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The Nine Habits of a Highly Effective Secretary for DHHS

With the recent passing of the torch from Aldona Wos to Rick Brajer (see blog), I’ve been thinking about…

What are the qualifications of a Secretary of DHHS?

What exactly are the qualities that would make a great Secretary of DHHS?  Remember, in Mary Poppins, when the children draft their requirements for a nanny?  Or, better yet, what are the “Seven Habits of a Highly Effective” Secretary for DHHS?  Or…in this case, the “Nine Habits”…

Here are my “Nine Habits of a Highly Effective Secretary of DHHS;” our Secretary of DHHS should have the following:

  1. A health care background
  2. A successful track record of his/her ability to manage large companies or agencies
  3. An understanding of the Medicaid system, and, maybe, even have first-hand knowledge of how the system affects recipients and providers
  4. A relationship with someone on Medicaid or a parent of someone on Medicaid
  5. A working knowledge of clinical coverage policies, reimbursement rates, and regulations surrounding Medicaid
  6. Both the capacity to listen and speak and do both eloquently and genuinely
  7. True empathy about the physical and mental health of Medicaid recipients and about providers, plus have the patience to handle all types of demographic differences
  8. An understanding that he/she is handling tax payers’ money, that redundancy in staff is excess administrative costs, and ability to trim the fat
  9. An ability to communicate with both the Senate and the House and to be frank with both

wosbrajer

Let us analyze the qualifications of Wos that we came to witness over the last few years, as well as, review the qualifications of soon-to-be Sec. Brajer with information to which we are privy.

Let’s see if both, either, or neither have these “Nine Habits of a Highly-Effective Secretary for DHHS.”

  1. Health care background:

Wos: Yes. And, yet, maybe not.  She is an M.D. Although I do not know whether she ever practiced medicine in North Carolina.  According to Wikipedia, (which is never wrong) Wos “prides herself on her work in the field of preventing HIV and AIDS.”  However, I was unable to find a single clinic in which Wos provided services.  While, generally, an “M.D.” automatically bestows a certain aura of understanding health care, I question whether this “M.D.” automatically has a working knowledge of billing for and receiving reimbursements under Medicaid in North Carolina.

Brajer: Hmmmm.  This one is more tricky. The two companies that Brajer owned, Pro-nerve LLC and LipoScience Inc., are health care related, in that Pro-nerve was an intraoperative neuromonitoring (IONM) company and LipoScience sold a diagnostic tool to health care providers.  Arguably, both companies are health care related, at least, in an ancillary way.  However, Brajer is not a health care professional, and, to my knowledge, has never rendered health care services. Furthermore, neither of Brajer’s companies was successful; quite the opposite is true, in fact. From my understanding, one company declared bankruptcy and the other was not far behind.  Which brings us to the next category…

Answer: Both…kinda.

2. A successful track record of his/her ability to manage large entities:

Wos: Prior to acting as the Secretary to DHHS, Wos served as the Ambassador to Estonia until 2006.  What she did besides political functions between 2006 and 2012, I do not know. Acting as an Ambassador does not entail managing large entities.  The most managerial skills that I can find in her background, prior to being appointed Secretary, are related to political fund-raising. Since I would not call her brief reign as Secretary of DHHS a success, I give Wos a “two thumbs down” on this criterion.

Brajer: He managed two companies.  We can bicker as to whether these companies should be considered large…neither employed 17,000 employees.  Regardless, the “successful” criterion appears to be lacking.

Answer: Neither…pickles.

3. An understanding of the Medicaid system:

Wos: “You’re asking me without having all the data available to answer a question,” she told lawmakers on October 8, 2013.  In her defense, she responded as such when asked whether the State was moving toward privatization for Medicaid.  No one could know the answer, except, maybe, McCrory.

On the other hand, the implementation of NCTracks was nothing short of a catastrophe of epic proportion. See blog. See blog.  Anyone with nominal knowledge of the Medicaid system would have, at least, paused to consider keeping HP Enterprises under contract during the switch to NCTracks or pushed back the go-live date.

