NC Budget and Tax Center, Trump Administration

Trump’s proposed $4.4 billion budget increase for Veterans Affairs is critically needed in North Carolina

President Trump, after slashing the budgets for 15 major agencies (e.g., Agriculture, Labor, Health & Human Services, Commerce, Education, Housing, Transportation, EPA, etc.) and completely eliminating funding for 19 other agencies, has proposed increasing the VA budget by $4.4 billion. In other words, the U.S. Department of Veterans Affairs (VA) is one of the very few agencies in government that could see its budget grow in the 2018 fiscal year – by 6 percent. (Note: Over the past 9 fiscal years under President Obama, the VA’s total budget grew by nearly 86 percent, increasing from $97 billion in 2009 to $182 billion in 2017). 

Given that one of North Carolina’s goals is “to be the most military friendly state in the country,” and that our state is home to nearly 800,000 veterans, 145,000 military defense personnel, and several major military installations, additional funding for the VA to expand health services and modernize its benefit claims system is a good step forward on the significant challenges affecting our state’s veterans and military retirees.

Challenges Affecting North Carolina Veterans

Last year the VA’s Office of the Inspector General (OIG) discovered in North Carolina: Read more

Commentary, NC Budget and Tax Center

Nothing has changed (Part 2): Reported amendment to GOP health care bill guts protections for people with pre-existing conditions

Last week, we reported reviving the GOP health care bill would mean more uninsured, costlier coverage in North Carolina. On Friday unfortunately, Republicans in Congress reportedly reached agreement on an amendment that would eliminate key Affordable Care Act (ACA) protections for people with pre-existing health conditions. Under the amendment, states could end some of these protections at will, and end others provided that they created or participated in a federal high-risk pool. Overall, it is clear the American Health Care Act (AHCA) is not fixable. Most Americans already know that 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.

Below are key points related to this amendment, according to the Center on Budget and Policy Priorities.

The amendment takes us back in time

The reported Meadows-MacArthur amendment to the American Health Care Act (AHCA) would allow states to request waivers of key pre-existing conditions protections. This would effectively restore pre-ACA law with respect to these protections, making an already severely flawed bill even worse. The amendment would allow:

  • Insurers to once again discriminate against people based on their medical history.
  • Women would again be charged more than men for coverage. While proponents claim that the deal preserves the ACA’s ban on gender discrimination, eliminating Essential Health Benefit requirements means that women would have to pay more for plans that included maternity coverage.
  • Plans would likely be able to impose annual and lifetime limits on coverage — including for people who get health coverage through their jobs.

Before the ACA, 105 million people with private health insurance — the large majority of whom had employer plans — had policies that imposed lifetime limits on coverage. Waivers of Essential Health Benefit requirements could mean returning to a time when millions of people with health coverage were one major illness away from medical bankruptcy.

AHCA’s Underlying Flaws Remain

The reported amendment makes no changes to the underlying bill. Under the AHCA:

  • 24 million more people would be uninsured by 2026 — meaning 1 of every 10 non-elderly Americans who have health insurance coverage under current law would lose it under the AHCA. This would eliminate all of the coverage gains made under the ACA.
  • Medicaid would be cut by $839 billion over ten years. The bill would effectively end Medicaid expansion and radically restructure the entire Medicaid program by converting it to a per capita cap or block grant. Under the House bill, 14 million fewer people will be enrolled in Medicaid by 2026.
  • People who currently purchase coverage through the ACA marketplaces would see large increases in their premiums and deductibles, and other out-of-pocket costs. Total out-of-pocket costs (premiums, deductibles, copays, and coinsurance) would increase by an average of $3,600 for current HealthCare.gov marketplace consumers, with larger increases for older and lower-income consumers and consumers in high-cost states.
  • High-income people would receive billions of dollars in tax cuts, averaging over $50,000 per year for people with incomes exceeding $1 million.
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