I thought politics worked like this: We elect people, they pass laws, things happen.
I learned back when Reagan was President a lot less might happen than hoped for – because the entire American political system is built to prevent anyone getting enough power to ever say, Here’s what we’re going to do – and doing it.
But studying how health care works in North Carolina government, the legislature and the private sector has added a whole new dimension to my perspective.
It turns out the legislature passes laws – but what happens when the state goes to implementing them can be something entirely different.
If anyone breathed a sigh of relief the day the legislature left town it was elderly Medicaid patients – for the old and infirm it was a trying eight months while the General Assembly was in Raleigh.
Right out of the hat Senator Doug Berger introduced a bill to cut home care for 20,000 Medicaid patients. The bill passed the Senate as part of the budget and went over to the House – where patients got a worse shock.
DHHS Secretary Lanier Cansler asked the House to add a new law to the budget to make it harder for every Medicaid patient to receive home care.
Cansler’s new law worked like this: If an elderly patient has just two handicaps he (or she) would lose their home care. They wouldn’t qualify any longer for care. In other words, if an eighty-year old woman was receiving care because she had had difficulty eating alone and had incontinence – she’d lose her care. Unless she had a third handicap. Like trouble bathing alone.
Cansler’s law would have cut more patients’ care than Berger’s bill.
But, then, something happened Secretary Cansler and his Department hadn’t counted on.
President Obama’s Administration told DHHS changing the eligibility requirements for home care – which is exactly what Cansler was doing – to cut 20,000 patients’ care could cost the state $2 billion in ‘Stimulus Money’.
Cash from Washington speaks louder than words – so legislators took Cansler’s provision out of the budget. Then they trimmed back Berger’s cuts. And added a provision to the budget that said no one anywhere in state government was to do anything that could cost the state ‘Stimulus Money.’ Then they adjourned.
That left DHHS in a quandary.
To ‘balance the budget’ the legislature had cut home care for 15,000 patients. But they hadn’t changed the eligibility requirements. So, legally, every one of the patients was still eligible for care. Plus the Obama Administration was telling DHHS not to change the eligibility requirements. Plus the legislature was telling DHHS not to even try because it could cost the state ‘Stimulus Money.’
So DHHS had to figure out how to cut 15,000 patients care – with no legal way to do it.
In effect legislators had plugged a number - $45 million – into the budget, said, There, it’s balanced, and adjourned. But it wasn’t really balanced. Because DHHS had no way to make the cuts.
So, now, the Grand Viziers at DHHS are trying to figure out how to cut the home care of 15,000 patients who’re legally eligible – which, of course, can’t be done without an end run around the law. And the Obama administration.
On top of that, to add the ludicrous to the preposterous, to pass his bill Senator Berger told legislators it would save taxpayers millions – but, in fact, his bill’s almost bound to backfire and cost money. When an elderly patient can’t get the care she needs to stay at home that only leaves her one choice: To go into a Nursing Home for care. Nursing Homes cost a lot more than home care. A recent study [link] says $44,000 a year more. And Berger’s final bill cut 15,000 patients.
So we’ve got the legislature passing a budget that’s not balanced; DHHS trying to figure out how to cut patients who’re legally eligible for care – and if it succeeds taxpayers lose money.
Whoever said politics makes sense.