Brajer: Unknown

Answer: Here’s to hoping that Brajer does.  I’m cheering for you! Go! Fight! Win!

4. A relationship with someone on Medicaid or a parent of someone on Medicaid:

Wos: Unknown.  If I were shaking a proverbial “8 Ball,” it would read, “Doubtful.”

Brajer: Unknown. Perhaps one of his former employees at Pro-nerve, LLC and LipoScience, Inc. is on Medicaid.

Answer: Gimme a ‘B’! B! Gimme a ‘R’! R! Gimme a ‘A’! A! Gimme a ‘J’! J! Gimme a ‘E’! E! Gimme a ‘R’! R! Whats that spell? Brajer!!

5.  A working knowledge of clinical coverage policies, reimbursement rates, and regulations surrounding Medicaid.

Wos: Unknown. Whatever Wos’ knowledge of regulations and clinical coverage policies is or lacked, she, initially, made up for any knowledge lacked with the key hire and quick resignation of Carol Steckel.  Unfortunately, Steckel’s experience was never replaced.

January 2013: “I am pleased to say that we are already taking steps to address some of these issues,” Wos said. “Now, the most important of this is that we have hired Ms. Carol Steckel, a nationally recognized — nationally recognized — expert in Medicaid to run our Medicaid program for the state. Carol is already moving ahead with systemic reviews of operations in this division. She is reviewing and establishing new policies and procedures.”

September 27, 2013: Steckel resigns. And blog.

Brajer: Unknown.

Answer: B! R! A! J! E! R! Let’s go, Brajer!

6. Both the capacities to listen and speak and do both eloquently.

Wos: Wos brandished an ability to speak publicly with ease.  Listening, on the other hand….eh?

Brajer: Unknown

Answer: I think you can, I think you can, I think you can…

7. Genuine concern about the physical and mental health of Medicaid recipients AND about providers PLUS have the patience to handle all types of demographic differences

Wos: She seems to think so. Her country club does not discriminate.

Brajer: Unknown

Answer: Go! Go! Go! Go! Go, Brajer!!

8. An understanding that he/she is handling tax payers money and that redundancy in staff is excess administrative costs and trim the meat

Wos: “My obligation as secretary is to find the best possible team in order to get the job done.”  Les Merritt served as CFO of DMA on a $300,000-plus contract.  Joe Hauck was paid over $228,000 for 6 months of advise to Wos.  Matt McKillip was paid $87,500 to serve as chief policy maker without any health care background.  Ricky Diaz pulled in $85,000 as communications director. Id.  Wos has handed out $1.7 million in pay hikes to 280 staffers, many with “no career or educational experience for the jobs they hold.” Id. The implementation of the MCOs also fell under Wos’ watchful eye.  The MCO system has created thousands upon thousands of high-paying jobs with our Medicaid dollars.  I believe that in the “trim the fat” category, Sec. Wos scores a goose egg.

Brajer: Unknown.

Answer: Please, Brajer! For the love of Pete!

9. Ability to communicate with both the Senate and the House and to be frank with both.

Wos: “Separation pay” v. “Severance pay?

In April 2013: “I think the word transparency can get pretty dangerous,” Wos said. “Because what does transparency mean? If transparency means that we’re in a planning process and you’re asking us, ‘Tell us all the things you’re planning,’ well, my goodness, allow us to work, and then we’ll give you everything that you want.”

Brajer: Unknown

Answer: Brajer, Brajer, He’s our man! If he can’t do it…[gulp].

____________________________________________

It concerns me that so many of future Sec. Brajer’s core abilities/habits to run and manage DHHS and the Medicaid program in a highly effective manner are unknown.  Nothing like placing all your money on red!  But we have HIGH hopes for Brajer!!!  Don’t let us down!!

The whole point of this blog is to pause and really contemplate what characteristics would comprise a great Secretary for DHHS. Obviously, the Governor has the full authority to appoint the Secretary, meaning that we taxpayers have little to no input as to whether we deem a person qualified, except in the indirect method of voting or not voting for the Governor.

