thousands of veterans of Iraq and Afghanistan coming home to North Carolina,” McCrory said. “Some of them have had problems with addiction, homelessness, getting a job and struggling with mental illness.”
The state established two veterans’ courts in late 2013, in Harnett and Cumberland counties, which McCrory called an “unqualified success.” He proposed creating two more such courts.
The governor also praised the recently announced plan for the state to sell the old Dorothea Dix Hospital campus to the City of Raleigh to create a destination park.
“And even better news, we’ll get $52 million, which we’ll direct toward supporting mental health and the well-being of our citizens,” McCrory said.
Any move to allocate profits from the Dix sale, however, will have to be approved by lawmakers.
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