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Health numbersThe legislative debate over Medicaid reform over the last two weeks once again revealed the Senate’s misplaced priorities – profits over people. The health of North Carolinians was not only compromised by pushing reform that employs commercial insurers and dismantling Community Care North Carolina (CCNC), but also by failing to expanding Medicaid to the half million people in the Coverage Gap. It is surprising that for a governing body that focuses most of its efforts on profits, the Senate fails to recognize the economic benefits of Medicaid expansion.

Unfortunately, many conservative policymakers agree with Sen. Harry Brown when he stated, “Every state that has expanded Medicaid has created a financial problem in their state budgets” during the expansion debate. Black and white statements like his fail to present the complete and complex picture of each state’s expansion experience. To present a more accurate picture, the Health Access Coalition created a chart outlining the successes and challenges for each of the 30 states and DC that has expanded Medicaid. The chart also provides information on whether the state used a waiver to expand Medicaid. Waivers allow states to tailor Medicaid expansion to meet specific state needs and even include Medicaid reform.

After reviewing this chart, it becomes clear that the biggest challenge states have experienced is providing health coverage to more people than expected – being able to reduce a state’s uninsured rate to 5 percent should be noted as a success! Further, “over-enrollment” proves that need for health care is great and that the long term benefits will be even greater. However, expansion is complex and along with increased enrollment comes budget concerns for the years when the federal match for expansion lowers from 100 percent to 90 percent starting in 2020. Even though states have to reassess their budgets and establish tools to cover Medicaid costs such as hospital assessments, there are several states that have experienced an economic boost. For example, Arkansas reports a combined savings of $120 million between fiscal years 2014 and 2015 due to expansion. Arizona has also gained of over $30 million in new revenue. Colorado has created 20,000 jobs since Medicaid expansion. One county in Illinois has seen a decrease of $158 million in costs associated with providing care to people without health coverage. Other states like New Hampshire are seeing reduced use of emergency rooms as health services are finally being provided to individual that face many barriers to health care for health concerns such as substance use and mental health.

Unlike Sen. Brown’s sales tax distribution plan, Medicaid expansion will have economic benefits for all 100 counties in North Carolina. Sen. Brown’s district, District 6, includes Jones and Onlsow counties. Failing to expand Medicaid by 2016 will cost Jones County $8.4 million less in business activity, $5.6 million less growth to the county’s economy, and $155.8 thousand less in tax revenue between 2016 and 2020. In Onlsow County, there will be $53 million less to the county’s economy, $77.3 million less in county business activity, and $292.9 thousand less in county tax revenue between 2016 and 2020 without expanding Medicaid. The most important benefit to these counties is that over 5,000 people will gain access to health care, but just in case North Carolina’s health benefits aren’t convincing, expansion will allow for $21 billion in federal funds to enter North Carolina.

Commentary

Among numerous other dramatic and heretofore unpublicized changes, the Senate unveiled another version of its plan to shift sales tax revenues away from urban counties toward poorer rural counties this morning. And while parties can legitimately debate the wisdom of various sales tax apportionment methods, the underlying premise of the legislation — that adequate tax revenues are essential for communities to fund education and other public structures that are central to economic health and development — runs directly counter to everything else the conservative legislative majority preaches.

On virtually every other day, government is the enemy and the beast that needs to be starved. Somehow, however, when it comes to sales tax revenue, all of a sudden government is essential for community health.If you doubt this, listen to Senator Harry Brown preach about the inability of counties like his (Onslow) to offer teacher salary supplements and build new schools.

Earth to Senator Brown: There are lots of ways to get after the problem of inadequately funded public structures and services…like, for instance, not wrecking the state income tax.

The bottom line: It would be nice if these guys would get their story straight.  While their rhetoric this morning on the importance of public investments is welcome, the hypocrisy it evidences with respect to just about everything else they do and say is stunning.

Commentary

Mooresville writer John Deem has a rock-anthem-inspired take this morning on the proposals in the General Assembly to shift sales tax revenues from urban to rural areas of the state:

Sales tax redistribution: Money for nothing and your trips for free

By John Deem

Nearly all of the debate over Republican legislators’ proposals for redistributing sales taxes has focused on fairness.

Is “point of sale” distribution unfair to rural counties whose residents spend money in urban areas but whose communities get none of the local sales tax collected on those purchases?

Is the notion of suddenly shifting millions of dollars in revenue unfair to the urban areas that must cut services, raise taxes, or both, to make up for unexpected shortfalls?

