NC Budget and Tax Center

Report: North Carolina’s latest state budget fails to effectively address N.C.’s existing and emerging needs

The NC Budget & Tax Center has released a report explaining the 2019 state budget that was passed this year by the state legislature and begins by pointing out North Carolina lawmakers approved a state budget “that falls short of helping all North Carolinians live healthy, prosperous lives.”

The report explains that the new $23.9 billion budget does not promote a long-term vision for an inclusive state, as it continues to under-invest in areas of great public need and doesn’t take into account upcoming federal budget cuts.

According to the report:

“The final budget that lawmakers enacted continues to limit a collective commitment to North Carolina, increasing spending by $881.7 million over 2018. To put that figure in perspective, this means that the final budget is just 1 percent above pre-Recession levels, despite the state’s population growth over that same period of 11 percent.”

The latest NC Budget & Tax Center report points out, among other things:

  • Total state spending for fiscal year 2019 marks 10 consecutive years that state spending has declined as a share of the state’s economy
  • Lawmakers left $561 million unappropriated
  • The legislature’s decision to leave in place tax choices from 2017 means roughly $3.5 billion less in revenue each year to fund community and voter priorities like protecting children from abuse, building healthy schools, serving seniors meals, protecting our water and air, and training the future workforce
  • Over two-thirds (71 percent) of new investments in the 2019 fiscal year budget are made up of ‘one-time’ funds, or non-recurring money

The report also explains that Governor Cooper and the legislature offered different visions for North Carolina in their 2019 budgets and provides a visual recap of their different tax and spending choices. Moreover, the report compares current funding to 2008 levels in various critical areas and answers relevant questions such as:

  • What percentage of the state budget goes to each core area (e.g., education, health & human services, public safety)?
  • Which agencies received the most one-time funding?
  • How much more would NC’s public schools need to receive to be funded at the same percentage as in 1970?
  • How much, on average, have Civil and Criminal Court costs & fees increased since 2008?

To find out the answers to these questions and see more graphs that explain our state’s 2019 budget you can access the latest NC Budget & Tax Center report here.

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

Medicaid and Medicare mark 53rd anniversary by continuing to serve millions of North Carolinians today

Medicaid and Medicare were signed into law on July 30, 1965 – exactly 53 years ago this week.

President Lyndon Johnson signs the Medicare and Medicaid Bill (July 30, 1965). LBJ Library photo

Since these programs were created, they have given millions of people access to a doctor so they can maintain their health. Over the long-term, these programs have provided significant returns on investment, such as benefiting children into adulthood by lowering disability rates and increasing their earning income potential. Today, these two healthcare programs are worth celebrating and expanding even further as they continue to serve millions of Americans and North Carolinians each day.

In North Carolina, 2.3 million people receive comprehensive, affordable health coverage through Medicaid. Medicaid provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Meanwhile, 1.8 million North Carolinians (18 percent of the population) are served by Medicare, which serves people over 65, younger people with disabilities, and dialysis patients.

At a time when some lawmakers in Congress and in our state’s General Assembly minimize the value of these critical healthcare programs and limit their potential, it is important to celebrate the 53rd anniversary of Medicaid and Medicare and recognize that their continued evolvement have helped transform the lives of millions of people in positive ways. In recognition of their 53rd anniversary, here are five facts and three charts that provide a quick glimpse into their reach, structure and impact.

Fact 1: North Carolina’s health insurance gap coverage gap needs to be closed: In 2016, North Carolina had the 9th-highest uninsured rate (16.2%) in the nation for ages 18-64. This is above the national average of 12.4 percent.

Fact 2: North Carolina’s legislature has rejected Medicaid expansion since 2013: If North Carolina expands Medicaid, over 600,000 more people in the state would receive healthcare coverage and $4 billion would be added to our state’s economy annually.

Fact 3: Medicaid is funded jointly by the federal government and the states: In North Carolina, the federal government pays for 66 percent of Medicaid’s costs, and the state pays the remaining 34 percent, resulting in a 2:1 federal “match.”

Fact 4: The Medicaid system is efficient: For every dollar spent on Medicaid, 94 cents is spent directly on health services. Furthermore, Medicaid’s costs increased at about one-fourth the rate of private insurance since 2007.

Fact 5: Women comprise 55 percent of Medicare beneficiaries in North Carolina: The average age of a Medicare beneficiary in our state is 71. In 2016, 1.5 million seniors and 321,600 people with disabilities in North Carolina were Medicare beneficiaries.

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

North Carolina has failed to make progress on mental health issues for 10 years

[Note: As was explained earlier this month in a post entitled “North Carolina needs help to meet strategic health objectives by 2020,” North Carolina is at real risk of failing to meet a series of objectives identified in 2010 as part of the “Healthy NC 2020” initiative. This post is part of a summer series that is providing in-depth coverage of some of the focus areas in which we are falling short.]

