The News & Observer began a series this weekend outlining the Medicaid problems facing North Carolina. Two things are clear. The system has had problems for a very long time. And, two, Pat McCrory has made the problems worse, not better.
In the big picture, the series doesn’t offer a lot of new information. But it does offer a clear timeline and puts the whole sordid affair into one good story. It illustrates the details that have caused the slow train wreck we’ve been watching since Aldona Wos took over as Secretary of the Department of Health and Human Services.
We’ve long known that Wos ran off most of the qualified employees. Now, we have the emails to prove it. We’ve also known that Wos paid huge sums to consultants to oversee the reorganization of the department. Now we know that those consultants had little experience in Medicaid administration and that they played a major role in chasing off qualified personnel. We’ve also known that Wos shunned transparency. Now we know that under her leadership, DHHS developed an institutional culture that demanded opacity instead of openness and that they shut out other government officials as well as the press. Finally, we know that nobody will be held accountable for the debacle that Wos has caused. Pat McCrory is standing by his cabinet secretary no matter how bad things get.
One pattern, though, emerges that transcends DHHS. McCrory and his budget director, Art Pope, keep trying gimmicks to patch holes in the budget that the governor and legislature caused. They tried to game the Medicaid system to get federal dollars to both fund the system and get revenue for non-Medicaid related programs.
This same type of scheming led McCrory and Pope to endorse a House budget that relies on exaggerated lottery proceeds to make up some of the revenue shortfall caused by tax cuts for the wealthy and corporations. The lottery commission told the legislative leaders that their predicted revenue was unrealistic. That didn’t stop McCrory, Pope and Speaker Thom Tillis from rolling out the plan.
Like the Medicaid scheme, they know it’s a bogus plan that is unsustainable, but they also know that the cuts that they’ll need to make based on current revenue are politically unacceptable. It’s ironic that Art Pope, the guy who built a career complaining about fiscally irresponsible Democrats, is using fiscal shenanigans to close budget holes. As one guy in the N&O series put it, “This sounds like government by amateurs.”