History will record that Aldona Wos, a Greensboro physician, socialite and Republican fundraiser, was secretary of the N.C. Department of Health and Human Services for two years and seven months. She bade a tearful farewell to the job last week, expressing satisfaction that the "improvement process" she talked about so incessantly—to the point that you'd have thought it was real—was not in vain.
Gov. Pat McCrory, in tears, declared her the best DHHS boss ever.
History will further record that DHHS survived Aldona Wos and again operates much as it did before.
That's not to say that Wos didn't crash around the agency causing mischief. Nor am I forgetting her many missteps, some comical, others quite serious. In fact, I'm reminded how unprepared she was to lead an agency with—then—17,000 employees, a budget (including the federal funds it disburses) of $18 billion and a mission to serve the poor.
Wos didn't seem to know that when you're serving the poor, young politicos who are between Republican campaigns shouldn't be on your payroll at $85,000 and up. That new database technology shouldn't launch before it's ready, because many who depend on government aid will be dropped. That writing memos about how to address yourself in memos will make you a laughingstock.
Worst, Wos didn't know that Medicaid, which serves the very poor and accounts for $13 billion of the $18 billion budget, including about $3.7 billion in state funds, was not "broken," as she'd thought or was told by the equally clueless McCrory. She was a long time learning that lesson—and never got the hang of explaining it.
"The improvement process has at times been truly painful," Wos conceded.
Yes it has.
Wos was a doctor in her native Poland before moving to New York and marrying the very wealthy Louis DeJoy. DeJoy's business brought them to Greensboro, where Wos plunged into Republican fundraising. She was George W. Bush's ambassador to Estonia in 2004–06.
I'm guessing, then, that at one of her glitzy parties for McCrory, they were swapping yarns about health care when the soon-to-be-governor had a thought. "She knows health! She can run DHHS!"
So Wos came to Raleigh, where noblesse oblige prompted her to work for $1 a year. Noblesse oblige also allowed her to lard the agency with consultants (e.g., Joe Hauck, on loan from her husband's business, at $310,000 for 11 months) and lavish raises on favored staff, including a pair of overpaid 24-year olds from the McCrory campaign.
Wos tried to install Dianna Lightfoot, an anti-abortion pal from the Triad, as head of child development, which oversees pre-K school programs. Lightfoot withdrew, however, when her history of nasty tweets and anti-pre-K commentaries surfaced.
More bad news followed when DHHS launched a pair of buggy IT systems, one to dispense food stamps, the other to pay Medicaid providers. For months, the mess-ups angered rich and poor who were due payments but not getting them.
Wos, meanwhile, was logging long hours, but they only seemed to fuel her confusion.
Any DHHS secretary might've stumbled into the same IT mistakes—maybe. But there's no excusing how Wos got the basics so wrong about the state's Medicaid plan.
When Wos arrived, GOP legislators were already two years into Medicaid-bashing, underfunding the program and then complaining when Medicaid "overspent." Remember, Medicaid costs vary according to how many of the eligible poor use covered services; states must pay what they owe, not what they wish they owed.
Senate Republicans, though, were determined to privatize Medicaid, meaning it would be handed to for-profit managed-care companies that would somehow reduce costs and put money in their corporate accounts while not short-changing the poor—or, more likely, while short-changing the poor and failing to save anything, if other states' experience is a guide.
Wos abetted this effort with enthusiasm, welcoming Carol Steckel, fresh from overseeing privatization in Louisiana, as her new head of Medicaid.
Steckel and Wos soon gave misleading information (see here and here) to State Auditor Beth Wood's office, leading to a Wood report blasting Medicaid bloat that was later shown to be entirely off-base. Wos and McCrory seized on Wood's flawed report to charge that Medicaid was, as they'd said, "broken."
The truth? Medicaid here differs from other states by keeping costs below the national average (see here and here) while improving services to the poor through a nonprofit corporation, Community Care of North Carolina, run by the state's health care providers. No shareholders to pay, and more effort put into the prevention and early diagnosis of treatable illnesses.
It took Wos more than a year to catch on, but finally she did, and Steckel left to work for—yes—a for-profit managed-care company. A task force recommended thereafter that we stick with the CCNC model.
McCrory agreed (though he's still AWOL on Medicaid expansion).
Those obstinate Senate Republicans keep insisting, however, that Medicaid is broken and should be privatized—one reason we have no state budget 43 days into the new fiscal year.
Whatever Wos learned, she never conveyed it to them.
This article appeared in print with the headline "Don't cry for me, Aldona."