NC Budget and Tax Center

With the influx of federal dollars, Medicaid expansion would pay for itself

Recent estimates of the costs and savings of Medicaid expansion from Governor Cooper’s recommended budget show that closing the coverage gap is a great deal for North Carolina. Given our state’s more than one million uninsured individuals and approximately 626,000 additional Medicaid enrollees expected to be newly eligible, the decision on whether or not to expand coverage is clear.

Each year since 2014, North Carolina has foregone billions of federal dollars as a result of not expanding Medicaid. Beginning in 2020 the federal government will pay for 90 percent of the cost of expansion, and the state’s 10 percent share will be covered through a combination of budget savings and fees collected.

With billions in federal dollars coming into the state, Medicaid expansion would generate significant savings for the state budget – an estimated $30.7 million and $69.3 million, respectively, in the first and second fiscal years. Increased federal Medicaid funding would reduce the need for existing state spending on health care services by state agencies like the Division of Mental Health, the Division of Health Benefits, the Department of Corrections, and other state agencies.

The remaining portion of the state’s share will come from assessing fees on hospital revenues and capitation payments made to Medicaid health insurance plans, common revenue-generating strategies used by states. Because these health care organizations will experience significant patient revenue growth with more insured patients under Medicaid expansion, they stand to benefit on net even after paying the fees.

In addition to the zero net cost of expanding Medicaid, it will allow hundreds of thousands of individuals to become newly eligible for affordable health coverage and achieve the benefits that come with it, including improved health and financial security. In addition, when our neighbors are healthy, we all benefit; it allows people to fully participate in their communities and lowers health care costs for all of us.

While the national conversation centers on health care as a right, North Carolina lawmakers in the General Assembly have the opportunity to cover the uninsured and to do it in a fiscally responsible way. With these data, lawmakers will have a tougher time making the case for why the time isn’t right for Medicaid expansion.

Commentary, immigration, News, Trump Administration

After Trump administration rule change, immigration visa denials soar

New data released by the U.S. Department of State show a significant uptick in the number of visa denials on grounds of public charge compared to data from prior years.

These data, in addition to the public charge rule change proposed late last year, demonstrate the Trump administration’s commitment to restricting immigration, particularly for families accessing critical resources.

While the public charge rule has existed in some form for more than 100 years, its current definition took effect in 1999 and is based on the likelihood that someone will become a “public charge” by using certain public benefits for which they are eligible.

Experts agree that the departure from previous data on visa denials is likely due to a revision made in early 2018 to the State Department’s Foreign Affairs Manual (FAM), which instructs U.S. consular officials on granting visas to immigrants and non-immigrants who are abroad and seeking to enter the U.S.

The new manual language imposes stricter rules about use of public benefits, income levels, and proof of financial support from family. This change came as part of a response to a 2017 White House Memorandum prompting increased vetting of visa applicants and others seeking entry into the United States.  While the FAM governs persons who are abroad and seeking to enter the U.S., the proposed public charge rule that is currently being reviewed at the federal level impacts those who are already inside the U.S. and are seeking to obtain a visa or green card.  The increase in denials based on public charge for visa applicants outside the U.S. could be a bellwether of what would happen if the proposed public charge regulation were to go into effect for applicants inside the U.S.

News about this dramatic increase in visa denials, along with confusion and fear about the current proposed rule,  could have a chilling effect on families accessing the programs they need to make ends meet.  It can also thwart our country’s vision of ensuring people in need can live in a country that respects and supports their well-being.

Suzy Khachaturyan is a Policy Analyst with the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center

North Carolina’s budget and policy choices can improve health

Deeper and smarter investments in education, infrastructure, economic security, housing, and other areas can eliminate barriers to good health for low-income residents and communities of color, according to a new report from the Center on Budget and Policy Priorities (CBPP).

In addition to these and other public investments, North Carolina can remove obstacles to better health by:

  • Improving access to affordable health care, including by expanding Medicaid under the Affordable Care Act (ACA);
  • Leveraging Medicaid to improve access to other economic and social programs known to improve health, like case management and supportive housing;
  • Enacting social and economic policies known to improve health, like creating and expanding paid leave programs and raising minimum wages; and
  • Improving state and local tax systems by basing them on a taxpayer’s ability to pay and ensuring they raise enough revenue to maintain the quality of the places in which residents live, work, learn, and play.

Social, economic, environmental, and behavioral factors account for 80 percent of an individual’s health; health care access and quality are responsible for just 20 percent.

