Editorial: Health care exec's fiery tone spotlights legit frustration

CBC Editorial: Monday, July 15, 2019; Editorial #8444
The following is the opinion of Capitol Broadcasting Company.

It would be easy to dismiss the intemperate letter from a Greensboro-based Cone Health official to State Treasurer Dale Folwell and members of the State Health Plan Trustees as just a hot-head popping off.

But it is more than that. Why would someone with the stature of Frank Kauder, assistant director of finance for Cone Health, write such a letter – inappropriate as it was?

It was exasperation and immense frustration. He is not alone. His vexation is shared by both the health care community and North Carolina citizens. They see an attack on the state’s health care system that will tear it down, not improve quality, expand access to services or make them more affordable.

He worries that the financial future of Cone healthcare -- and therefore its ability to serve the needs of its community -- is being jeopardized.

With practically no serious discussion with health care providers or consumers, Folwell and the legislative leaders are acting arbitrarily to impose their will. It is a remarkable list of policies and administrative actions they have imposed that are creating uncertainty and chaos.

Just for example:

• Without question, the refusal to expand Medicaid is the most dismal legislative decision of the century. It is unfathomable, both from a moral obligation to care for the sick as well as financially irresponsible --- regardless of the tortured logic coming from Sen. Phil Berger and House Speaker Tim Moore. There is NO LOGIC and it simply DOES NOT COMPUTE to say you are working to lower health care costs and at the same time not expand Medicaid. Their rigid refusal has cost many lives, jobs, and dollars.
• Hundreds of thousands of hard-working citizens in the state cannot access health care services only because the legislature won’t support federally funded Medicaid expansion.
• Billions of tax dollars – including those paid by North Carolinians -- are going to other states for their Medicaid expansion. Ninety percent of the cost for North Carolina’s expansion will be paid by the federal government. The state has to come up with the other 10 percent. So sure of the need for Medicaid expansion, and so desperate for help are the state’s hospitals that they have offered to pay the 10 percent for the state. Still Berger and Moore are immobile. Remarkable!
• Health care organizations are wrestling with the legislatively mandated transition of the state’s Medicaid and N.C. Health Choice programs to Medicaid Managed Care. The notion is to provide “cost certainty” for the state by turning Medicaid management over to for-profit organizations and changing from a fee for service to a capitation or flat-fee plan. The concern is about execution. The budget legislators passed – and has been vetoed by Gov. Roy Cooper – would impose dramatic cuts to the state Department of Health and Human Services which is responsible for administering the transition. One sure way to wreck this complicated change is failure to provide the necessary funding for the transition.
• Health care executives are wrestling with a dictatorially imposed payment schedule for the State Health Plan that serves more than 700,000 state workers, public school educators and government retirees. The deadline has passed and just three small providers have signed onto the plan. What kind of coverage will these workers and retirees have come January 2020? Will most of the providers be out-of-network? The uncertainty is unnecessary and needs to be resolved.
• The ill-conceived efforts to abolish the state’s “certificate of need” system. There are some services that hospitals can provide at a profit. Because hospitals are required BY LAW to provide services to ALL, including those who cannot pay, and also have the need to continuously invest in new equipment and facilities, that profit is crucial to economic stability in the system. Certificate of Need is in place to prevent cherry-picking of profitable service lines.

We will not go into the situation in Greenville where the legislature at first threatened to cut $35 million in Medicaid funding to Vidant Health System and then made funding for a new Brody Medical School building contingent on a legislatively mandated resolution of a governance dispute.

Frank Kauder may have picked the wrong words and used an improper tone. But make no mistake, he was not alone in highlighting frustrations and disagreement that many, many North Carolinians – from board rooms to kitchen tables – share about the legislative leadership and state treasurer’s hectic, ideological force-fed policy making.

2020 can’t come soon enough.

Capitol Broadcasting Co. CEO Jim Goodmon served as a director of the Duke University Health System. He is now a director emeritus.