Trying To Get It Right

Dale Folwell is the State Treasurer of North Carolina. He was responsible for getting the state out of debt to the federal government unemployment benefits program (over the objections of many Democrats) and is now working to bring transparency to health benefits for state workers (again over the objections of Democrats and some Republicans).

The Carolina Journal reported on June 17th that Mr. Folwell is actually  making some progress.

The article reports:

With a deadline just 13 days away, Community Care Physician Network, North Carolina’s largest network of independent physician clinics, announced Monday, June 17, it signed on to the State Health Plan’s cost-cutting Clear Pricing Project.

Community Care Physician Network is associated with 2,500 primary care clinicians, pediatricians, family medicine physicians, obstetricians/gynecologists, psychiatrists, psychologists, nurse practitioners, and physician assistants. The group has more than 880 practices statewide. The network treats more than 2.5 million North Carolinians, including 700,000 Medicaid beneficiaries.

“Their physicians are leaders in our state in developing the highly regarded medical home model. They’re known nationwide for high quality care, patient satisfaction and by using their innovative, collaborative approach to drive down costs,” Folwell said in a news release announcing the move.

Folwell says health care costs must be reduced immediately. The State Health Plan is only 3% funded, has $35 billion in unfunded liabilities, and will become insolvent in 2023. The Treasurer’s Office projects taxpayers could save $258 million and plan members $57 million annually under the Clear Pricing Project. The changes take place in 2020. Providers have until June 30 to join the project.

“It made good sense to us,” Conrad Flick, Community Care Physician Network co-president, said of linking with the reconstructed plan. “We’re dedicated to our communities and our patients, and focused on providing them with better and more cost-effective health care.”

The article concludes:

The N.C. Healthcare Association, the lobbying arm of hospitals and large health systems, continues to oppose Folwell’s plan. The group pushed for passage of House Bill 184 to halt the reforms and launch a two-year study instead. The House passed the measure, but it has gotten no traction in the Senate.

Hospitals say the cost-cutting features of Folwell’s plan jeopardize the survival of rural hospitals. Folwell said most rural hospitals will be better off financially under the plan, and nine of 10 primary care physicians will get more money.

Montana is among a handful of states that use the reference-based pricing model for their state health plans. Officials there told Carolina Journalthe results are positive.

Dale Folwell is attempting to bring the same sort of fiscal sanity to healthcare in North Carolina that he brought to unemployment benefits. Let’s hope that he is successful.

Bad Day at Black Rock

Below is a guest post by Raynor James, an eastern North Carolina resident who has followed the debate on North Carolina House Bill 184 very closely:

Tuesday, April 3rd was a sad day in the North Carolina House of Representatives.

Let me tell you about it. Dale Folwell is North Carolina’s Treasurer. He’s a very popular fellow for all the right reasons. He did a good job when he served in the North Carolina General Assembly. He got North Carolina’s unemployment insurance out of debt to the Federal Government when he served in Governor McCrory’s administration, an accomplishment that continues to save North Carolina’s employers significant sums annually. He’s known as a problem solver.

North Carolina’s State Health Plan (which pays for medical expenses of current and retired state employees) is seriously underfunded and is projected to be bankrupt by the year 2023.When Dale Folwell was elected Treasurer, many who voted for him expected him to solve the Plan’s problems as its administration was in the Treasurer’s portfolio.

Enter HB-184 which if implemented will tie the Treasurer’s hands and not allow corrective action to be taken while a committee studies the situation.

HB-184 was debated on the floor of the House April 3rd. Let’s look in on how some conservative House members tried to kill the bill.

First, Representative Michael Speciale offered two amendments to the bill. Representative Speciale’s first amendment would give the Treasurer a vote on the study committee and would make it impossible to expand the size of the committee (something that is sometimes done when the “powers that be”don’t like the direction a committee seems to be taking).

That amendment passed by a vote of 106 to 5.

Representative Speciale’s second amendment would remove Section 2 from the bill. Section 2 requires that Blue Cross-Blue Shield continue to be used during the study period.

It also prevents the Treasurer from switching the Plan to using referenced based pricing for medical services to the Plan during the study period.That amendment failed by a vote of 88 to 23.

During debate on HB-184 itself, Representative Larry Pittman cited a memo from the Plan’s Board of Trustees that projects that the plan will be out of money in 2023, and said that we can’t wait on a two year study. He talked about how hospital groups were groaning about how burdensome the Treasurer’s planed payment changes would be on them [tie pricing of medical services to 172% of the average Medicare pays for the same service], and pointed out how well funded many hospitals are. In support of his assertion, Representative Pittman mentioned that the hospital at East Carolina has given $10 million dollars to fund a stadium.

