The latest effort in Washington to repeal and not actually replace the Affordable Care Act has a different name, the Cassidy-Graham plan, but it should look familiar.
It is essentially a proposal like the ones that came before it this year to make massive cuts in Medicaid, end subsidies that make it possible for low-income families to afford coverage and give insurance companies the ability to both charge people with pre-existing conditions more and offer sketchy policies that don’t cover essential benefits.
Some of the mechanisms are different in this plan, most notably the cuts are camouflaged in Medicaid block grants to the states that are reduced, capped and then ended, leaving North Carolina $8.7 billion short in 2027. That’s right, the bill not only repeals the Affordable Care Act, it ends Medicaid as we now know it.
No one knows exactly how many people in all will lose their health care under the latest attempt to undo the progress that the Affordable Care Act has made. And senators won’t know either when they vote, as the Congressional Budget Office says there is not time to fully evaluate the new plan.
But it appears Congress is voting anyway, without committee hearings, without real debate, even without information about exactly what their disastrous new legislation will do.
A few things are certain. Millions of people will lose their coverage and again be one illness away from bankruptcy as they use the emergency rooms for primary care. Other will forego preventive care altogether because they cannot afford it. And the folks at the lower ends of the economic ladder will feel the effects most acutely.
That last one folks in North Carolina are used to.
The troubling news from Washington comes on the heels of the release of the latest data from the U.S. Census Bureau that shows that while poverty declined slightly in 2016 in North Carolina, there are still roughly 1.5 million people in the state living below the poverty line and 21 percent of the state’s children.
The slight progress in 2016 was more the result of the strength of the national economy and programs like the Affordable Care Act that allowed hundreds of thousands of people to access health care than any initiatives by the folks who have run the General Assembly for the last six years
The record of how legislative leaders treat low-income people is clear. They gutted the state’s unemployment insurance system to the point that it is now harder for laid-off workers in North Carolina to get benefits than virtually everywhere else in the country.
A few years ago, the General Assembly abolished the state Earned Income Tax Credit, giving North Carolina the dubious distinction of being the only state ever to create a state EITC to help low-wage workers and then take it away from them.
Just this past session, House and Senate budget writers ended the state funding mechanism for legal services for low-income people and made it almost impossible for judges to waive court fees in minor cases where the defendants have no ability to pay.
Of course, they also refused to expand Medicaid — like 30 other states have done — which would have provided coverage for 300,000 low-income people. This session, despite having a budget surplus and putting hundreds of millions of dollars in the state savings account, they forced the Department of Public Instruction to cut funding that provides extra support for struggling schools, most of them with a majority of low-income students.
Even this year’s progress reducing the waiting list of at-risk kids for NC PreK was an odd choice. It was funded with federal block grant money currently at risk in President Trump’s budget when the state could easily pay for it and make sure every eligible child could enroll.
There is plenty more but you get the idea. State lawmakers have waged war since 2011 on programs that help low-income people in North Carolina.
And it is not because they needed the money to balance the budget. The General Assembly has cut taxes by $3.5 billion since 2013, with the bulk of it going to corporations and the wealthy. The top one percent of taxpayers, with average annual incomes of a million dollars, have received an annual break of $22,000 a year.
Now legislative leaders may have the chance to strike an even more devastating blow by rationing federal Medicaid dollars as they see fit — without federal oversight — until the money disappears completely in 10 years.
Given their record recently, that is a scary prospect indeed. You can almost hear them licking their chops.
That is what is at risk in this latest pernicious health care plan bubbling up in Washington — a proposal that would make some insurance companies happy, but take health care away from the folks who need it the most, the folks in North Carolina already reeling from six years of a combination of neglect and outright attacks.
Chris Fitzsimon is founder and executive director of N.C. Policy Watch.