Wednesday, February 20, 2013

Medicaid expansion supported in ND

The Governor of North Dakota, Jack Dalrymple, did include Medicaid Expansion in his budget and NDESPA applauds him for it.  We also applaud the ND House of Representatives for passing Medicaid Expansion by a vote of 57-36. The bill now goes to the Senate for consideration.

The Advisory Board Company's overview of where each state stands on Medicaid Expansion indicates confidence that ND will participate.
North Dakota*: Gov. Jack Dalrymple (R) in January said the politics associated with the ACA should not prevent North Dakota from participating in the Medicaid expansion. He is supporting a bill that would allow the state health department to access federal funds allocated through the ACA. Dalrymple also said he will include the expansion in his budget proposal and that members of his staff will testify in favor of the expansion before state lawmakers (Jerke, Grand Forks Herald, 1/12).
Representives opposed to Medicaid expansion introduced a separate bill HB 1362 that separates funding for Medicaid expansion to a stand-alone bill.

When HB 1362 had a public hearing, the support far out numbered the opposition. 
Testimony by the North Dakota Department of Human Services highlighted the benefits expansion would provide North Dakotans

More than 23 groups are on record as in favor of Medicaid Expansion.

Kaiser Family Foundation's Fact Sheet on Medicaid Expansion skillfully explains the ins and outs of the opportunity.   

AARP North Dakota submitted an op ed on Medicaid expansion makes the case for ND to embrace the program.  

The Governor needs citizen support to move the effort through a reluctant legislature. The research is clear, Medicaid expansion is a smart and effective opportunity which North Dakota should not pass up.
The Oregon Health Insurance Experiment: Evidence from the First Year

Oregon Health Study - Click for home page Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, and The Oregon Health Study Group NBER Working Paper No. 17190, July 2011, JEL No. H51,H75,I1
NPR coverage on study results and the study results:

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

Some key statements from the paper:

“Our estimates of the impact of public health insurance apply to able-bodied uninsured adults below 100 percent of poverty who express interest in insurance coverage.”
“...our results are specific to a population of low-income, uninsured adults in Oregon who expressed interest in obtaining health insurance (by signing up for the lottery). This group is not representative of the low-income uninsured adults in the rest of the United States on a number of observable (and presumably unobservable) dimensions. One striking difference is that our study population has more whites and fewer African-Americans (by about 15 percentage points each) than the general low-income, uninsured adult, US population. It is also somewhat (4 to 5 years) older and on some measures appears to be in somewhat worse self-reported health (Allen et al. 2010).”
“...have substantial and statistically significantly higher health care utilization, lower out-of-pocket medical expenditures and medical debt, and better self-reported health than the control group that was not given the opportunity to apply for Medicaid.”
“...(25 percent) decline in the probability of having an unpaid medical bill sent to a collection agency and a 20 percentage point (35 percent) decline in having any out-of-pocket medical expenditures.”

Monday, February 11, 2013

Child Care Stabilization Needed in ND

Child care centers in North Dakota are in trouble. Unable to keep up with the cost of wages for employee retention, many day cares are struggling to make ends meet.

The story of a child care center closing at the end of this month in Bismarck illuminates the looming crisis. When child care centers close, families are left scrambling:

“I’m hearing from a lot of panicky parents,” said Ellene Lang, the director of the Early Childhood Learning Center on Divide Avenue.

Her facility may have room for a couple of preschool-age kids, but the infant and toddler rooms are full until 2014.

It is a similar situation for LaRae Dockter, the director of Discovery Childcare Center. She said she usually receives five to 10 calls a day from parents looking for child care but her phone has been ringing off the hook so far this week. She has had King’s Kids parents break down in tears in her office.

Day care facilities contacted by the Tribune indicated that child care in Bismarck has become increasingly hard to come by. Most day care and preschool facilities are running at capacity and facing their own staffing issues.

A bill is up for consideration in the House of Representative, HB 1422. HB 1422 is designed to help stabilize child care during the economic boom in ND. The bill would allocate $15 million to child care centers to help meet the income gap.

The Human Services Committee of the ND House of Human Services is deep in discussion on this bill and likely to work on it today. Monday, February 11, 2013. Time is of the essence and the members of the House Human Services Committee need to hear strong support for the bill. The evidence is overwhelming that investment in childcare a worthwhile expenditure.

Contact members of the House Human Services Committee to urge a DO PASS recommendation: 


Saturday, February 2, 2013

The Ending Fund Balance: A Moving Target

For advocates, understanding the state’s budget is crucial to their work. Therefore, it can be maddening when budget information tends to shift like sand under out feet.

So it is with the ending balance of the general fund. In September of 2012, the Office of Management and Budget forecast the general fund ending balance (surplus) for the 2013 biennium at $1.6 billion. However, less than three months later, the Governor’s proposed budget estimated the ending fund balance of the general fund for the biennium would be $69 million.

That is a whopping difference of over $1.5 billion and a whole lot of money to take off the table before the legislative session even started.

Now that the legislature is underway, some policymakers are using the deflated number as an excuse to turn back legislation that would tap into that surplus in order to address the growing number of low income North Dakotans.

Why does it make a difference and where did the money go?

The short answer for why it makes a difference is that the general fund is where policy makers and advocates direct their attention when making determinations about how the state’s tax dollars should be allocated. When the surplus available to policy makers for the upcoming session is no longer available, or greatly reduced, that changes the debate and the viability of spending bills brought before the Legislature.

Granted, this isn’t the first time the balance of the general fund has been manipulated to control the outcome of spending bills. Last session, legislators manufactured a general fund “deficit” to deter spending, while at the same time enacting over a half billion dollars in tax reductions and exemptions. 

That deficit, in hindsight seems preposterous since at the end of the 2009-2011 biennium, the general fund balance for the biennium was $997 million: the highest end-of-biennium balance in North Dakota history, both in nominal terms and as a percent of the appropriated budget. 

Where did the 2011-13 biennium surplus go?

Again, the short answer is that it hasn’t gone anywhere, yet. What the governor proposed in his budget would use the current surplus to pay for items that would normally be paid for out of general fund revenues in the next biennium.

For example, the Governor proposed increased transfers from the general fund to the highway fund ($620 million) and the housing incentive fund ($30 million) and the 2013-15 transfer to the property tax incentive fund ($372 million) are all being counted against the 2011-13 general fund surplus balance instead of being considered a general fund expenditure for the next biennium.  

No one would argue these expenditures are not legitimate and important investments for our state. They are. However, by pulling this fiscal maneuver, it insinuates that the spending depletes our state’s resources and, therefore, deters any additional investments in our state’s people.

This gambit actually serves two purposes. It reduces the amount of the surplus that many are lining up to spend this session and it shifts necessary and legitimate spending to this biennium rather than the next so budget hawks may claim moderate increases in spending for the coming biennium. The really disturbing part of all the money shuffling is that it may pave the way for more unnecessary tax breaks later this session.

Instead of having open debate about the needs that exist in this state and what our priorities for allocating the abundant resources of our state should be; legislative leaders and the governor are manipulating the outcome by the ridiculous assertion that there is no money for other necessary spending.

And, of course, they can do it.  Veterans to the process know legislators can do anything they want if they have the votes. Is it right and honorable? No. It’s tricky and disingenuous. But, that is the cost of elections.

Legislative veterans also know that following the state’s budget is a challenge because changes can and do happen right up until the closing gavel. That is to be expected. However, as advocates, we need to be aware when information is massaged, (or even manipulated) to tell a story that limits honest dialogue.

And more importantly, we need to stand ready to call their bluff.

Author: April Fairfield, North Dakota Economic Policy Project