Call this blog an exercise in examining what habits, if in existence, would make the most highly effective Secretary of DHHS and an opinion as to whether these habits exist in our former and future Secretaries.

We are cheering for Brajer!  But…

One fact about the future is that it is unknown.

North Carolina Medicaid Reform Update – Round and Round She Goes

Given how long the Medicaid reform discussions have been going on at the legislature, you may be glazed over by now. Give me the memo when they pass something, right? Fair enough, let’s keep it brief. Where do things stand right now?

Last Wednesday, the Senate staked out its position in the ongoing debate between the House and the McCrory administration.

The Senate’s newest proposal is an unusual mix of different systems and new ideas. Not willing to commit to one model for the whole Medicaid program, the latest version of the bill includes something new called Provider Led Entities, or “PLEs.” PLEs are yet the latest in the alphabet soup of different alternatives to straight fee-for-service billing for Medicare/Medicaid. You’ve all heard of HMOs, PPOs, MCOs, and ACOs. PLEs appear to be similar to ACOs, but perhaps for political reasons the Senate bill sponsors saw the need to call the idea something different.  See Knicole Emanuel’s blog.

In any event, as the name suggests, such organizations would be provider-led and would be operated through a capitated system for managing the costs of the Medicaid program. The Senate bill would result in up to twelve PLEs being awarded contracts on a regional basis.

PLEs are not the only addition to the Medicaid alphabet soup that the Senate is proposing in its version of HB 372. The Senate has also renewed its interest in taking Medicaid out of the hands of the N.C. Department of Health and Human Services entirely and creating a new state agency, the Department of Medicaid (“DOM”).

(One wonders whether the continual interest in creating a new Department of Medicaid independent of the N.C. Department of Health and Human Services had anything to do with embattled DHHS Secretary Wos stepping down recently.)

The Senate also proposes creating a Joint Legislative Oversight Committee on Medicaid (“LOC on Medicaid”).

But creating the DOM and using new PLEs to handle the provision of Medicaid services is not the whole story. Perhaps unwilling to jump entirely into a new delivery system managed by a wholly new state agency, the Senate bill would keep LME/MCOs for mental health services in place for at least another five years. Private contractor MCOs would also operate alongside the PLEs. The North Carolina Medicaid Choice coalition, a group which represents commercial MCOs in connection with the Medicaid reform process, is pleased.

One very interesting item that the Senate has included in its proposed legislation is the following requirement: “Small providers shall have an equal opportunity to participate in the provider networks established by commercial insurers and PLEs, and commercial insurers and PLEs shall apply economic and quality standards equally regardless of provider size or ownership.” You can thank Senator Joel Ford of Mecklenburg County for having sponsored this amendment to the Senate version of House Bill 372.

By pulling the Medicaid reform proposal out of the budget bill, the matter appears headed for further negotiation between the House and the Senate to see if the two can agree this year, unlike last year.

By legislative standards, that counts as forward progress… Here come the legislative discussion committees to hash it out more between the two chambers. We will keep a close eye on the proposals as they continue to evolve.

By Robert Shaw

Lawyer photo

 

New NC Senate Bill Proposes 4-6 MCOs!! And the Creation of ARPLOs!!

Senate Bill 568 was filed today!!! It is a bill that you should follow!

SB 568 reads: “It is the intent of the General Assembly to transform the State’s health care purchasing methods from a traditional fee-for-service system into a value-based system that provides budget predictability for the taxpayers of this State while ensuring quality care to those in need.”

It proposes, among other things, a consolidation of the 9 current managed care organizations (MCO) here in North Carolina to “not more than 6” and “no less than 4” MCOs.

It further establishes another acronym: ARPLOs.

“At-Risk Provider-Led Organizations (ARPLOs). ARPLOs are capitated health plans administered by North Carolina’s provider-led Accountable Care Organizations that will manage and coordinate the care for the Patient Population, outside of the PCMHs, pending waiver approval where appropriate for this transformation by the Center for Medicare & Medicaid Services.”

Remember, the House has pushed for ACOs and the Senate has pushed for MCOs.  See blog.

Is the Senate bending toward the House??????

