NC Budget and Tax Center, Trump Administration

Nothing has changed: Reviving GOP health care bill would mean more uninsured, costlier coverage in North Carolina

President Trump earlier this week stated that he still wants to reform healthcare in America, even though Congress – with its Republican majority – failed to repeal and replace the Affordable Care Act (ACA) last month. According to Trump, he wants to finish healthcare reform before shifting to tax reform and working on infrastructure.

However, this approach is not feasible as the House Republican health care bill – the American Health Care Act (AHCA) – is not fixable. Almost every piece of the bill would cause people to lose coverage, make coverage less affordable or less comprehensive, or cut taxes for high-income people. The fact that the Congressional Budget Office (CBO) estimated the AHCA would cause 24 million people to lose coverage by 2026 says a lot. House Republicans are reportedly considering making the bill worse by rolling back additional ACA rules that currently protect 134 million people with pre-existing conditions and require plans to offer comprehensive coverage.

The proposed health care bill would mean more uninsured and costlier coverage in North Carolina. According to a recent report by the Center on Budget and Policy Priorities:

  • The Proposed Plan Would Shift $6 Billion in Medicaid Costs to North Carolina — And Result in Thousands Losing Coverage and Access to Services

North Carolina would have to raise taxes or cut other parts of its budget by $6 billion over ten years to maintain North Carolina Medicaid under the House Republican health plan.

  • The Plan Would Raise Costs for North Carolinians Buying Marketplace Coverage by $7,549, on Average

North Carolinians, especially older residents, would pay far more under the House bill. The bill would raise total out-of-pocket health costs – premiums, deductibles, copays, and coinsurance – by an average of $7,549 per year for people with coverage in North Carolina’s health insurance marketplace. County-by-county data showing how North Carolinians would face higher premiums and lower tax credits can be found here.

  • Wealthiest North Carolinians Would Get Windfall Tax Cuts While Medicaid Is Cut and Medicare Is Put at Risk 

The House bill would spend more than $600 billion on tax cuts largely for high-income households and drug companies, insurance companies, and other large corporations. In particular, it would repeal the ACA’s two Medicare taxes, which only affect people with incomes above $200,000 ($250,000 for married filers).

Overall, the House proposal is fundamentally flawed because it shifts costs to low- and moderate-income consumers and the states while giving massive tax cuts to people at the top. Removing key consumer protections would only make a bad bill even worse for North Carolinians.

NC Budget and Tax Center

Medicaid expansion has allowed millions with substance use disorders to get health coverage, access treatment

Substance Use Disorders (SUDs) have become a serious challenge in America. Abuse of prescription painkillers now ranks second as the nation’s most widespread illegal drug problem, according to the NC Department of Health and Human Services.

Today, the Center on Budget and Policy Priorities (CBPP), released a report concluding that the Affordable Care Act (ACA) expansion of Medicaid to low-income adults has allowed millions of people with SUDs to get health coverage and access to SUD treatment services. This same conclusion was reached by the U.S. Surgeon General last year when it released its comprehensive report ‘Facing Addiction in America’.

Opioids—prescription and illicit—are the main driver of drug overdose deaths. In the U.S., opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999. A significant increase in drug overdose death rates from 2014 to 2015 was primarily seen in the Northeast and South. North Carolina was one of the states in which drug overdose death rates had a statistically significant increase (14.5 percent) between 2014 and 2015. Read more

NC Budget and Tax Center, Trump Administration

Trump’s $2.5 billion budget cut to EPA would hurt N.C. as funding is dropped to its lowest in 40 years

The environment affects us all. The same can be said of government budgets. Unfortunately, President Trump’s proposed budget would hurt all North Carolinians if the federal Environment Protection Agency (EPA) budget is cut by $2.5 billion, or 31 percent—the biggest cut of any federal agency. Adjusted for inflation, Trump’s proposed budget would cut EPA’s overall funding to its lowest level in 40 years.

Under Trump’s proposed budget, North Carolina could lose between $10 and $50 million in federal assistance in the 2018 fiscal year. This would be a significant loss considering federal funds make up half of North Carolina’s Department of Environmental Quality (DEQ) budget. Of the $228 million base budget for DEQ in the 2017-18 fiscal year, federal funds cover $118 million.

