NC Budget and Tax Center, public health

Analysis: 5 reasons a Medicaid work requirement would hurt North Carolina’s struggling families

Lawmakers in Congress and in North Carolina’s General Assembly are considering “work requirements” in Medicaid as part of an overall health care reform package. However, evidence shows that denying medical care to sick, poor people because they lack a job is not a good idea.

Here in North Carolina too many families across the state are one bad accident, lay-off, or catastrophe away from the brink. Regardless of politics, we all share in the responsibility to ensure that when our most vulnerable do hit hard times, they do not go without the basics – housing, food, and medical care.

The NC Budget & Tax Center has released a Brief that lists 5 reasons why a Medicaid work requirement is not a good policy idea in North Carolina. Here’s a quick summary (bonus: the conclusion at the bottom points out what we really need in NC):

 1) Medicaid beneficiaries want to work but can’t find jobs for reasons that work requirements don’t solve.

In North Carolina, nearly 8 in 10 Medicaid adults live in a family with at least one worker. Most people on Medicaid who can work do so, and for people who face major obstacles to employment, work requirements won’t help to overcome them. Such barriers to work include having an illness or disability that prevents them from working (35 percent), lacking child care assistance or are taking care of family (28 percent), participating in school (18 percent).

Furthermore, in 88 of the state’s 100 counties, there are more unemployed workers than there are job openings. This is a major challenge that policymakers must address to enable more jobless adults to access employment opportunities. Medicaid work requirements do not address the job gap.

2) Low wages keep millions of working people across North Carolina in poverty.

Across all 100 counties in NC, there are 2.2 million North Carolinians who have a job but are still earning poverty-level incomes, which is $24,600 for a family of 4. There are 95 counties in which the working poor make up more than 20 percent of the labor force. In 17 of the state’s 100 counties, the working poor population is between 30 and 40 percent. In other words, having a job is good but not enough to get by for many people across the state.

3) Medicaid makes it easier for people to work and search for work.

According to a statewide Medicaid assessment, a majority of enrollees (52 percent) report that Medicaid has made it easier to secure and maintain employment. Among unemployed enrollees looking for work, 75 percent report that Medicaid makes it easier to look for work.

4) A Medicaid work requirement redirects resources away from the goal of reducing poverty.

Spending taxpayer money to cover increasing administrative costs rather than using it to serve the public is not smart public policy. A work requirement for Medicaid beneficiaries would add to health plan administrative costs and shift money away from providing care, according to health insurers that administer benefits for millions of poor Americans. Jeff Myers, president and CEO of Medicaid Health Plans of America, has said work requirements are an administrative burden: “plans would rather spend their time and resources actually caring for their members.

 5) Dedicating resources to work training programs that help people access job opportunities is more effective in the long-term.

To help North Carolinians who are struggling find work and to secure better jobs, investments targeted to skills training programs that result in an industry-recognized credential and providing a strong career pathway program at every community college will increase skills and employment outcomes.

Research shows that public investments in these areas help low-income adults and youth find jobs, improve their earnings and contribute to their communities. For example, one study found that individuals receiving services are more likely to be employed (by about 10 percentage points) than those who have not received services.

 Conclusion

It is clear that instead of cutting funding and making it more difficult for vulnerable parents and children to access health programs in times of need, what we really need in NC is to change how we end poverty  – by providing adequate funding to help North Carolinians create and find work, get access to education and job training, child care, or mental health services to lift them out of poverty.

NC Budget and Tax Center, public health, Trump Administration

GOP health care bill would hurt one million rural North Carolinians who benefit from Medicaid

A new report finds the House-passed health bill – the American Health Care Act – would devastate health care in rural America, primarily because of the dismantling of Medicaid.

This is concerning considering that last year in North Carolina Medicaid offered health coverage to 1.9 million poor seniors, children, parents, and people with disabilities – of which the majority (1 million) lived in the rural parts of the state.

Specifically, North Carolina’s rural counties accounted for the following Medicaid beneficiaries: 60 percent of poor seniors, 53 percent of blind individuals, 58 percent of people with disabilities, 54 percent of pregnant women, and 51 percent of all infants and children. In other words, rural North Carolinians benefit greatly from Medicaid.

According to the report, “Medicaid has long played an even larger role in providing health coverage and paying for care in rural areas than in urban areas. Medicaid’s importance to rural America has only grown under the ACA. Nearly 1.7 million rural Americans have newly gained coverage through the Medicaid expansion.”