More to come…

Medicaid Reform in a House Divided and MCO, ACO…Who Cares?

We are living in the most polarized society in recent American history. A recent study shows that the feeling of political partisanship has more than doubled over the past 2 decades. So since 1995, politically, America has parted the Red Sea with voters increasingly ebbing away from the middle.

Even more interesting is that, according to the same 2014 study, political animosity is at an all-time, recent high. I say “recent” because I cannot fathom a more polarized society than the society in the 1850s-1860s leading up to the Civil War. So, when I say “recent,” I mean post-invention of the telephone.

According to the Pew Research Center, “[i]n each party, the share with a highly negative view of the opposing party has more than doubled since 1994. Most of these intense partisans believe the opposing party’s policies “are so misguided that they threaten the nation’s well-being.””

partisanship

If BOTH parties express this identical sentiment, someone is wrong.

So, now, here, in this extremely polarized society, our NC General Assembly is tackling one of our most important and most divisive issues…Medicaid Reform.

But, you say, “Knicole, our General Assembly is an overwhelming Republican majority.  Our Governor is Republican.  How can this vast and deep political polarization prevent NC from creating a new, better, non-broken Medicaid system?”

In NC, even the Republicans are polarized, at least as to the issue of Medicaid reform.  The two differing opinions as to Medicaid reform can be found in our separate houses: the Senate and the House of Representatives (House).  As for our executive branch, Governor McCrory sides with the House.

The houses are divided by acronyms: ACOs (House) versus MCOs (Senate).

The House plan for Medicaid reform involves accountable care organizations (ACOs).  The ACO plan includes physicians, hospitals and other health care providers collaborating to serve Medicaid recipients and assuming the monetary risks.  For example, one ACO may be liable for 6000 Medicaid recipients.  The ACO would be given X dollars per Medicaid recipient to cover the person’s overall health care.  Say the ACO, via its health professionals, conducts a preventative breast exam on a woman and discovers a lump.  The ACO would pay to remove the lump and, hopefully, the woman is ok.  If the ACO fails to practice preventative medicine and the woman is diagnosed with breast cancer, then the ACO must finance the more expensive surgery and chemotherapy required.  The ACO’s incentive would be to provide the best, proactive health care because, regardless, the ACO will be liable for that individual’s care.  With ACOs, there is a financial incentive to keep people healthy and the profit is shared with the state.

The Senate plan for Medicaid reform involves managed care organizations (MCOs).  Unlike ACOs, MCOs will not be comprised of health care providers.  The MCOs will be large companies that will be charged with managing Medicaid by contracting with a network of providers.  Many Medicaid services require prior authorization, which would be in the hands of the utilization review team employed by the MCO.  Similar to the ACO, the MCO would be given an amount of money based on the number of Medicaid recipients within its network.  The profit for the MCO is the money remaining at the end of the fiscal quarter that was not spent on services for Medicaid recipients.

What is better?  Does better mean the most cost-savings?  Does better mean the best quality of care for Medicaid recipients?

In order to determine whether the MCO-model or ACO-model is better and what exactly “better” means, you have to follow the money.  For both models, you have to ask, “If the actual medical services provided cost double the anticipated amount, who bears the burden?” And, conversely, “If the actual medical services provided cost half the anticipated amount, who pockets the profit?”

There are numerous ways for an insurer to be paid.  At one end of the spectrum, you have capitation; while at the other end of the spectrum you have a more typical financial relationship in which the insurer simply pays the health care provider its reasonable and usual amount.

Capitation is how we currently have our MCOs set up for behavioral health care in North Carolina.  As we currently use capitation for our MCOs, I would assume that the Senate-model MCOs would also be capitated.  Capitation places the risk on the MCO because the MCO receives a fixed amount regardless of actual cost.  However, there is concern (or should be) that the MCOs will provide patients less care than needed in order to pocket a profit.

On the other hand, ACOs typically do not rely on full capitation.  The ACOs may share the risk, and, therefore, the profit, with the state.

