For most North Carolinians, the myriad choices that comprise the state budget may affect the quality of their children’s education, or whether their favorite state park is kept in good shape, or whether the DMV has enough employees to keep wait times to a minimum.
Then there are our neighbors for whom budget decisions can bear directly on their personal well-being. Case in point: people who, if the state Senate has its way, would lose their health insurance coverage under Medicaid. And it’s not as if this group of people is likely to find a simple work-around. Not only are they among the state’s poor, but they’re also elderly, blind or totally disabled.
It’s evidently true that North Carolina now goes beyond the minimum standards set by the federal government in determining Medicaid eligibility. In other words, the state has, for any number of years, decided it would go a little bit out of its way to make life more tolerable for some of its most disadvantaged residents.
But this “generosity” comes at a cost – a sore point for many legislators, in view of overall Medicaid expenses that have soared to where they now eat up nearly a fifth of the entire $21 billion budget.
More than that, they’ve soared while the General Assembly’s Republican majority and Gov. Pat McCrory together have made tax-cutting a top priority. Cuts taking effect this year are expected to reduce revenues by some $500 million a year. Because the budget has to stay in balance, spending cuts have to be found as well.
The Senate, which approved its budget after a greased-lightning review that left skeptics wondering what they’d just been hit by, made a choice regarding Medicaid that seems to comport with federal law, but that also seems likely to inflict actual suffering on real people who already face more than their share of troubles. That’s the case even though overall Medicaid spending would continue to rise, tracking population growth.
Rip in the net
North Carolina’s social safety net includes a program called State/County Special Assistance. Its main purpose is to help low-income, low-wealth residents who are at least 65, or who are at least 18 and are blind or totally disabled, defray the cost of living in an adult care home or other facility.
The Senate budget, technically Senate Bill 744, tightens up on Special Assistance in three ways. First, it specifies that people who apply as of Nov. 1 must have income no more than the federal poverty level to be eligible. Current law doesn’t include that cutoff, although aid recipients must have unmet financial needs related to a reasonable standard of care. The federal poverty level stands at $11,600 for a single person.
Second, the proposed budget cancels the provision that now allows someone to become eligible for Special Assistance upon moving to North Carolina “to join a close relative” who’s lived here for at least the previous 180 days. The applicant himself or herself would have to live here for 90 days before qualifying.
Third, and most significant in terms of health care, the bill would strip Special Assistance recipients of their automatic eligibility for Medicaid. That’s the program, funded jointly by federal and state governments, that covers a range of medical and health-related expenses for the needy and the vulnerable.
The legislature’s fiscal staff has reckoned that almost 11,900 people now enrolled in Special Assistance would lose Medicaid benefits – the bulk of which are funded by federal taxpayers, not North Carolina taxpayers. The state’s savings are pegged at $28.8 million during the fiscal year beginning July 1.
A key supporter of the change, Republican Sen. Ralph Hise of Spruce Pine, says the number of people affected is more likely to be in the range of 5,200. That’s supposed to be consolation? Perhaps we can assume that Hise’s mother isn’t among them.
Hise also speculates that some of the people who’d lose Medicaid – remember, these are old folks with meager income and assets, or similarly poor people who are blind or totally disabled – could obtain health insurance coverage under the federal Affordable Care Act, otherwise known as Obamacare.
That’s a cynical notion indeed. The state’s Republican legislators who in lock step have resisted any cooperation with Obamacare, any attempt to encourage North Carolinians to enroll, now suggest the program they loathe could take them at least partly off the hook for their callous decision to curtail Medicaid benefits.
The problem, however, is that the Affordable Care Act’s subsidies, meant to keep the program affordable for lower-income people, kick in only for those who earn at least 138 percent of the federal poverty level.
There are bound to be some people caught in the Senate’s Medicaid squeeze who make too little to qualify for the subsidies, meaning they wouldn’t be able to afford the ACA’s premiums, yet too much to qualify for Medicaid under the regular rules. North Carolina’s decision not to expand overall Medicaid eligibility to close the so-called coverage gap – as the ACA envisioned all states would do – simply rubs salt in this civic wound.
Teachers win, lose
Signs are that neither Gov. McCrory nor House leaders are enthused about many features in the Senate budget, Medicaid cutbacks included. Another bone of contention is likely to be the Senate’s plan for teacher pay raises, which hinges higher pay on teachers’ willingness to forgo their protections from arbitrary firing.
Paying teachers more is an urgent matter in a state where their average salary has dropped to 46th in the country. But besides making teachers unfairly give ground on job security if they want to earn closer to what they’re worth, the Senate plan has another huge drawback: Legislators would fund much of the expense by laying off all the teacher assistants who now help manage classes in grades two and three – upwards of 7,000 employees. If pupils weren’t given the attention they needed during those pivotal years, parents would have a good idea whom to blame.
The House, before it adjourned for the week on June 5, was beginning its public review of the budget handed over by the Senate. Also in the picture is McCrory’s recommended budget, with its own approaches to Medicaid reform and teacher pay – approaches that the Senate brushed aside. House members are sure to have their own ideas.
North Carolinians for whom strong public schools and ready access to affordable health care are important – in advancing equal opportunity and in relieving unnecessary suffering – can hope that the House and the governor will stand against the Senate’s harsh proposals. Certainly the Council of Churches’ member organizations would rather see this state’s Medicaid program, when it comes to serving some of our most hard-pressed citizens, go the extra mile.