On March 21, EPA’s Acting Chief Financial Officer issued a confidential and detailed 64 page plan communicating the final EPA funding levels the president would submit to Congress. It points out that EPA’s budget would be cut by 31 percent compared to last year, would lay off over 4,100 EPA employees, and would completely scrap over 55 programs. Some of the major eliminated programs focus on Safe Drinking Water, Sustainable and Healthy Communities, Air-Climate-Energy, Human Health Risk Assessment, Waste Management, Vehicle & Fuel Standards, Civil enforcement, Compliance, Audits & Investigations.

Read more

NC Budget and Tax Center, Trump Administration

Trump’s budget proposes elimination of funding to fight poverty in North Carolina

There are many ways in which President Trump has signaled his lack of commitment to strengthening and growing the middle class in this country, but his budget is perhaps the clearest signal that his priorities focus on the privileged few rather than the many. The results, if his budget is to move forward, are harmful to us all.

Among the programs that are identified for outright elimination in Trump’s budget blueprint is the Community Services Block Grant (CSBG). This $714 million program, run through the U.S. Department of Health and Human Services, supports organizations across the country working in poor communities to connect families to services and jobs and, in so doing, strengthen communities.

North Carolina allocates $20 million each year to 35 organizations, primarily Community Action Agencies, operating from Union to Nash and Edgecombe counties with the dollars it receives through the CSBG program.  These organizations deliver locally tailored services to families living in poverty—from case management to job referrals and training to food assistance—and build collaborations with faith-based organizations and private sector efforts to stabilize neighborhoods, as well as strengthen community engagement to promote economic security and inclusion. The vast majority of funds in North Carolina are spent on self-sufficiency programming, education and employment activities.

CSBG funding in North Carolina served 120,000 people in 2016. Nearly 40 percent of those receiving services had earnings from work, often also supplemented by other assistance to make ends meet. Ninety-nine percent had low incomes—below $46,000 or so annually for a family of four.

These institutions in North Carolina, and across the country, are also often a key infrastructure for responding to natural disasters. They communicate the emergency resources available to affected families, coordinate services in communities and fund immediate relief and long-term rebuilding activities.

In the work to strengthen the state’s economy, a retreat by the federal government from its commitment to fund anti-poverty and community building programs will need to be met by North Carolina policymakers. Absent these dollars, North Carolina risks the loss of another important infrastructure statewide that connects more people and places to opportunity.

NC Budget and Tax Center

Analysis: Trump’s ‘skinny’ budget omits 85% of details that previous administrations have included

Government budgets affect us all, whether it is the federal budget proposed by the president, a state budget agreed to between governor and legislators, or the local city budget passed by city council. All of these budgets matter, as they are all interconnected and the vehicle through which lawmakers support thriving communities. Society as a whole benefits when budgets are adequate to address needs, as well as strategic, debated, and transparent.

As previously reported, President Trump’s proposed skinny budget lacks vision as it makes no attempt to balance the allocation of money against the needs and priorities of our country. Today, however, we focus on the fact that regardless of whether people agree with the President’s policies, his released skinny budget fails the country as it does not to contain valuable information when compared to the skinny budgets of previous administrations, both Republican and Democratic.

Trump’s skinny budget contains substantially less detail than skinny budgets of the past five administrations, going back to Ronald Reagan. The Center on Budget and Policy Priorities (CBPP) conducted an analysis of President Trump’s skinny budget and found it did not provide any details for six out of the seven assessed budget areas (see chart below). The budget areas with no details were: grand totals for budget, spending levels, proposed policy changes, revenue proposals, entitlement proposals, and economic assumptions.

In other words, Trump’s skinny budget omitted 85 percent of the budget details that previous administrations have included. Analysis also shows that, while previous administrations have provided details over multiple years (the two most recent administrations — Bush and Obama — covered 10 years), Trump provides figures for only one year.

Government officials and policymakers should know that this is lack of information and transparency is not acceptable. People expect, as they rightly should, that government operations and reporting be effective and efficient. President Trump needs to learn that politics should not interfere with good government management practices in the budget process.