Another HUGE difference between ACOs and MCOs is that, with MCOs, the insurer in effect dictates what a health care provider is allowed to do.  For example, say a dentist believes that a person is in need of dentures.  Maybe 4-5 teeth have already fallen out and the remaining teeth are suffering more mild rot.  The dentist requests prior authorization from the MCO to extract teeth, create a mold of the mouth, and order dentures to be custom-created.  The MCO denies the requests saying, for example, not enough teeth have fallen out or not enough rot is present in the remaining teeth.  The dentist’s hands are tied to the decision of the MCO, unless the patient can fork over the cost of care that the MCO refuses to authorize.  And, BTW, the person who denied the request may have graduated from college with a BA in History . . . or in any event something else other than a field of medical or dental care

An ACO, on the other hand, is run by physicians, hospitals, and other health care providers. Theoretically, the decisions to authorize services would be made by those same people who swore the Hippocratic Oath.

With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

(I doubt a History major ever swore to heal the sick).

There has also been contemplation as to whether the General Assembly should remove the responsibility of managing Medicaid from the Department of Health and Human Services (DHHS) completely.  Obviously, this suggestion is extreme and would require a Waiver from the federal government to transfer the “single state agency” requirement from DHHS to another entity.

Regardless of what decisions are made…whether the GA requires a private Medicaid panel to usurp Medicaid responsibilities from DHHS….whether NC adopts an MCO-model or an ACO-model for Medicaid reform….as it currently stands, our houses are divided.  No bills pass a divided legislature.

The Senate and House both indicate that Medicaid reform is a forefront issue during this long session, but, so far, there has been no indication of a Great Compromise.

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important.  During flu season, in particular, emergency rooms (ERs) are full of people suffering from flu-like systems.  Many of those in the ER are uninsured, but many of those in the ER have a valid Medicaid card in their wallet.

So why would a Medicaid recipient present themself to the ER instead of contacting a primary care physician?  In many instances, the Medicaid recipients do not have access to primary care. Many physicians simply refuse to accept Medicaid.  Some managed care organizations (MCOs) refuse to contract with a number of physicians sufficient to address the needs of its catchment area.

A December 2014 audit conducted by the Office of Inspector General (OIG) found that access to primary care for Medicaid recipients is in serious question…especially with the onslaught of states moving Medicaid to managed care systems.

32 states contract with 221 MCOs.   From each of the 32 states, OIG requested a list of all providers participating in Medicaid managed care plans.  Remember that, here in NC, our MCOs only manage behavioral health care. We have not yet moved to managed care for our physical health care.  However, this may change in the not so distant future…

Our Senate and House are attempting to pass Medicaid reform. The House is pushing for accountable care organizations (ACOs), which would be run by physicians, hospitals, and other health care organizations. The Senate, on the other hand, is pushing for MCOs. I urge the Senate to review this OIG report before mutating our health care system to managed care.

Federal regulations require MCOs to maintain a network of providers sufficient to provide adequate access to care for Medicaid recipients based on population, need, locations of providers, and expected services to be utilized.

However, as we have seen in NC, the MCOs are not properly supervised and have financial incentives to terminate provider contacts (or refuse to contract with providers). In NC, this has resulted in hundreds, perhaps thousands, of behavioral health care providers going out of business.  See MCOs Terminating Providers and Restricting the Freedom of Choice of Providers for Medicaid Recipients: Going Too Far? and NC MCOs: The Judge, Jury, and Executioner.

The consequences of MCOs picking and choosing to contract with a select few are twofold: (1) the non-selected providers go out of business; and (2) Medicaid recipients lose access to care and choice of providers.

Because of #2, OIG conducted this audit, which, sadly, confirms the veracity of #2.

To conduct the audit, OIG contacted 1800 primary care physicians and specialists and attempted to make an appointment.  OIG wanted to determine (1) whether they accepted Medicaid; (2) whether they were taking new Medicaid patients; and (3) the wait time for an appointment. OIG only contacted physicians who were listed on the states’ Medicaid plans as a participating provider, because Medicaid recipients rely on the states’ lists of participating providers in locating a physician.

Yet, the results of the OIG audit are disturbing, to say the least.

