Like most of the governors before him, Steve Beshear views Medicaid as a beast to be tamed rather than a tool to tackle the sorry state of Kentuckians' health.
But Beshear can't outsource responsibility for poor, sick Kentuckians to low-bidding out-of-state companies or the courts, as much as he might wish he could.
The sooner he comes to grips with that, rolls up his sleeves and dives into problem solving, the better for everyone, especially him, since he's relying on substantial Medicaid savings to avoid more cuts to education and other public services.
One of Beshear's problems fell into the lap of U.S. Senior Judge Karl S. Forester, who ordered that documents in a lawsuit filed by Appalachian Regional Healthcare against one of the three Medicaid managed care contractors be sent to Beshear.
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The judge's order loosely translates into, "Psst, guv, pay attention and do your job."
Beshear should pay attention because Kentucky can't make significant economic gains until it deals with the high cost of having so many sick and disabled people. One in three Kentuckians either has no health insurance or is covered by Medicaid, the federal-state program for the poor, disabled and elderly.
The Affordable Care Act gives states more flexibility and funding to innovate and increase access to care and coverage. But aside from a few smart moves, such as increasing drug abuse treatment for low-income parents, Beshear hasn't shown much interest in that, either.
The way to really bend the Medicaid cost curve is to bend the obesity, smoking, teen pregnancy, diabetes, heart disease, cancer, addiction and rotten teeth curves.
We should be hearing about what Medicaid is doing to manage chronic illnesses and promote prevention.
Instead, barely six months in, managed care Medicaid has degenerated into legal skirmishes and sniping over money.
We're in no position to judge the various grievances, but Beshear is. He's also the person who's best able to strongly enforce contract provisions and negotiate new agreements if what's in place is unworkable.
At the very least, he and his administration need to stop acting as if the problems are solely a dispute between Coventry, one of the three contractors, and ARH — especially now that Coventry has announced it's also cutting off King's Daughters Medical Center in Ashland.
Something is seriously wrong when two of the three managed care companies don't have two of the most important providers in Eastern Kentucky in their networks, which will be the case if Coventry follows through with its plans to drop ARH and King's Daughters.
A compromise reached Friday gave 25,000 ARH patients a reprieve until June 30 from having to change doctors or managed care plans.
As welcome as that is, it's a long way from a seamless system of health care.
It's good that House Speaker Greg Stumbo is calling out the managed care companies. Ultimately, though, the responsibility is Beshear's.