NC Budget and Tax Center, public health

Senate GOP health “repeal without replacement” proposal would do great harm to NC

By now many have heard that the proposed Senate GOP “repeal and replace” health care bill is dead after some Senate Republicans could not support it. However, the bad news is that Senate Majority Leader Mitch McConnell says they will now pursue a vote to repeal without replacement. McConnell announced last night that the vote— which is expected to fail — will occur next week, at President Trump’s request.

What does this mean for North Carolina? If the Senate proceeds to repeal the ACA without a replacement, the number of uninsured North Carolinians would rise (and double) from 1.1 million to 2.1 million in 2019 alone. Furthermore, Federal government investments on North Carolina’s health care would be reduced by $1.6 billion in 2019, and by $59 billion from 2019 to 2028, because the Medicaid expansion, premium tax credits, and cost -sharing assistance would be eliminated.

This type of negative impact on the state’s most vulnerable and on the state’s budget is dangerous considering we recently reported that North Carolina is not on track to achieve its 2020 health objectives, and that the legislature’s Fiscal Research Division has projected state budget shortfalls of $1.2 billion to $1.4 billion in fiscal years 2019-20 to 2021-22.

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. We now know that it would not be in North Carolina’s best interest to see the GOP health bill, or elements of it, arise down the line and in other forms.

What would “Repeal without Replace” do?

Sen. McConnell now says that he plans to bring to a vote a version of the 2015 Affordable Care Act (ACA) repeal reconciliation bill that President Obama vetoed. Assuming a similar timeline to the 2015 version, that bill would:

  • Completely end expansion as of Jan. 1, 2020. There would be no phase-out and no statutory option for states to keep their expansions, even if they could afford to do so at regular match.
  • Completely eliminate the ACA’s tax credits and cost sharing subsidies – with no replacement – as of Jan. 1, 2020.
  • Immediately repeal the ACA’s high-income and corporate taxes, cutting taxes for households with incomes over $1 million by over $50,000 per year.
  • Immediately repeal the ACA’s individual and employer mandates.

What would the consequences of “Repeal without Replace” be?

The Congressional Budget Office (CBO) analyzed the consequences of this approach in January 2017, and found: Repealing much of the Affordable Care Act (ACA) would cause 32 million people to lose coverage by 2026 and roughly double premiums in the individual insurance market. Specifically, the report showed:

  • Coverage: 18 million people would lose coverage in 2018, 27 million would lose coverage by the early 2020s, and 32 million would lose coverage by 2026.
  • Individual market premiums: Compared to current law, premiums would be 20-25 percent higher in the first year, 50 percent higher by the early 2020s, and would double by 2026.
  • Individual market stability: By the early 2020s, about half of U.S. population would live in areas with no individual market insurers, increasing to 75 percent by 2026. Essentially, the individual market would collapse in most of the country.

According to the Urban Institute:

“The vast majority of those becoming uninsured would be members of working families (82percent), and more than half (56 percent) would be non-Hispanic whites. The vast majority of adults becoming uninsured would lack college degrees (80 percent).”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

Environment, Governor Roy Cooper, public health

“People of NC require your protection”: Gov. Cooper urges EPA to quickly set a safety standard for GenX

Gov. Roy Cooper: Asking the EPA for multiple health studies about GenX

Gov. Roy Cooper sent a letter to EPA Administrator Scott Pruitt today seeking “urgent action to get us answers and solutions” about the health risks of GenX in drinking water. “We need the EPA to move more quickly to finalize its health assessment of GenX and set a maximum contaminant level for it,” Cooper wrote.

GenX is a byproduct of the manufacture of Teflon and non-stick surfaces. Chemours, a spinoff of DuPont, has discharged GenX into the Lower Cape Fear River for decades, but only within the last 18 months have scientists from the EPA and NC State University discovered the chemical in the water. Since then, GenX has been detected at high levels in the drinking water leaving the public utility plants — no traditional treatment method removes it — although the amounts have decreased over the past three weeks since Chemours stopped discharging it into the river. Residents in parts of Brunswick, Pender and New Hanover counties, including the City of Wilmington, presumably have been drinking GenX-contaminated water.

An emerging contaminant, it is not regulated, and thus the EPA has not set a health standard for it. However, last week the state health department set a health goal for GenX of no more than 140 parts per trillion — a drastic reduction from the original 70,000 ppt DHHS had proposed.

The EPA, DuPont and Chemours already agreed to a 2009 consent order requiring the companies to reduce the amount of C8, a chemically similar precursor to GenX, in drinking water of residents living near the Washington Works facility in Parkersburg, W.V. However, as Cooper wrote, Chemours has stated that it believes the order doesn’t apply to the Fayetteville plant. “I ask that the EPA revisit this consent order immediately and modify it to apply to any and all release of GenX.”

 

7-17 Letter to Epa_0 by LisaSorg on Scribd

NC Budget and Tax Center, public health

Latest data: NC will not come close to 2020 health objectives; legislature’s policy failures implicated

One of North Carolina’s goals is “to be one of the healthiest states in the nation.” However, the reality is that our state is not on track to reach this goal anytime soon.