51% of the providers could not offer appointments to enrollees, which raises serious questions as to the adequacy of the MCO networks.

OIG chart

  • 45% did not accept Medicaid
  • 35%: could not be found at the location listed by the plan,
  • 8% were at the location but said that they were not participating in the plan.
  • 8% were not accepting new patients.

The average wait time was 2 weeks for those physicians accepting Medicaid. Over 25% had wait times of more than 1 month, and 10 percent had wait times longer than 2 months.

I guess they can always go to the ER.

Right Wing, Left Wing: Does It Equal a More Balanced Senate Bill 744?

Our Senate put forth Senate Bill 744 with radical and shocking changes to our Medicaid system. However, one section of our General Assembly cannot create law. Both sides,the Senate and the House, much agree on a Bill in order to create law.

Senate sent SB 744 to the House on May 31, 2014. Between May 31 through June 13, 2014, the House revised, omitted, and added language to SB 744, making SB 744 a much different document than what the Senate had fashioned. Today, SB 744 is back in the Senate for more revisions. The end result will be a law that appears nothing like the initial SB 744 brought to the Senate on May 15, 2014.

The “ping pong” revision system between the Senate and the House that our founding fathers installed in order to generate actual laws is a well-crafted, finely-tuned balancing machine. It is an effort to keep all ideological agendas in-check. When one side dips too low, the other side counters in an effort to maintain balance. It reminds me of a bird in flight.

Our nation’s symbol is the bald eagle. I am sure everyone knows that, right? But did you also know that the bald eagle is not named the bald eagle because its white head gives the appearance that it is bald? No, bald eagle, in Latin, is haliaeetus leucocephalus (from Greek hali-, which means sea; aiētos , which means eagle; leuco-, which means white, and cephalos, which means head). So, literally its name means “sea eagle with white head.”

Even more important about the bald eagle is its set of wings. A bald eagle has a right wing and a left wing, and without both, the bald eagle would not be able to fly.

We need both the right and the left wings in order to maintain balance in our government. Both sides are necessary, and, yet, it seems that nowadays the left and right sides are at war with each other. Politics has become so polarized that the right wing and the left wing forget the attributes of the other.

The result of the ping pong revision system, in theory, is that, by the time a bill is brought into final shape and enacted into law, all polarized ideations have been balanced out in order to move forward. It does not always work that way, and it becomes increasingly difficult to balance the sides when the sides become more and more divided.

The Senate created SB 744, the House has made its alterations…and, if SB 744 passes, it will pass after many more modifications, no doubt.

When our state Senate passed Senate Bill 744 and sent it to the House, I blogged about the shocking ramifications to Medicaid had that bill been passed.

I listed the most shocking changes included within SB 744:

1. DHHS must immediately cease all efforts to transition Medicaid to the affordable care organizations (ACOs) system that DHHS had touted would be in effect by July 2015;
2. DHHS, DMA will no longer manage Medicaid. Instead a new state entity will be formed to manage Medicaid. (A kind of…scratch it all and start over method);
3. All funds previously appropriated to DHHS, DMA will be transferred to Office of State Budget and Management (OSBM) and will be used for Medicaid reform and may not be used for any other purpose such as funding any shortfalls in the Medicaid program.
4. Categorical coverage for recipients of the optional state supplemental program State County Special Assistance is eliminated.
5. Coverage for the medically needy is eliminated, except those categories that the State is prohibited from eliminating by the maintenance of effort requirement of the Patient Protection and Affordable Care Act. Effective October 1, 2019, coverage for all medically needy categories is eliminated.
6. It is the intent of the General Assembly to reduce optional coverage for certain aged, blind, and disabled persons effective July 1, 2015, while meeting the State’s obligation under the Americans with Disabilities Act and the United States Supreme Court decision in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999).
7. Repeal the shared savings program and just reduce the reimbursement rates by 3%.
8. DHHS shall implement a Medicaid assessment program for local management entities/managed care organizations (LME/MCOs) at a rate of three and one-half percent (3.5%).
9. Additional notices as to State Plan Amendments (SPAs), DHHS must post the proposed SPAs on its website at least 10 days prior to submitting the SPAs to the Center for Medicare and Medicaid Services (CMS).
10. Reimbursement rate changes become effective when CMS approves the reimbursement rate changes.
11. The Department of Health and Human Services shall not enter into any contract involving the program integrity functions listed in subsection (a) of this section that would have a termination date after September 1, 2015.
12. The Medicaid PROVIDER will have the burden of proof in contested case actions against the Department.
13. The Department shall withhold payment to any Medicaid provider for whom the DMA, or its vendor, has identified an overpayment in a written notice to the provider. Withholding shall begin on the 75th day after the day the notice of overpayment is mailed and shall continue during the pendency of any appeal until the overpayment becomes a final overpayment (can we say injunction?).