Below are key points from the report of why the proposed GOP health care bill would not meet rural needs:

  • Medicaid has expanded access to substance use disorder treatment at a time when many rural communities have been ravaged by the opioid crisis.
  • Medicaid expansion has become a critical financial lifeline sustaining rural hospitals.
  • The bill’s new tax credit for the purchase of individual market coverage would be woefully inadequate for many people in rural areas, and would leave many of the 1.6 million current rural marketplace enrollees unable to afford their high insurance premiums. Unlike the Affordable Care Act’s (ACA) far more generous and flexible tax credit, the House bill’s credit wouldn’t adjust for geographic variation in premiums and would provide too little assistance for older people.
  • In North Carolina, 25 percent of Marketplace Consumers live in rural areas; under the ACA, their average tax credit is $8,411. However, under the proposed bill, their average tax credit would decrease by 66 percent to $2,869. Furthermore, North Carolinians living in rural areas would see the biggest increase – $7,549 – in total out-of-pocket costs under the proposed health bill. Both the net premium ($5,921) and cost-sharing ($1,628) out-of-pocket costs would increase.
  • Rural populations tend to be older and sicker than urban populations. For example, people in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. For these reasons, rural residents likely benefited disproportionately from the ACA’s protections against discrimination based on medical history — and they could be disproportionately harmed by removing those protections, as well as by the other major provisions of the House bill.

To learn more see: Medicaid works for women in North Carolina and Medicaid has allowed millions with substance use disorders to get health coverage, access treatment.

NC Budget and Tax Center, public health

On Mother’s Day: Remember Medicaid works for women – but proposed cuts would have a harsh, disproportionate impact

This weekend we celebrate Mother’s Day. Next week we celebrate National Women’s Health Week. The fact is women play an important role in society every day and one thing we can always do for them is support them in having adequate health care. Currently, more than 40 million women and girls are enrolled in Medicaid. However, proposals in Congress to cap and cut Medicaid would have devastating consequences for the nearly 1.1 million women in North Carolina who rely on the program.

This is worrisome considering that Medicaid allows women to obtain the health care they need throughout their lives. According to a recent report, “women have unique health care needs — and nearly half of all women have an ongoing condition requiring regular monitoring, care, or medication.”

By the numbers: North Carolina Women and Medicaid

1.1 million: number of women in NC enrolled in Medicaid

54%: share of women in NC enrolled in Medicaid

898,200: number of women and girls in NC that live below the poverty line

17%: share of women and girls in NC that live below the poverty line (worse than U.S average of 16%)

54%: share of births in NC financed by Medicaid

The race and ethnicity of NC women in Medicaid

White: 44%

African-American: 35%

Hispanic: 14%

Asian/Pacific Islander: 1%

Other: 5%

Overall, women would bear an outsized share of harmful Medicaid cuts because they not only make up a majority (54 percent) of North Carolina’s Medicaid beneficiaries, but are also the primary users of maternity benefits and specific health care services for women. They are much more likely to use Medicaid’s long-term services.

North Carolina hurts when women and girls cannot access the health care that they need to lead healthy, full lives.

Current health bill proposals have disproportionate impact on women

The House-passed health bill also includes several provisions that are especially harmful to women with private insurance.

For example, it would allow states to opt out of the ACA’s Essential Health Benefits (EHB) standard, effectively allowing insurers to charge women more than men by leaving many women without affordable access — or any access — to maternity coverage.

Additionally, it also would give states the option of allowing insurers to charge far higher premiums to people who are pregnant, have had a c-section, or were treated for injuries resulting from domestic violence.

Learn more: To get a better understanding of Medicaid and its impact in North Carolina you can view various graphs in our NC Medicaid Chartbook or read our series, Medicaid Matters: Protect and Expand NC Health Care.

Commentary, Environment, public health, Trump Administration

Two paragraphs that sum up Trump’s attitude toward protecting the environment

The first two paragraphs of a New York Times story today sum up perfectly the approach the Trump Administration is taking towards protecting—or rather not protecting—the environment.

The Environmental Protection Agency has dismissed at least five members of a major scientific review board, the latest signal of what critics call a campaign by the Trump administration to shrink the agency’s regulatory reach by reducing the role of academic research.

A spokesman for the E.P.A. administrator, Scott Pruitt, said he would consider replacing the academic scientists with representatives from industries whose pollution the agency is supposed to regulate, as part of the wide net it plans to cast.

No reason to have actual scientists on a scientific review board. Let the polluters make the rules to protect us from pollution. That’s certain to work well.

