NC Budget and Tax Center, public health

NC’s and the nation’s uninsured rate has fallen to a historic low under ACA, but you’d never know that listening to Senate leaders

Here’s some important and quick facts that all Americans and North Carolinians should know this week, when the Senate will formally vote in an attempt to repeal the Affordable Care Act:

The United States has made significant progress over the past seven years when it comes to reducing the number of people that are uninsured, according to data from the Centers for Disease Control and Prevention (CDC). In 2016, only 9 percent of America’s population was uninsured, compared to 18.2 percent in 2010. That’s the lowest share since the CDC began tracking this statistic 45 years ago! If you prefer numbers: 28 million people were uninsured last year, compared to over 48 million in 2010. In NC, only 11.4 percent of all North Carolinians were uninsured last year, compared to 21.3 percent in 2010. Take a moment to think about that.

“There has never been a decline this large and over such a short period of time.” –Rachel Garfield, associate director for the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.

The last time the percentage of uninsured in our country was close to the historic low of 9 percent we saw in 2016 was 39 years ago, in 1978. Here are a few things that happened back in 1978 (when the percentage of persons under 65 without health insurance was 12 percent):

    • President Jimmy Carter signed H.R. 1337 into law, which allowed home-brewing of beer in the United States (sparking the craft beer revolution).
    • U.S. Senate proceedings were broadcasted on radio for the first time.
    • Grease, starring John Travolta and Olivia Newton-John, was released.
    • Woody Allen’s Annie Hall won Best Picture.
    • The rainbow flag of the LGBT movement flew for the first time at the San Francisco Gay Freedom Day Parade.
    • Pope John Paul II became the 264th pope.
    • Mavis Hutchinson, a 53-year-old grandmother, became the first woman to run across the U.S.
    • The Dallas Cowboys defeated the Denver Broncos in Super Bowl XII.
    • Pete Rose, the all-time MLB leader in hits, gets his 3,000th major league hit.

Below you can see the official U.S long-term trends in health insurance coverage since 1968:

CDC_US Healthinsurance1968-2015 by LT on Scribd

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center, public health, Trump Administration

Warning: Last-ditch GOP effort offering $200 billion to buy votes won’t fix unfixable Senate health bill

Earlier this week we reported that the Senate GOP health “repeal without replacement” proposal would do great harm to NC, as it would double the number of uninsured in North Carolina.

Unfortunately, the latest is that in a last-ditch effort to save their bill to repeal the Affordable Care Act (ACA), Senate Republican leaders are reportedly offering $200 billion to win the votes of senators from states that expanded Medicaid under the ACA.

Here’s a brief explanation from the Center on Budget and Policy Priorities:

“This new fund would presumably supplement private coverage for those who gained Medicaid coverage under the expansion but would lose it under the Senate bill.  No senator should fall for it. While $200 billion seems like a lot of money, it’s only 17 percent of the bill’s $1.2 trillion in cuts: $756 billion from Medicaid and $427 billion from subsidies to help low- and moderate-income people buy coverage in the individual market.”

Overall, it is clear that this additional money would do nothing to fix the major and fundamental problems that the bill would create:

  • It would do nothing to offset the Medicaid cuts resulting from the per capita cap, which would affect children, seniors, and people with disabilities in all states.  These cuts would shift ever-increasing costs to states, forcing the states to respond by making ever-deepening cuts in eligibility, benefits, and provider payments.
  • It would do nothing to address the bill’s harm to people with private coverage, including the loss of coverage for millions of people (due largely to sharp cuts in marketplace subsidies), increased costs for those who stay covered, and the loss of access to health care for millions with pre-existing conditions.
  • It would do nothing to address the fact that millions of lower-income marketplace consumers in non-expansion states (like North Carolina) would see their deductibles jump many thousands of dollars under the Senate bill.

No one should be fooled:  The reported $200 billion cannot fix this bill, and does not come close to undoing coverage cuts.

