12-8-10 — FRANKFORT- So you thought we’d get a respite from partisan politics after the Nov. 2 election. Right.
Gov. Steve Beshear and Senate President David Williams, R-Burkesville, who wants Beshear’s job, were in full campaign mode last week, jousting over Medicaid and Passport, the Medicaid managed care partnership which serves clients in 16 counties around Louisville. An audit by state Auditor Crit Luallen found Passport was making a lot of money off the deal with the state when its purpose was to save the state money.
By all accounts, Passport delivers high-quality service to clients, receiving national recognition for those services. It’s not so clear if it does so for a lower cost than traditional fee-for-service. Williams believes managed care saves money, and apparently so does Beshear who plans to seek proposals from others to deliver Medicaid services in other parts of Kentucky. But we don’t really know because, as Luallen pointed out, we don’t have a side-by-side comparison of managed care and fee-for-service for the same population.
But nothing that occurred last week in Frankfort indicates that’s either Williams’ or Beshear’s primary concern. Janie Miller, Beshear’s Secretary of the Cabinet for Health and Family Services, tried to make the case they had restrained increases in the state contract with Passport and got no cooperation from lawmakers. Williams seemed at times actually to defend Passport, but his aim was of course to shift blame to Beshear.
When Beshear, on the day the Medicaid Cost Containment Task Force was scheduled to meet, told Passport’s board either to terminate its entire management team or lose its state contract, worth about $800 million a year, Williams called it a “government takeover.” He suggested when tax dollars pass to Passport, they cease to be tax dollars and contended that the excess reserves, high salaries, conflicts of interest, and excessive spending on travel were “nothing illegal or unethical.” That seems an odd thing for a Republican actively seeking Tea Party support. But Beshear’s timing was politically convenient, too.
Beshear’s position on managed care seems inconsistent as well. During the legislative session, when lawmakers sought information on Passport costs, Beshear and Miller said it doesn’t offer a lower cost alternative. Yet Beshear just announced a plan to seek proposals from vendors, including for-profit vendors, to expand managed care across the state — presumably to save money. The plan involves shifting Medicaid funds budgeted for next year to this and then recouping that money through lower costs when managed care expands beyond the Passport service region. Conveniently, of course, that delays the result and the potential financial reckoning until after next year’s election. House Speaker Greg Stumbo correctly points out that it will be a lot more difficult to monitor and control state payments in excess of costs to for-profit vendors.
The back-and-forth finger-pointing probably represents a preview of the coming General Assembly. It’s a non-budget session, but lawmakers face choices on issues like corrections reform and pensions that have huge budget implications. Unfortunately, those issues are subject to political posturing and there is no reason to believe Williams, Beshear or more than a few rank and file lawmakers are more concerned with Kentucky’s future than their own political prospects.
Williams is not only thinking about Beshear, he’s also looking over his shoulder at Phil Moffett, the Louisville businessman running for the Republican gubernatorial nomination and seeking the support of TEA Party and Rand Paul partisans. Get used to it. The campaign has begun.
Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at firstname.lastname@example.org.