Representative Pittman asked that members not pass the bill and added that when Treasurer Folwell had requested info from the hospital groups, they had sent him the schedules he asked for with page after page blacked out. “They might as well have slapped him in the face and spit on him,” Representative Pittman said.

He continued by saying passage of the bill would hurt both members of the Plan and taxpayers who pay the freight and pointed out that members of the Plan are also taxpayers, so they get hit two ways.

He stated that Dale Folwell is “competent” and “honest” and renewed his request by saying, “Defeat this bill.” Representative Michael Speciale said, “We’re told that if we don’t pass this bill, the sky will fall; we’ll lose our rural hospitals.” He went on to say that they’d heard the same thing when he was trying to get rid of the CON [Certificate of Need] laws [which did not pass] and shortly thereafter they closed one of the hospitals in my district.”

“I hear fake news ads” [on the topic of rural hospitals closing if HB-184 doesn’t pass] when I drive in my district.”

Representative Speciale went on to say that Dale Folwell got the people together who are opposing him [mainly large hospital groups] and asked how much waste, fraud, and abuse there is in the system. The answers they give him ran from 12% to 25%, so he took a middle number and asked them to figure out how they could reduce costs by 15% and said that they needed to get together again as soon as that was done.

After that meeting, Treasurer Folwell tried to set follow up meetings, and time after time he was stonewalled.

Representative Speciale continued, “Now we’re faced with $33 to $36 billion dollars in unfunded liabilities. If we don’t allow him to cut costs, how are we going to cut costs because it’ll be on us!”

“Dale Folwell has increased what would be going into rural hospitals. He’s compromised, but they won’t budge an inch.If we do not pass this bill, then the hospital lobby will sit down and talk to him. Let the state Treasurer do what he was elected to do. Throw the politics aside and vote NO!

Representative Keith Kidwell said, “For the last 10 years, health care costs have gone up and up. We asked Treasurer Folwell to handle it. Let’s not bobble him,or we’ll be faced with taking $235 million to $509 million [dollars] from the general fund to deal with the problem AND $1.1 billion will be added to the unfunded liability.”

“HB-184 will cost us a ton of money!” “Cut through partisanship and look at the numbers! We HAVE to block this bill!’

In spite of those eloquent pleas and others, too, HB-184 passed 75 to 36, and it will now be sent to the North Carolina Senate where it is hoped that wiser voices will prevail.

If you’d like to hear the whole debate, you can go to the NC General Assembly website at which NC House sessions are archived.

Thank you, Raynor. This is a picture of what is going on in the North Carolina state legislature. President Eisenhower warned about the military-industrial complex. What we see here is the result of intense lobbying by the healthcare-industrial complex. We need to stop this bill.

The Next Financial Collapse The Taxpayers Will Be Asked To Bail Out

On January 17, 1962, President John F. Kennedy signed Executive Order 10988. This order allowed federal employees to form unions. Eventually bureaucrats at all levels of government formed unions. So what was the result of this? The eventual result is large amounts of unfunded liabilities in terms of generous retirement benefits and medical benefits for retirees. These are listed as unfunded liabilities because the actual cost of the benefits negotiated did not show up in the annual budgets of the towns and cities that were approved by the states. This is the perfect negotiating tool–unions make large donations to candidates. These unions then negotiate for retirement benefits for union members. Those doing the negotiations want to stay on the good side of the unions in order to continue to receive campaign contributions.

The Daily Signal posted an article today showing the per capita amount of these unfunded liabilities in every state.

Here is the chart and the list:

The article reports:

Contractual or constitutional obligations for government pensions could mean that paying the pensions of retired government employees may take precedent over paychecks for current employees.

Moreover, some state constitutions prevent any changes to government employees’ pension benefits. That means current government employees can’t ever be required to contribute more to their pension plan than they did on the first day they were hired. And, actually, not a single term of their initially promised pension benefits ever may be altered.

Just imagine how detrimental it would be to private employers if they never were allowed to alter the benefits they initially offered their employees.

With an average funding ratio of only 33.7 percent across state and local pensions and every single state at risk of defaulting on pension obligations (as measured by Pension Protection Act standards, assuming a risk-free rate of return), taxpayers across all states face significant tax increases to pay for their governments’ unfunded pension promises.

As the federal government attempts to cut the amount of taxes each American pays, the states may be forced to raise their taxes to cover their unfunded liabilities. States and municipalities need to fund their pension programs as the money is needed and encourage employee participation–past practices need to change.