In 2010, the state of North Carolina identified 13 major health focus areas and established 41 decennial health objectives and targets to meet by the year 2020. As part of the state’s ‘Healthy NC 2020’ improvement plan, the state identified a mental health focus area and developed three measurable objectives for it, recognizing that this area is an essential part of individual health throughout one’s lifespan.

Unfortunately, analysis of new data shows that North Carolina has not made any progress on its three mental health objectives since 2008. Today, the state’s suicide rate is higher, the number of poor mental health days among adults has gone up, and the rate of mental health-related visits to the emergency room has increased.

In other words, the state of mental health in North Carolina has only gotten worse since 2008.

Moreover, despite our state’s opioid crisis and increased prevalence of mental health conditions, analysis also shows that state funding has fallen by 18 percent since 2013 for the state’s Division of Mental Health, Developmental Disabilities, and Substance Abuse.

Worsening mental health conditions is a problem that affects all North Carolinians as it significantly affects people in many ways, including their sense of wellbeing, interpersonal relationships, and productivity in the workplace and in school. Furthermore, mental health conditions are also associated with increased health care costs and service utilization. Given the fact that our state has failed to make progress on mental health issues for 10 years, policymakers and health stakeholders must do more now to break down the barriers that people face in accessing mental health care and needed services.

A good place to start is by effectively addressing the mental health gaps that we have known about for almost a decade, as our ‘Healthy NC 2020’ plan states:

“Identified gaps in necessary services in the state include a lack of public awareness regarding service availability, a need for increased services in rural areas, lack of culturally competent services, and a dearth of mental health service providers.”

 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

North Carolina needs help to meet strategic health objectives by 2020

The State of North Carolina is not doing enough to promote the health of its people.

In 2010, the State of North Carolina identified 13 major health focus areas and established 41 decennial health objectives and targets to meet by the year 2020, with the goal of making North Carolina a healthier state. Unfortunately, our state is nowhere close to reaching this goal anytime soon.

My analysis last year of our state’s progress in achieving the goals outlined in our health improvement plan, Healthy NC 2020: A Better State of Health, found that “at the current pace it would take the state 48 more years (or until the year 2065) to achieve all of its 2020 targets.

With eighteen months to go until 2020, analysis of new state data shows that not only will our state not come close to achieving these health objectives but also that our state is worse off today in 17 key health objectives compared to nine years ago.

In other words, instead of making progress towards becoming “one of the healthiest states in the nation,” various health conditions in North Carolina have gotten worse.

For example, 12 out of 13 (92 percent) of the state’s major focus areas are negatively affected, including: maternal and infant health, mental health, substance abuse, chronic disease, injury & violence, and physical activity and nutrition. Within these focus areas, some of the major health objectives in which our current status is worse off today compared to nine years ago includes:

  • the rate of mental health-related visits to emergency rooms;
  • the unintentional poisoning mortality rate;
  • the percentage of individuals aged 12 years and older reporting illicit drug use;
  • the suicide rate;
  • the percentage of people spending more than 30 percent of their income on rental housing;
  • the percentage of adults with diabetes;
  • the infant mortality racial disparity between whites and people of color

Moreover, North Carolina has consistently trailed other states in overall health rankings for almost two decades, and currently ranks 33rd in the country.

Based on the evidence it is clear that in order to improve our state of health and make progress on our 2020 goals a real concerted effort is needed from health professionals, insurers, business and community leaders, advocacy organizations, consumer groups, the faith community and North Carolina’s residents.

Over the summer I will be releasing a series of posts covering more in-depth some of the state’s ‘Healthy NC 2020’ focus areas, the goal of which will be to lift up where we are falling short and how we can make progress for the state and for each North Carolinian whose health and well-being depends on the policies and systems that support them.

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

Federal tax plan and ongoing federal budget debates make N.C.’s future uncertain

Six months have passed since the federal tax law took effect, and there should be no uncertainty by now that President Trump and many in Congress intend to continue to call for more federal budget cuts and promote a federal cost-shift to the states.

While the $1.5 billion federal rescission package that Trump proposed appears to have been stopped by the Senate this week, the federal dollars that were at risk that support many critical state programs and services is concerning.  The truth is that real uncertainty exists today and is likely to remain in the coming years as the President and some in Congress intend to reduce the discretionary federal budget—a large part of which is sent to state governments to support local community priorities. Furthermore, uncertainty will continue to lurk on the federal horizon as more legislation is introduced to change the federal tax law and more health-care changes are proposed. Our nation faces a highly challenging fiscal future, and this requires all states to maintain fiscal flexibility to adapt effectively.

North Carolina receives approximately $14 billion from the federal government every year to support critical programs and services across the state, including Medicaid for seniors, children, and people with disabilities; highway transportation improvements; child support enforcement; workforce training; emergency preparedness; and substance use disorder prevention grants.

If federal budget cuts are made to these programs, our state lawmakers will be confronted with some very difficult choices. Read more