How NC’s broken politics made a disaster of Medicaid again

By: - November 20, 2019 5:30 am

Tuesday’s inevitable announcement of a delay in North Carolina’s Medicaid transformation is an unqualified disaster.

We will labor over who to blame. Republicans will castigate Democratic Gov. Roy Cooper, who vetoed the “mini-budget” funding transformation in August. 

And Cooper will lambast the Republican state legislature, because of its dogmatic and, frankly, dimwitted refusal to accept a mostly federally-funded expansion of the government healthcare program, which should not be confused with Medicaid transformation.

Secretary of Health and Human Services Mandy Cohen, a Cooper appointee, acknowledged the drawbacks of indefinitely postponing the transformation to a managed care system, in which the state pays per-person costs rather than the current fee-for-service model. 

If the delay impacts patients is unclear. It certainly affects patients far less than the legislature’s refusal to expand Medicaid. 

But it will, without question, derail the state’s ability to complete a long-expected overhaul by its targeted Feb. 1 start date. 

Megan Thorpe, a spokeswoman for Cooper, called it the result of an “irresponsible” state legislature, which adjourned last week without plans to return until January.

“By choosing gridlock instead of negotiating a compromise, they delayed Medicaid transformation and broke their promise to vote on expansion, leaving 500,000 North Carolinians without affordable, quality healthcare,” Thorpe said.

Sen Joyce Krawiec, the Republican who chairs the Senate Health Care Committee, called the development a “crisis of Governor Cooper’s own making.” 

Of course, I’d wager no one is inclined to stomach Republicans’ posturing, or their impersonation of empathy, when it concerns Medicaid. With all due respect Sen. Krawiec, it is too late to feign compassion for the poor.

Since 2013, Republican lawmakers have blockaded expansion of Medicaid to a half-million low-income North Carolinians because government aid — when it is the brainchild of progressives — is as anathema to this party today as it has ever been.   

However blame is split, Tuesday’s announcement of the delay in Medicaid transformation is more evidence of a perilous dysfunction in North Carolina government, of an intractability in partisan politics as dangerous to government efficacy as it is corrosive to public confidence in government. 

Republicans do not trust their counterparts in the Democratic Party. And Democrats, long diminished by a dominant Republican Party, have been scorched by the majority party’s leadership too many times to count, a point driven home by Cooper Tuesday.

“I think you can look at the history of what’s happened in the legislature to see who you can trust or not,” the governor told WRAL.

Indeed, you would hardly have to tax yourself to recall the House GOP leadership’s torching of legislative norms in September, when they held a surprise vote to override Cooper’s veto of the overall budget bill with the lion’s share of Democrats absent, allegedly because they were assured by Republicans there would be no vote.

The GOP would rather commit robbery than contemplate compromise.

You need look no further than the budget to comprehend their rejection of any compromise, all compromise, to advance their vision, more fodder for understanding how we could possibly find ourselves in this position on Medicaid transformation.

Most people do not act this way, because it is inconceivable, because it is unthinkable that we would teach our children to comport themselves in such a manner. But partisan politicians, to be sure, are not most people.    

We can do better in North Carolina. We must do better, because what we need more than Medicaid transformation is a transformation of our broken political discourse.

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Billy Ball

Billy Ball, worked at NC Policy Watch from 2016 to 2020 — first as an education reporter and later as managing editor.