NC Medicaid reform: ACOs dead this year

North Carolina’s Medicaid reform proposal in which Accountable Care Organizations (ACOs) would bear some financial risk for assigned Medicaid populations will not be adopted by the Legislature this year.

Just now in the News and Observer:

Rep. Nelson Dollar, a member of an advisory committee on Medicaid changes, liked the idea of creating Accountable Care Organizations a whole lot more than his Senate counterpart, Louis Pate, did. Pate has said the plan that the state Department of Health and Human Services rolled out in February didn’t go far enough.

Gov. Pat McCrory’s administration wants to change the way the state handles Medicaid by making the budget more predictable and filling gaps in care. DHHS worked on the plan for about a year.

Though he likes the basics, Dollar says not to expect legislation this year that would allow ACOs to be in place by July 2015, as DHHS had posited.

“A direction has been set, there are many more details to be worked out,” Dollar, the chief House budget writer, said this week. “We have made great progress on Medicaid reform. We want to make sure in North Carolina we get it done right and that we have an efficient and effective system serving our citizens for many years to come. It’s far more important that we make sure we get all the detail work right as opposed to setting artificial deadlines.”

In recent years, the legislature has had to scramble to fill Medicaid budget holes. DHHS Secretary Aldona Wos promised the department would do better than it had under previous administrations, (”Cost overruns will not be tolerated and will not be acceptable,” she said at a news conference last year. “There’s a budget for a reason.”) But lawmakers heard last month that there’s another Medicaid shortfall projected at $68 million to $131 million. Legislators who keep an eagle-eye on the Medicaid budget, members of the Joint Legislative Oversight Committee on Health and Human Services, meet again Thursday. 

McCrory joins JLF, lawmakers, national business and legislative groups for Tax Day news conference

Tax Day marked the occasion for a news conference touting the long-term benefits of North Carolina’s 2013 state tax reform package.

Gov. Pat McCrory joined Sen. Bill Rabon, R-Brunswick; Rep. David Lewis, R-Harnett; John Hood, president of the John Locke Foundation; Jonathan Williams, director of the American Legislative Exchange Council’s Tax and Fiscal Policy Task Force; and Gregg Thompson, state director of the National Federation of Independent Business, for the event.

Click play below to watch the 20-minute briefing.

The New ICD-10: Code Overkill?

For those that think Obamacare is a fist-clenching, jaw-tightening, eye-rolling daily dosage of headline news, an even bigger non-Obamacare headache has yet to fall in the hands of medical providers.

Physicians are in for a real treat come October 2015, as they will be required to comply with an upgraded coding system – formally known as the International Classification of Diseases (ICD) – used for patient diagnoses and inpatient procedures.

For roughly 30 years, third-party payers have used the 9th edition of this coding system (ICD-9) to communicate with and reimburse medical providers.  The 10th edition has been established by the World Health Organization for almost a decade and still awaits full implementation in the U.S..  The Obama administration fully supports this massive transition, claiming that the new coding system will be more sophisticated and efficient for the medical community.

Under ICD-10, the number of codes will exponentially increase from 17,000 to 155,000.  Wow.

Now, some new codes certainly are necessary due to medical innovation and new diagnoses.  But after reading Stephen Hayes’s article on the matter in The Weekly Standard, some are just plain hilarious.

Check out the full article here.

Cliches of Progressivism

Max Borders begins the (potentially endless) series of articles on the cliches of progressivism with this one, on the supposed need for the state to solve the problem of inequality.

It takes a high level of education to train yourself to miss the screamingly obvious

You might be a ‘progressive’ if … you think the only thing worse than a poor neighborhood losing a grocery store would be a poor neighborhood gaining a Wal-Mart, a Family Dollar, or a select few other stores that excel at providing goods to the poor (they’re on the list alongside Enemy Restaurants). — Yours truly, 1/19/13

A journalism student at UNC-Chapel Hill wrote a column in The News & Observer this weekend to describe his mixed feelings over the closing of a Roses store in Chapel Hill. How the student arrived at his position — that, his fond childhood memories of the store and how his family relied upon the low-price retailer aside, the loss of Roses is a good thing, but good luck explaining that to the poor who don’t realize they’re being exploited by cartoon supervillain Art Pope — can only be seen as a triumph of the strictly orthodox, anti-free-inquiry model currently employed in American academe.

A sampling:

Roses sells almost anything you can think of, and it sells it cheap. Fruit of the Loom is about as close as it got to carrying anything like a “brand-name,” but that was the point. We’d go there to pick up a $10 lamp or a small toy if I were on the way to a friend’s birthday party. It’s where I went to get my parents their birthday and Christmas presents when I was buying them out of pocket money. And whenever I asked my mom to buy me something – a new pair of pants or a soccer ball, for instance – her reply was always the same: “Can’t we just get that at Roses?” …

Roses is the only store of its kind within walking distance of the neighborhoods that surround University Mall. Many of these are among the poorest in Chapel Hill. … Were they being exploited? Absolutely. But that doesn’t make things any easier for them in the short run now that Roses is leaving.