Every 10 years since 1990, North Carolina has set decennial health objectives with the goal of making North Carolina a healthier state. In 2011, the state identified 13 major health focus areas and established 41 objectives and targets to be meet by the year 2020. According to our state’s health improvement plan, “Healthy NC 2020: A Better State of Health”:

“The case for improving the health of individuals throughout the state is strong…the improvement of population health is an important economic development strategy, because health is a form of human capital and as such is a significant “input” into our economic system.”

Unfortunately it appears our state will fall woefully short of achieving the goals outlined in its health improvement plan. Analysis of the latest state data and overall health rankings finds the following:

  • North Carolina is not on track to achieve major health objectives by 2020.

The state is not likely to meet targets for 32 out of 41 health objectives (78 percent) by 2020. At the current pace it would take the state 48 more years (or until the year 2065) to achieve all of its 2020 targets. As a result, 12 out of the 13 (92 percent) state’s major health focus areas are negatively affected and not likely to be successful in achieving the 2020 objectives related to them.

  • North Carolina is worse off in 18 key health objectives compared to nine years ago. In other words, instead of making progress, certain conditions have gotten worse.

Major health objectives in our state that are worse off today compared to nine years ago include: the unintentional poisoning mortality rate; the percentage of individuals aged 12 years and older reporting illicit drug use; the suicide rate; the rate of mental health-related visits to emergency rooms; the percentage of people spending more than 30 percent of their income on rental housing; the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease; the number of critical violations per restaurant/food stand; and the percentage of adults with diabetes. Read more

News, public health

As Congress returns to work, Senate health care bill faces uncertain future

Members of Congress return from their July 4th recess this week with no apparent head-way on the Senate’s Better Care Reconciliation Act.

If you missed it over the weekend on Policy Watch’s News & Views with Chris Fitzsimon, Brendan Riley with the Justice Center’s Health Advocacy Project explains in clear terms why Senate Majority Leader Mitch McConnell is struggling to find the votes needed to pass their bill to replace the Affordable Care Act. (Click below to hear the full radio interview.)


And with just three weeks until Congress’ August recess, President Trump tweeted Monday he cannot imagine they would dare to leave Washington without ‘a beautiful new HealthCare bill fully approved and ready to go.’

2018 Fiscal Year State Budget, Environment, public health

NCGA welcomes 2017 hurricane season with abysmal disaster relief funding budget

Last week, the NC General Assembly welcomed in 2017’s hurricane season with a woefully inadequate budget proposal for Hurricane Matthew disaster relief funding. At only $150 million slated for hurricane recovery with $930 million of unmet need, the NCGA misses an opportunity to address long-term environmental and community resiliency.

Poultry waste can be seen streaming into floodwaters from flooded poultry facility near Seven Springs, NC

Poultry waste can be seen streaming into floodwaters from flooded poultry facility near Seven Springs, NC

Last October, in the wake of the hurricane, the Neuse River reached an historic peak of 29.74 feet, wreaking havoc on the region’s waterways and displacing thousands of people, destroying homes and entire communities, and exacerbating existing environmental justice issues in the region. The flooding contaminated the Neuse, Cape Fear, and Lumber River watersheds from various industrial polluters – including 14 swine waste lagoons, human waste from wastewater treatment facilities, and coal ash from a dam breach at the H.F. Lee plant near Goldsboro. Upper Neuse Riverkeeper Matthew Starr notes that communities are likely also facing contamination from poultry facilities, but because the Department of Environmental Quality does not require them to be permitted, they have no record of where these facilities are and therefore cannot do the appropriate testing.

Climate change will make problems worse

In a region that is already hurting from decades of environmental injustices – enduring the worst of industrial swine and poultry operations and coal burning power plants – displacement and disruption from this kind of natural disaster only worsens conditions for the families who have historically been industry dumping ground.

Unfortunately, climate change will only make the problem worse. The National Oceanic and Atmospheric Administration (NOAA) predicts that this year’s hurricane season will be a busy one – with an above-average number of storms expected in the Atlantic. Climate change creates conditions for continuous rainfall and flooding, not just major storms, which also pose a threat for frontline communities. Flood plain management in eastern North Carolina will be critical for its ability to weather future natural disasters. The state must move agricultural and municipal wastewater facilities out of the 100-year floodplains to avoid future flooding-induced contamination, and we must rebuild the outdated water and sewer infrastructure to protect the health and safety thousands of families. With last week’s announcement from the Trump Administration that the U.S. will exit the Paris Climate Agreement, it is unlikely that we will see action quick enough to curb the worst effects of a quickly changing climate.

We need leadership

The NCGA must take the long view in rebuilding eastern NC. NC leaders continue to ignore the scale of the problem, continue to leave thousands of children and families behind. How much longer will our elected leaders insist on a Band-Aid to stop a gaping wound?