Since my last blog about Senate Bill 744 (the Appropriations Bill), Senate Bill 744 has reached its 7th revision.

The House took it upon itself to delete many of the shocking changes in the Senate Bill. Just like the bald eagle using its right and left wings to balance out.

First, the General Assembly’s proposed cease and desist order that would have stopped Gov. McCrory and Sec. Wos from implementing Medicaid reform and the accountable care organizations (ACOs), is deleted from the current version of the bill. Gone too is the “new state agency” created to manage Medicaid. Medicaid services are no longer eliminated. The Office of State Budget and Management (OSBM) is no longer receiving all funds appropriated for the Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA).

On June 13, 2014, the House finished its revisions to SB 744 and sent the revised bill back to the Senate. On June 18, 2014, the conference committee for SB 744 was formed and includes:

  • Sen. Harry Brown, Chair
  • Sen. Andrew C. Brock
  • Sen. Kathy Harrington
  • Sen. Tom Apodaca
  • Sen. Ralph Hise
  • Sen. Neal Hunt
  • Sen. Phil Berger
  • Sen. Brent Jackson
  • Sen. Wesley Meredith
  • Sen. Louis Pate
  • Sen. Bill Rabon
  • Sen. Shirley B. Randleman
  • Sen. Bob Rucho
  • Sen. Dan Soucek
  • Sen. Jerry W. Tillman
  • Sen. Tommy Tucker

SB 744 is still not law. It takes both the House and Senate to pass the bill, and then the Governor has to sign the bill. So we have a ways to go. We need the agreement of the right wing and the left wing.

The two main political parties were not always so polarized.

A couple of our founding fathers, John Adams and Thomas Jefferson, were fierce political adversaries. Imagine the political distance between Barack Obama and Ted Cruz. Despite their political differences, both Adams and Jefferson believed in the importance of funding public education. Rather than defaming the other’s point of view, Adams and Jefferson collaborated and compromised. “The whole people must take upon themselves the education of the whole people and be willing to bear the expenses of it,” wrote Adams. “There should not be a district of one mile square, without a school in it, not founded by a charitable individual, but maintained at the public expense of the people themselves.” Adams and Jefferson were able to balance out the right wing and the left wing in order to fly a straight path.

Back when our founding fathers squabbled and debated key issues, both sides worked together, instead of running mudslinging commercials and scoffing at the other side’s position on the media. During one of the biggest debates in history, the creation of our government, the lawmakers convened together for about 4 months. The Constitutional Convention lasted from May 25 to September 17, 1787 (the first one). The delegates were within close proximity of one another, which led to more conversations and more compromises. Until the Constitution was drafted, the delegates continued to meet together. I imagine they ate lunch together and shared whiskey and cigars in the evenings.

Maybe our lawmakers should schedule a new constitutional convention, both on the state and federal level. At least, both sides need to realize that the right wing and the left wing are necessary. Otherwise we would just fly in circles.

NC Medicaid Expansion Blocked! Final Step: Governor’s Signature

Yesterday it became official.

Both North Carolina House and Senate have approved the bill blocking the expansion of Medicaid. Last step: Gov. McCrory’s signature.

The House, the bill passed 74-40.  The Senate voted 31-16 to reject the programs.

Also, in a recent news release, McCrory said the state did not build the systems needed to run its own exchange so it should leave that task to the federal government.