North Carolina was one of the states that refused to expand Medicaid in order to prepare for the implementation of Obamacare, partly due to claims by Governor Pat McCrory and officials in his administration that Medicaid was "broken." But an investigation by North Carolina Health News, a nonprofit newsroom that covers health care issues, reveals that McCrory's people edited out information from the Department of Health and Human Services' response to an audit that shows the state Medicaid program wasn't "broken" at all.
Documents obtained by North Carolina Health News through a public records request show that in January, incoming Sec. Aldona Wos and Medicaid head Carol Steckel eliminated detailed explanations of alleged high administrative costs, management problems and budget overruns in past years.State auditor Beth Wood finished her audit of DHHS while Bev Perdue was still in office. Wood's audit claimed Medicaid was plagued by budget overruns of $375 million over the last three years, a total that swelled to $1.4 billion when federal matching funds were factored in. When DHHS got the results, its original response claimed that any overruns were due to consumption--a factor that DHHS can't control because Medicaid is an entitlement. They also pointed out that the state budget office had regularly approved of any overruns. However, this was edited out by Steckel. This was one of several edits she made on January 22--roughly a week after McCrory appointed her. Read the track changes version here or here.
The resulting document accepts the criticism in Wood’s assessment wholesale and paints the health care program that covers 1.6 million North Carolinians as “broken.”
The criticisms contained in the audit have yielded talking points used by Wos, Steckel and McCrory for the past eight months as justification for turning down a federal expansion of the program under the Affordable Care Act and proposing to privatize the program.
One of the other changes Steckel made was to take out any attempts to defend or explain DHHS spending, including numerous references to warnings outgoing DHHS secretary Lanier Cansler sent to legislators and budget office officials that budget targets were too low. Perdue backed DHHS up, pointing out the state was squeezed by a growing population and the effects of the economic downturn. She also cut out statements that states can't change Medicaid rules without federal approval--and in the time it takes for approval to come through, the state can spend more than what it wants to spend. In essence, any attempts to explain budgeting procedure, as well as references to how DHHS warned other branches that it needed to spend more were cut out almost willy-nilly by Steckel, who left for a private-sector job in late September.
So here's the obvious question--did McCrory, and/or his staffers, manufacture a crisis that didn't exist? This isn't quite to the point of where you can say "Pat McCrory lied and people may die," but at the very least the governor has some explaining to do.