Opportunities to be healthy are not available to all North Carolinians. Where there is greater income and wealth inequality, there are also greater disparities in health. Income and wealth inequality and a history of structural racism have erected barriers to health for low-income residents as well as communities of color:

  • Black North Carolinians die more than three years earlier than white residents, on average.
  • Black babies born in North Carolina are nearly twice as likely as white babies to be born with low birthweight.
  • Black babies are also more than twice as likely as white babies to die before their first birthdays.

Generating revenue that will allow for investments in programs that help to ameliorate these deep disparities has been more difficult in North Carolina, due to changes to the state’s tax code starting in 2013. Findings from the CBPP report support the need for increased investments, including those strategies described above, in order to equip all North Carolinians with opportunities to be healthy.

Suzy Khachaturyan is a Fiscal Analyst with the Budget & Tax Center. 

Commentary, NC Budget and Tax Center

Support breastfeeding with paid family and medical leave

Note: This post refers to breastfeeding as nursing and avoids the use of gender-specific language in order to remain inclusive. For more information about this, visit the links here and here.

Too many parents are faced with the difficult choice between earning an income and caring for their newborns. As National Breastfeeding Month 2018 comes to a close, it is important to consider barriers that new parents face to nursing their infant and what opportunities exist to better support new parents. The American Academy of Pediatrics recommends exclusive nursing for the first six months of an infant’s life, followed by nursing that is supplemented with complementary foods for an additional six months. However, data from the CDC show that only 25 percent of infants are nursed exclusively for the first six months and only 36 percent are nursed at 12 months of age.

Despite overwhelming evidence demonstrating the short- and long-term benefits of nursing for both parents and infants, families can face tremendous barriers to adhering to the recommendations. These include challenges with lactation, poor social supports, barriers to health services, limited knowledge of the benefits of nursing, embarrassment, and challenges relating to employment and child care. It is also important to recognize that many new parents are unable to nurse their infant for reasons that include medical conditions and contra-indications, situations of foster care or adoption, cases where caregivers are not the birthing parent, and more.

The trade-off families face between nursing their infant and earning an income reflects the lack of options that exist for many working families. The only federal protections for new parents is the Family and Medical Leave Act (FMLA), which provides 12 weeks of unpaid leave and job protection for eligible employees who need time off to recover from childbirth or personal medical crisis, or care for a seriously ill loved one. However, a staggering 41 percent of American workers did not have access to, or were ineligible for, FMLA in 2012. Read more

NC Budget and Tax Center, What's Race Got To Do With It?

Racial and ethnic gaps in infant mortality have grown in North Carolina

Infant mortality data reveal longstanding economic and social disparities that exist along racial and ethnic lines — disparities that are actually getting worse in many cases. Overall infant mortality has declined from 1991 to 2016, as the number of deaths prior to age 1 per 1,000 live births in North Carolina declined from 12.2 deaths to 7.2 deaths. However, when disaggregated by race and ethnicity, the data tell a more complex story.

The infant mortality rate is declining more rapidly for white children compared to many communities of color. From 1997 to 2016, the rate declined 22 percent for white infants but only decreased by 14 percent for African-American and Black infants. Mortality among Hispanic and Latinx infants actually increased by 25 percent during the same time period.

The more rapid decrease in infant mortality for white infants has compounded disparities that already existed across groups. Deaths among Hispanic and Latinx infants have historically been closer to white infant deaths, though there has been an increase in the percentage of Hispanic and Latinx infant deaths from 1997 to 2016.

These changes equate to an increase from 2.2 to 2.68 times the number of African-American and Black infants, meaning that for each white infant that dies per thousand births, there are nearly three African-American and Black infants who die. For Hispanic and Latinx infants, these rates increased from 0.68 to 1.2 deaths for each white infant that dies per thousand births from 1997 to 2016. In addition, if the disparity gap were closed and the white infant mortality rate was reflected across all racial and ethnic groups, 238 fewer African-American and Black infants and 19 fewer Hispanic and Latinx infants would die each year.

These growing gaps in infant mortality are rooted in disparate access to economic opportunities and resources that impact health. While two leading causes of infant death in the United States are attributable to preterm births and birth defects, the underlying root causes point to social factors such as family income, access to health care and insurance, access to prenatal care, mother’s education, and experiences of discrimination and systemic racism. Addressing and eliminating racial barriers to economic opportunity is a vital step in protecting infants and giving everyone in North Carolina the chance to live full and healthy lives.

Suzy Khachaturyan is an MSW/MPH intern with the NC Budget & Tax Center.