Here’s what would really help, as we stated earlier this week:

“Based on the facts, it is clear that NC’s two U.S. senators should support the idea of starting from scratch with a different, bipartisan approach that leaves Medicaid aside and focus on making real improvements to marketplace stability and affordability.”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center, Trump Administration

New battle: GOP now slashing billions from programs that help Americans in order to pay for tax breaks for the wealthy

In Congress, the House Budget Committee is moving forward today with discussing their recently released 2018 budget plan that will set a fiscal framework for budget, tax, and appropriations bills to follow and for years to come.

To unlock Congress’ power to expedite tax overhaul this year, the House GOP fiscal blueprint, titled “Building a Better America”, gives instructions to 11 House committees to achieve at least $203 billion in mandatory cuts. These cuts would mark the largest amount of deficit reduction through the budget process in two decades. If that were not enough, the GOP budget resolution states: “These targets are a floor, not a ceiling, and our Committee expects the authorizing committees will achieve significantly larger budgetary savings.”

The Center on Budget and Policy Priorities explains how the House GOP budget framework affects our country:

“It would cause pain to tens of millions of Americans, especially struggling families and others who have fallen on hard times, and would cut deeply into areas important to future economic growth, from education to basic scientific research.  It would do so while opening the door for tax cuts geared toward those who already are the most well off.

“The budget plan is broadly similar in direction and theme to President Trump’s budget:  cutting trillions of dollars from basic assistance, health programs, and core investments in our economy; promising both big tax cuts and so-called deficit-neutral “tax reform” without providing any specifics for how those tax cuts would be paid for; and relying on rosy economic assumptions to show a balanced budget by 2027 on paper.”

For those interested in knowing which Congressional committees will play a major role in cutting the budget, here’s the breakdown:

“The House Ways and Means Committee, which would do much of the GOP’s tax-writing this year, would be charged with finding the most mandatory savings — at least $52 billion. That could include cuts to programs like the Social Services Block Grant, Temporary Assistance for Needy Families, Supplemental Security Income or Disability Insurance.

“The House Judiciary Committee would be tasked with the second-highest amount of savings, with a total of $45 billion — most of which would likely come from medical malpractice reforms. The Education and Workforce Committee, as well as the Energy and Commerce panel, would each need to produce $20 billion in savings, with another $10 billion from the House Agriculture Committee.”

For those wondering if North Carolina’s congressional delegation has GOP members in some of these committees, the answer is yes: House Ways and Means (George Holding, 2nd District); Education and Workforce (Virginia Foxx, 5th District); Energy and Commerce (Richard Hudson, 8th District); Agriculture (David Rouzer, 7th District).

Stay tuned as we continue to analyze and cover the rapid and fluid news on the federal budget and healthcare front this week.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center, public health

Senate GOP health “repeal without replacement” proposal would do great harm to NC

By now many have heard that the proposed Senate GOP “repeal and replace” health care bill is dead after some Senate Republicans could not support it. However, the bad news is that Senate Majority Leader Mitch McConnell says they will now pursue a vote to repeal without replacement. McConnell announced last night that the vote— which is expected to fail — will occur next week, at President Trump’s request.

What does this mean for North Carolina? If the Senate proceeds to repeal the ACA without a replacement, the number of uninsured North Carolinians would rise (and double) from 1.1 million to 2.1 million in 2019 alone. Furthermore, Federal government investments on North Carolina’s health care would be reduced by $1.6 billion in 2019, and by $59 billion from 2019 to 2028, because the Medicaid expansion, premium tax credits, and cost -sharing assistance would be eliminated.

This type of negative impact on the state’s most vulnerable and on the state’s budget is dangerous considering we recently reported that North Carolina is not on track to achieve its 2020 health objectives, and that the legislature’s Fiscal Research Division has projected state budget shortfalls of $1.2 billion to $1.4 billion in fiscal years 2019-20 to 2021-22.

