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.

News, Trump Administration

Report: States receiving “mixed messages” from DeVos, feds over ESSA plans

U.S. Education Secretary Betsy DeVos

A new report from Education Week indicates some states completing draft plans for adhering to new federal education laws are complaining of “mixed messages” from the U.S. Department of Education and its controversial leader, Michigan GOP booster Betsy DeVos.

Federal lawmakers approved the nation’s update of education law in 2015 with the intent of eschewing powers over school accountability to states rather than the federal government. Called the Every Student Succeeds Act, or ESSA, the revised law seemed to address longstanding complaints from Democrats and Republicans that the country’s older K-12 law centralized too much power in the federal government.

Now, with states turning in drafts of their plans to Devos’ agency, there seems to be some brewing discontent with the Department of Education.

The report comes with North Carolina officials planning to wrap the state’s public comment period on its draft plan July 27.

From Education Week:

The back and forth between states and Washington over the Every Student Succeeds Act has become more complicated than many had expected.

Although U.S. Secretary of Education Betsy DeVos took office in February pledging to let states seize control of key education policy decisions under the new federal K-12 law, her department’s responses to states’ ESSA plans have surprised—and in some cases irritated—state leaders and others.

The U.S. Department of Education has expressed skepticism about elements of those plans, from the ambitiousness of long-term academic goals to the use of Advanced Placement exams in state accountability systems.

Last month, the Council of Chief State School Officers said the first set of feedback to three states was “too prescriptive in certain areas and goes beyond the intent of the law.” Early indications are that states won’t necessarily make sweeping changes just to please DeVos’ team.

And in an interview, Sen. Lamar Alexander, R-Tenn., one of ESSA’s architects, said the feedback letters seem to fly in the face of the law’s intention that the states—not the federal government—should be calling the shots when it comes to the details of school accountability.

“I want to nip in the bud the idea that somehow it’s business as usual in Washington,” Alexander said.

The department’s responses to states haven’t been entirely consistent. For example, Delaware—one of the first three states to get feedback from federal officials about its ESSA plan—was told by peer reviewers that its proposed use of AP courses for measuring college- and career-readiness wouldn’t fly. But the department didn’t voice the same concerns about similar approaches in plans submitted by Louisiana and Tennessee.

For states, there’s a balancing act between wanting to submit a plan that will pass legal muster at the department and wanting to take advantage of the flexibility that’s in ESSA, said Julie Rowland Woods, a policy analyst with the Education Commission of the States who has been tracking states’ work on the law.

“There’s sort of mixed messages coming from the department, and states are really looking for guidance on how they can complete these plans in an appropriate way,” Woods said.

So far, 17 plans have been submitted to the department from 16 states and the District of Columbia.

In June, department leaders raised concerns about elements of Delaware’s plan. Among other issues, they indicated that the state’s long-term academic goals weren’t truly “ambitious” (a term that is used in ESSA but is not defined by the law), and that the state’s plan to use yardsticks like AP scores was a nonstarter.

But in a revised plan the state sent to Washington later that month, Delaware kept options such as AP for schools to use to measure postsecondary readiness, saying that contrary to the department’s feedback, all options listed were universally available to schools serving grades 9-12. And it declined to change those long-term goals, saying that regardless of the department’s view of what counts as “ambitious,” the state’s push to cut in half the ranks of students not proficient in math and English/language arts by 2030 represented a big challenge.

“To reach these goals for the lowest-performing subgroups, it requires approximately a 3 percentage-point increase in proficiency year over year, which is extremely ambitious for our [districts],” a Delaware department spokeswoman, Alison May, said.

Still, the state did change how it planned to use science- and social-studies-test scores, after being told by the department that using them as they planned to do in their original submission would violate ESSA.

Nevada moved its science tests out of the core academic-achievement indicator and under the school quality and student-success umbrella in its revised plan, said the state’s deputy superintendent for student achievement, Brett Barley.

However, he said that many of the changes in the plan Nevada resubmitted last month involved filling in gaps for the department, including providing features like interim academic goals and more information about the relative weight of English/language arts and math scores.

“We never got feedback from them that made us say, ‘Wow, this is something that we don’t want to do,’ ” Barley said.

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.

Commentary, Trump Administration

Trump’s budget would sink SHIIP counseling and leave seniors struggling to stay afloat

The ongoing effort in Congress repeal the Affordable Care Act is far from the only bad news from Washington of late when it comes securing health care for vulnerable people. Both of the budgets proposed by the Trump administration and the U.S. Senate would completely eliminate funding for State Health Insurance Assistance Programs. This would affect North Carolina’s assistance program, NC Seniors Health Insurance Information Program (NC SHIIP), which relies heavily on federal funds to provide valuable services to North Carolina’s Medicare beneficiaries.

NC SHIIP offers free, unbiased, accurate, and highly personalized one-on-one counseling to residents in all 100 North Carolina counties. In 2016 alone, NC SHIIP counseled more than 105,000 Medicare beneficiaries. NC SHIIP operates under a cost-effective and innovative model, utilizing a small paid staff and a network of approximately 1,000 trained volunteer counselors to meet the needs of North Carolina’s Medicare recipients. The counselors meet with Medicare beneficiaries, many of whom are elderly, retired, or disabled, to explain the increasingly complex Medicare program and to ensure consumers are taking full advantage of their benefits. Last year, NC SHIIP helped North Carolinians save more than $44.3 million on Medicare coverage and prescription drug costs. These cost savings are especially pertinent, given that 1 in 4 beneficiaries who rely on NC SHIIP have incomes below 150% of the Federal Poverty Level. This blatant disregard for the importance of consumer assistance programs puts the future of NC SHIIP at risk.

Mike Causey, North Carolina’s Commissioner of Insurance shared his support for NC SHIIP in a recent brief, stating, “Removing this program would eliminate the best and most reliable free and local resource that Medicare beneficiaries have in North Carolina.”

Without NC SHIIP, confused consumers will be forced to utilize a federal resource that is not equipped to handle the call volume or offer personalized assistance necessary to adequately explain Medicare benefits.

The proposed federal budgets are a direct attack on North Carolina’s most vulnerable. NC SHIIP protects the Medicare benefits of North Carolina residents who are elderly, disabled, and low-income. The program ensures access to affordable and comprehensive health care coverage. Without federal funding, NC SHIIP would be unable to provide these critical services. The House of Representatives is scheduled to debate the 100% funding cut for State Health Insurance Assistance Programs in the next few weeks.

Sydney Idzikowski is an MSW intern at the N.C. 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.