Billion dollar budget approved lacks health care focus

Billion dollar budget approved lacks health care focus

By Rose Hoban

Both chambers of the General Assembly gave their stamp of approval on Thursday for a $27.9 billion state spending plan for the coming fiscal year that still faces review by the governor.

The budget proposal is notable for how few big health initiatives there are coming in the wake of a global pandemic that put health care issues front and center to the country and world. 

“Poison pills are not overabundant in this budget,” said Senate minority leader Dan Blue (D-Raleigh) as he spoke about the plan negotiated between members of the Senate and House. 

Blue told the Senate that he had freed his caucus to vote their consciences on the budget. The longtime senator, and Democrat familiar with budget negotiations, also argued that the spending plan before them did not go far enough to address teacher salaries or give large enough raises for state workers. 

Blue did a comparison between what Bank of America offered its starting employees and salaries for public school teachers. Bank of America, according to Blue, recently announced that starting pay would be no lower than $22 per hour, the equivalent of about $46,000 per year. In comparison, starting salaries for North Carolina public school teachers in the current budget are at about $37,000.

“That comes out to less than $18 an hour to teach in North Carolina’s public schools as a starting salary,” Blue said. 

The Senate voted 38 to nine to approve the spending plan, with 13 Democrats joining Republicans in favor.

On the other side of the state Legislative Building, in the House of Representatives, Democrats also voiced objections to the spending plan, mostly about the secret process in which the budget was negotiated in closed-door meetings without input from Democrats. Then it was brought to the floor for an up-or-down vote without any opportunity for amendments, without going through the process of being amended and debated by each chamber. 

“There are 51 talented Democrats over here elected by the people of North Carolina who’ve been completely cut out of the process,” said Deb Butler, a House member and Democrat from Wilmington. “We have judges, teachers, an economist, lawyers, businessmen, a farmer, a state trooper… There’s a lot of talent over here that’s going unused.“

In contrast, Republicans in both chambers lauded the restraint they displayed in not increasing state spending significantly, even with a budget surplus in the billions. The spending plan also leaves more than $7 billion in state reserves.

“Our general fund state debt is dropping by 60 percent over eight years as we follow a philosophy of pay as you go,” Rep. Donny Lambeth (R-Winston-Salem), one of the senior appropriations chairs, as he presented the budget on the House floor. “This budget has taken reasonable steps to prepare for an economy downturn, or recession to help with rising-cost, runaway inflation, supply chain breakdowns, labor shortages, COVID uncertainties, gas prices, and other pressures on state operations.”

enough unfavorable votes from Democrats to override a potential budget veto by Democratic Gov. Roy Cooper. Nineteen Democrats joined 

If votes are being counted, it appears that neither chamber mustered Republicans in the House to approve passage with a total vote of 84 to 28.

Health care budget highlights

In addition to the $4.7 billion set aside for the Medicaid budget, more than $1.84 billion has been earmarked for health and human services priorities in the coming fiscal year, which starts July 1. That number is an increase of less than $42 million from what was originally set aside for health and human services priorities when lawmakers drafted their original two-year budget plan late last year

That is only a 2.3 percent increase from the initial number, compared to a national inflation rate that’s expected to top 8 percent over the past year, according to the Bureau of Labor Statistics.

“We need nurses, we need school social workers, we need counselors, and we don’t have the money,” said Rep. Rachel Hunt (D-Charlotte) during the floor debate. “Except we do have the money. We’re just choosing not to spend it that way.”

What’s notable in the wake of a global pandemic that found many counties and municipalities without enough resources to address the overwhelming need, there are no extra dollars in the state budget to bolster public health preparedness, keeping the budget flat at a total of just over $2 million. 

“In the just-experienced pandemic, the executive branch took an oversized, in our opinion, role in terms of the response,” Berger said. Berger, a longtime political sparring partner with Cooper, added that the legislature planned to look more into preparedness issues next year instead, after limitations on the governor’s emergency powers written into last year’s budget go into effect. 

As always, there are many pages of policy changes written into the budget bill, and some of those address a potential public health emergency in the future, allowing for the waiver of a number of health services regulations in case of another pandemic. Those policies include making it easier to have additional ambulance workers and nursing assistants and would allow for increased bed capacity in nursing homes and adult care homes without having to jump through as many regulatory hoops. 

In the short term, language in the bill also gives nursing homes the ability to hire unlicensed workers to do the work of certified nurse aides for up to four months, an attempt to help nursing homes address ongoing staffing issues generated by the pandemic.

The bill also authorizes the state health director to issue standing orders to facilitate vaccines, diagnostics, diagnostic tests, and other treatments for COVID-19. Until now, that power has only been possible because of the ongoing state of emergency.

The state office of the chief medical examiner receives funding in the budget to add seven new pathologists, something needed as the staff there have struggled with the increased caseload created by the pandemic and the continuing opioid overdose crisis. 

Other highlights of the health care budget include:

  • $52 million to continue rate increases begun during the pandemic for in-home personal care workers and workers in nursing homes to help bring those workers’ salaries closer to $15/ hour. 
  • $1.3 million in annual funding for the new 9-8-8 suicide/ crisis hotline
  • Allocates $14.8 million in funding from the opioid lawsuit settlement for local mental health management entities to purchase the medications for medication-assisted treatment, for research on opioid treatment research and allocates $1 million to TROSA that must be used to provide housing support to individuals in recovery from opioid use disorder or individuals receiving Medication-Assisted Treatment.
  • Allocates $7.7 million from the JUUL lawsuit settlement to provide tobacco cessation programs to young people, one of the largest appropriations for tobacco control since 2012. 
  • Appropriates more than $3 million to crisis pregnancy centers.

Medicaid expansion remains unresolved

One of the most hoped-for measures in the budget — Medicaid expansion  — did not appear in the budget plan. The policy move would add some 600,000 low-income North Carolinians to the program, which is funded jointly by the state and the federal government. 

Both House Speaker Tim Moore (R-Kings Mountain) and Senate leader Phil Berger (R-Eden) have distinctly different ideas about how to implement it. Berger’s plan would have the policy implemented along with more freedom for advanced practice nurses, changes to how the state regulates hospitals and tweaks to telehealth. 

“The Senate passed a comprehensive bill that deals with health care access, and sent it over to the House,” Berger told reporters on Wednesday afternoon. “The Senate has and continues to stand willing to negotiate the terms of that bill, if there is a compromise that can be reached, we have been met with silence.” 

“If you talk to individual House members, they think they’ve passed Medicaid expansion. But if you read the bill, they passed a study,” Berger said. 

Moore’s vision for expansion is more streamlined than Berger’s, but his proposal pushes any real decision on the policy until a special session in December, and also lacks a guarantee of passage. 

Both men have said they plan on wrapping up this short legislative session within the next 24 hours, which leaves little room for surprises such as a compromise on closing the health insurance coverage gap. 

Surprises are always possible in the General Assembly at this time of year.

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