As is often the case when politicians create a solution then look for a problem, the local sales tax fairness doctrine misses the point completely.

Rural residents travel to urban areas to spend money because that’s where the businesses are. Those businesses are in urban areas because that’s where the people are. Lots of them.

It costs money to build and maintain roads, water and sewer systems, and other infrastructure to accommodate not just residents, but also the throngs of workers, shoppers, sports fans and others outsiders drawn to an urban area’s employers, stores and attractions. So does providing adequate levels of police, fire and emergency medical services not just for the local citizenry, but for the visitors taking advantage of everything the big city has to offer (and that their own communities do not).

Local governments in urban areas outspend rural communities on a per capita basis not because they can, but because they have no choice. Large populations create unique challenges that can’t be addressed through “equal” funding, which can be a puzzling concept for some elected officials who rest on the simplicity of ideology rather than the complexity of reality.

The fact is, residents of rural communities already get the best of both worlds. They have access to urban amenities, usually within a reasonable drive, but have to deal with few, if any, of the challenges urban communities must wrangle with every day. Meeting those urban challenges costs money – money rural communities don’t have to spend and, therefore, should not siphon from their big city neighbors.

That’s only fair.

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"Healthywealthy" by threestooges.net. Licensed under Fair use of copyrighted material in the context of Healthy, Wealthy and Dumb via Wikipedia - http://en.wikipedia.org/wiki/File:Healthywealthy.jpg#mediaviewer/File:Healthywealthy.jpg

“Healthywealthy” by threestooges.net. Licensed under Fair use of copyrighted material in the context of Healthy, Wealthy and Dumb via Wikipedia

No, this post is not an attempt to personally disparage the folks running North Carolina government. Rather it is an attempt to conjure up an image that captures the impact of the decisions that state leaders have been inflicting of late on their brethren and sistren at the local level.

As some readers will recall, The Three Stooges were an outlandish and slapstick comedy trio that had a long run in the middle part of the last century. In one of the trio’s recurring bits, one Stooge (usually Moe – pictured on the left) would slap or punch the second Stooge, who would then, in turn punch the third member of the group. The third and most hapless Stooge would then turn beside him and find that he only had thin air to punch.

Sadly, this comedy bit pretty well captures the essence of what’s going on in North Carolina government right now: Whether it’s the McCrory-Pope team or the General Assembly that starts the punching, the ones left flailing at thin air are local governments.

For the latest classic example, check out the bill under consideration in the state Senate during the waning days of the 2014 session that would hamstring local governments in their ability to raise local sales taxes for important needs. While Senators sought to alter some of the the impacts of the bill last evening, it still promises to have a deleterious impact — especially on big counties like Wake and Mecklenburg. And, of course, this comes on the heels of several previous haymakers in which state leaders have slashed state support for locals.

The bottom line is that the overarching policy of the current conservative state leadership when it comes to local government is this: We’re all for local control that’s closest to the voters — except when we’re not (i.e. any time anyone at the local level even thinks about doing something — like raising taxes to provide essential public services — with which we disagree). SLAP!!!

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ICYMI, the editorial page of the Greensboro News & Record pulled no punches this weekend in an editorial excoriating state senators for their last minute proposal to hamstring local governments when it comes to use of the sales tax for public services and structures at the local level. Here’s an excerpt from “Oddest idea yet”:

Republican state senators canceled a floor vote on a confusing sales-tax bill Thursday until they could get their stories straight. Which means it might not return.

Of all the heavy-handed directives the legislature has pushed down on local governments in the past couple of years — airport and water system takeovers, de-annexations, local redistrictings, elimination of privilege licenses — this one might be the most illogical.

The measure, which originated in the Senate Finance Committee without notice Wednesday, was presented as a means of giving counties additional tax flexibility. With voters’ approval, they could add to the local sales tax, designating revenue to schools or transportation projects.

But the strings attached tied everything in knots.

The legislation put restrictions on how new revenue could be spent — for education or for transportation, but not for both. It put a cap on the local sales-tax rate. And, perhaps most baffling, it required that if a county raised the sales-tax rate, it would have to raise it all the way to the cap….

The half-baked sales-tax bill, which also includes unrelated provisions boosting economic development efforts, was yanked from the calendar before the Senate adjourned for the weekend. Senators will return to Raleigh Monday, but the wacky sales-tax proposals ought to vanish as quickly as they appeared.

For more information on the proposal in question, click here for succinct summary.