News, public health

How NC’s Congressional delegation voted on repealing the Affordable Care Act

Members of the U.S. House narrowly (217-213) pushed through the Republican plan for repealing and replacing the Affordable Care Act on Thursday.

While critics of Obamacare praised the bill’s quick passage, the latest version came without any analysis by the nonpartisan Congressional Budget Office.

The North Carolina delegation split along party lines, with the exception of Republican Rep. Walter Jones. The Pitt County congressman voted against the bill noting that it would result in dramatically higher premiums for low-to-middle income seniors and discriminate against veterans.

Here’s how the full delegation voted:

Nay
Rep. G.K. Butterfield – 1st District – 202-225-3101
Rep. Walter Jones – 3rd District – 202-225-3415
Rep. David Price – 4th District – 202-225-1784
Rep. Alma Adams – 12th district – 202-225-1510

Yea
Rep. George Holding – 2nd District – 202-225-3032
Rep. Virginia Foxx – 5th District – 202-225-2071
Rep. Mark Walker – 6th District – 202-225-3065
Rep. David Rouzer – 7th District- 202-225-2731
Rep. Richard Hudson – 8th District – 202-225-3715
Rep. Robert Pittenger – 9th District – 202-225-1976
Rep. Patrick McHenry – 10th District – 202-225-2576
Rep. Mark Meadows – 11th District -202-225-6401
Rep. Ted Budd – 13th District – 202-225-4531

What select members of the delegation are saying about Thursday’s vote and the American Health Care Act of 2017 (AHCA):

Rep. Mark Meadows, (NC-11):

“This process has never been about getting a win for Republicans or a win for the Freedom Caucus—it’s been about getting a win for the countless Americans who are being crushed by the broken system of Obamacare. Today is a victory for them.

From the earliest stages of the discussion, I’ve stated that my goals were to 1) bring down premiums for Americans, and 2) protect those with pre-existing conditions. After weeks of negotiations, conversations, and substantive changes to the bill, I believe we reached the point where both of these criteria will be sufficiently met. I believe the revised AHCA will substantially reduce healthcare premiums and provide a strong net of protection for the most vulnerable Americans.”

Rep. Virginia Foxx (NC-5):

“For seven long years, families and small businesses have suffered the devastating consequences of Obamacare. Costs are skyrocketing, choices are diminishing, small businesses are struggling, and jobs are being destroyed. That’s what the American people have been forced to live with, and that’s why Republicans promised to provide a better way. We are on a rescue mission, and this vote is an important step in repealing a failed law and delivering free-market, patient-centered solutions.”

Rep. Walter B. Jones (NC-3):

“…the rushed, behind-closed-doors process they’ve used is shameful. Over the past several weeks, they cut deal after deal to secure members’ support, and then pushed the bill to the floor without a CBO score. As a result, no one has any idea how much those deals will cost the American taxpayers, or how they might affect the cost, quality and availability of health insurance coverage for American families. Seven years ago, Speaker Nancy Pelosi infamously said of the Obamacare bill: ‘You have to pass the bill so we can find out what’s in it.’ Sadly, the Washington Republican leadership is repeating the same mistakes.”

“Furthermore, there are many aspects of the bill that deeply trouble me because of their potential effects on Eastern North Carolina and rural America. For example, the bill discriminates against as many as 7 million American veterans by making them ineligible to receive tax credits provided in the bill. It would also result in low-to-middle income seniors paying dramatically higher premiums.”

Rep. G.K. Butterfield (NC-01):
“I am deeply disappointed that Republicans have once again decided to abandon the interests of the American people.  Today’s vote in favor of the latest version of Trumpcare, which repeals the Affordable Care Act (ACA), is shameful.

“No matter how Republicans try to spin it, this updated bill still rips health care away from 24 million people.  It still cuts Medicaid by more than $800 billion over the next decade.  It still hands a $1 trillion tax giveaway to corporations.  It still jeopardizes coverage for nearly 300,000 residents of the First Congressional District who have pre-existing conditions.”

Rep. David Price (NC-04):

“…this legislation will take affordable health care away from more than 24 million Americans, allow insurers to discriminate against those with pre-existing conditions, cause premiums and out-of-pocket costs to skyrocket, and threaten women’s health and special education.

 “Incredibly, House Republicans – the self-described champions of fiscal restraint and open government – are forcing a vote on legislation introduced late last night that has not been scored by the CBO and which many members admit they haven’t had a chance to read. The only thing we know for certain is that it would cut the numbers of people covered, and the quality of their coverage, more than the Republican bill that collapsed in the House last month.”