Based on the facts, it is clear that NC’s two U.S. senators should support the idea of starting from scratch with a different, bipartisan approach that leaves Medicaid aside and focus on making real improvements to marketplace stability and affordability. We now know that it would not be in North Carolina’s best interest to see the GOP health bill, or elements of it, arise down the line and in other forms.

What would “Repeal without Replace” do?

Sen. McConnell now says that he plans to bring to a vote a version of the 2015 Affordable Care Act (ACA) repeal reconciliation bill that President Obama vetoed. Assuming a similar timeline to the 2015 version, that bill would:

  • Completely end expansion as of Jan. 1, 2020. There would be no phase-out and no statutory option for states to keep their expansions, even if they could afford to do so at regular match.
  • Completely eliminate the ACA’s tax credits and cost sharing subsidies – with no replacement – as of Jan. 1, 2020.
  • Immediately repeal the ACA’s high-income and corporate taxes, cutting taxes for households with incomes over $1 million by over $50,000 per year.
  • Immediately repeal the ACA’s individual and employer mandates.

What would the consequences of “Repeal without Replace” be?

The Congressional Budget Office (CBO) analyzed the consequences of this approach in January 2017, and found: Repealing much of the Affordable Care Act (ACA) would cause 32 million people to lose coverage by 2026 and roughly double premiums in the individual insurance market. Specifically, the report showed:

  • Coverage: 18 million people would lose coverage in 2018, 27 million would lose coverage by the early 2020s, and 32 million would lose coverage by 2026.
  • Individual market premiums: Compared to current law, premiums would be 20-25 percent higher in the first year, 50 percent higher by the early 2020s, and would double by 2026.
  • Individual market stability: By the early 2020s, about half of U.S. population would live in areas with no individual market insurers, increasing to 75 percent by 2026. Essentially, the individual market would collapse in most of the country.

According to the Urban Institute:

“The vast majority of those becoming uninsured would be members of working families (82percent), and more than half (56 percent) would be non-Hispanic whites. The vast majority of adults becoming uninsured would lack college degrees (80 percent).”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center, Trump Administration

Oh, those pesky facts: White House wrongfully attacks nonpartisan Congressional Budget Office

Non-partisan government agencies that often go unnoticed but are grounded in upholding principles such as accountability, integrity, and reliability include the U.S Congressional Budget Office (CBO) and the Government Accountability Office (GAO). You might recall that CBO is the office that recently analyzed the President’s proposed budget as well as the Senate’s proposed health care bill and found:

Unfortunately, earlier this week, the White House released a video on Twitter to continue a discouraging and damaging pattern of attacking the CBO. At the state level, this would be equivalent to the Governor attacking the General Assembly’s Fiscal Research Division (FRD) or Program Evaluation Division (PED). It is worth noting that as the party in control of Congress, Republicans were the ones that hand-picked the current CBO director in 2015.

This is what Maya MacGuineas, the President of the nonpartisan Committee for a Responsible Federal Budget had to say in response to this latest attack:

“The CBO is the fiscal scorekeeper of Congress. Its work is solid, nonpartisan and provides a tremendous service in understanding the costs and tradeoffs of thousands of different proposed policies.

Going after the CBO reminds me of those parents on the soccer sidelines screaming at the ref who, while he may not be 100-percent perfect, isn’t rooting for either team. He sure as heck is doing a better job than the screaming parent would be if he or she were calling the game.

It is important to remember that their estimates are just that — estimates. Of course the CBO is not perfect. But importantly, they do their work employing rigorous analysis, excellent oversight and no political agenda. Their output is incredibly important and helpful in guiding the policymaking process.

As former CBO Director Rudy Penner said, ‘A forecast does not have to be perfectly accurate to be useful. If a weather forecaster predicts three inches of rain and only two inches fall, it can be said that it was a terrible forecast in that it was off by one-third. Nevertheless, it was useful to know that a lot of rain was coming.’

Thank goodness the CBO continues to play by the rules, release unbiased estimates and continues to contribute important information to the discussion. It’s not as though they make up economic growth numbers to make the numbers add up. Now that would be something to tweet a snarky video about.”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.