Gosh, it almost sounds as if Roses helps poor people by providing low-costs goods that others can’t or won’t, without even requiring them to travel very far. One might think that would enable poor patrons to have more money left over to buy other needs for their families, expanding the purchasing power of their relatively fewer dollars.

You might even think this is a good thing, if you go for the notion that it’s good to help the poor help themselves, that it’s good to be a job creator that employs the poor, that it’s good to “give back to the community” when you’re a successful entrepreneur, which an entrepreneur can do only after being successful (i.e., providing services people want at prices they’re willing to pay).

All that could tempt a journalism student into some rather heterodox thinking on campus as well as in life. Fortunately, this temptation is quashed:

My sorrow is complicated by the fact that Roses is owned by Art Pope, a man whose politics I vehemently oppose.  … As I reached the age of political awareness, I realized that Art Pope was essentially using his customers’ money against them. And because of their limited mobility and the lack of other nearby options, there wasn’t much they could do about it.

So here is the situation:

Assume there are poor people who have “limited mobility” and a “lack of nearby options” who somehow need food, clothing, and groceries just like “privileged” people.

Assume you are an evil capitalist maniacally bent on exploiting them.

How would you, evil capitalist, exploit these poor people?

  1. Ignore them because the poor don’t have much money. They can rot in the streets for all I care.
  2. Treat them like a captive market — if they want something, they can figure out how to come to my store in my wealthy part of town, and pay my high prices. Since they have no place else to go, they’ll have to, muahahaha!
  3. Treat them like consumers and cater to their needs, offering them low-priced goods and placing the store near them, saving them time and money on transportation, too. It’s a low profit margin, and it keeps out the privileged people who like to use “the poor” as political bludgeons but don’t want to be that close to actual poor people; however, no one else is offering this combination, so it just might be a working business model.
  4. C, because that’s what Art Pope does, and by definition what Art Pope does is evil

The student goes on to make an oblique comparison to “vestiges of Jim Crow” (in college, of course, this is a guaranteed-A-paper tactic). It also includes these two sentences that the editor should have struck, if not to save face for the writer, then at least for the paper:

  • “I believe systems of commerce need to prohibit the creation of an underclass that at once produces and consumes low-cost goods for the benefit of the upperclass.”
  • “The big picture tells us that Roses is an exploitative institution that ultimately perpetuates the poverty of its customers.”

Academe is not all lost yet, however. Duke’s Michael Munger wrote a letter in response, which was published today. I can’t improve upon it, so here it is.

Munger’s main points are these:

  • “Some folks are so ignorant of markets that they think selling quality products at low prices in convenient stores such as Roses is ‘exploitative.’”
  • Having this ignorance in print “makes for a useful reading for my economics classes.”
  • The student is getting his ideas from “UNC, [which] is protected from any kind of competition and takes its budget from public taxes.” He pays just “a fraction of the cost of mislearning economics; he is essentially using taxpayers’ money against them. And because the state uses taxes to subsidize leftist think tanks like the journalism school, there isn’t much those of us who care about education can do about it.”

Dispatches from the campaign trail, April 15, 2014


• Hope you’ve filed your taxes …

• House Speaker Thom Tillis, R-Mecklenburg, has rejected WRAL’s invitation to join an April 23 debate with fellow Republican U.S. Senate hopefuls Dr. Greg Brannon of Cary, nurse Heather Grant of Wilkesboro, and the Rev. Mark Harris of Charlotte. The Tillis team made it official Monday, citing a prior engagement.

• WWAY-TV in Wilmington posts video interviews with the three Republicans and two Democrats seeking the 7th Congressional District seat being vacated by retiring Rep. Mike McIntyre, a Democrat.

• The Democratic primary in the 12th Congressional District got a little less crowded at James “Smuggie” Mitchell dropped out of the contest to succeed former Rep. Mel Watt, who resigned to run a federal housing agency. Mitchell, who was passed over last week by the Charlotte City Council when it chose state Sen. Dan Clodfelter as mayor, cited poor fundraising. The race still features seven Democrats and two Republicans.

• Cue Warren Zevon (“I’d like to meet his tailor”): Rockingham County District Attorney Phil Berger Jr., who’s considered the most likely candidate to win the Republican primary in the 6th Congressional District, tells the News & Record he’s begin fitted for a madras jacket, honoring retiring Rep. Howard Coble. Coble’s sartorial splendor drew the notice of D.C. gossip site Buzzfeed.

Academic research backs fiscal conservatives’ approach to boosting economic growth

Scouring 681 peer-reviewed academic journal articles published since 1990, John Hood reaches a clear conclusion: The research supports fiscal conservatives’ preferred state and local policies for boosting economic growth.

Hood offers details in a new report. You’ll learn details here and by watching the video clip below. Hood will also discuss his research, especially the implications for state tax policy, during a 2 p.m. news conference in Raleigh.

N.C. Appeals Court sides with former police chief in Taylortown dispute

A unanimous three-judge panel of the N.C. Court of Appeals ruled this morning against Taylortown in the lawsuit pitting the town against former police chief Timothy Blakely. Appellate judges upheld most of a lower-court ruling favoring Blakely. The only part of the appellate decision that favors the town is a ruling that a judgment of more than $100,000 for Blakely should be reduced by about $5,800.