TALLAHASSEE, Fla. - Not long ago, the airwaves were filled with predictions health-care reform would be a disaster for taxpayers and consumers. That hasn't happened.
According to the Congressional Budget Office, the Affordable Care Act (ACA), often referred to as "Obamacare," will cut the federal budget deficit by a $100 billion. That despite adding health coverage for about 10 million people, by federal estimates.
Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, says the reform has been able to do this because it's had real success at one of its key goals: holding down the cost of health care.
"The growth of health-care costs has been at close to historic lows, both in the public programs, Medicare and Medicaid, as well as the private sector," says Van de Water.
Some critics still argue health-care reform will be a disaster, but that position is not getting a lot of support from the data. Other critics have simply fallen silent. Up until now Florida has opted out of billions in federal funding to extend Medicaid to another 850,000 low-income Floridians, but one million of the state's residents signed up for a health plan through the ACA.
The overall federal deficit has dropped dramatically. It's now projected to total nearly $5 trillion less by 2020 than was expected just four years ago. More importantly, Van de Water says the ACA is improving the health of the vital Medicare program, which is threatened by an influx of millions of baby boomers.
"Medicare will continue to need adjustments, but it's clear health reform has made Medicare's prospects better, not worse," he says.
Another prediction that hasn't come true yet is premiums would skyrocket. Van de Water says the huge variation in the cost of insurance makes it difficult to describe a simple pattern. But he says it looks like slowing the rise in health-care costs has helped keep the price of premiums in line, especially in the new insurance exchanges.
"Premiums in the health-insurance exchanges have turned out to be lower than what the congressional office was originally projecting," Van de Water says. "Now premiums are still going up, but it's likely they're going up by less than what would have otherwise been the case."
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Earlier this month, a new Arizona Public Service rate hike went into effect and one senior advocacy group said those on a fixed income may struggle to now pay their energy bills.
According to the utility, the average residential customer will see an expected bill increase of about 8%, which translates to about $10.50 a month. They said it is all in an effort to continue to provide Arizonans with reliable and resilient power and make "critical investments" in their system.
Aimee Cvancara, associate state director of AARP Arizona, contended the possible effects could be significant.
"Folks who are on a fixed income, whether that is a retirement income or even a working income with limited mobility, it is difficult to absorb a $10 to $12 cost in your monthly bill that was unanticipated," Cvancara pointed out. "Particularly because it's not the only increase that folks are seeing right now."
Cvancara emphasized consumers are feeling the weight of increased prices on everything, from groceries to gas, rent and now power. Arizona Public Service rooftop solar customers could also see an additional $2 to $3 a month on their bills but the Arizona Solar Energy Industries Association and Attorney General Kris Mayes are both demanding for a rehearing on the case with the Arizona Corporation Commission to challenge the rate hike.
Cvancara noted moving forward, a significant concern for Arizona consumers is going to be something called the system reliability benefit mechanism, which allows Arizona Public Service to recover costs between rate cases for new, utility-owned generation resources.
"This is a new thing for APS customers," Cvancara explained. "It is going to allow the utility to file for up to 3% rate increase and they can do that five times before they have to file for another rate increase."
Some ratepayers and environmental groups oppose the system reliability benefit mechanism, as they argued it will only raise rates and increase demand for fossil fuels. Cvancara said the Arizona Corporation Commission should always strive to balance investments for reliable energy versus the cost consumers will face.
Disclosure: AARP Arizona contributes to our fund for reporting on Budget Policy & Priorities, Consumer Issues, Health Issues, and Senior Issues. If you would like to help support news in the public interest,
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A 2023 study from the University of Nebraska Medical Center concluded the number of Nebraskans with a mental health or substance abuse disorder has probably increased over the pre-pandemic level of 20%. It also observed 88 of Nebraska's 93 counties have a shortage of behavioral health professionals.
Nonetheless, the state budget now awaiting Gov. Jim Pillen's signature cuts $15 million from the Division of Behavioral Health's funding for the state's six Behavioral Health Regions, which distribute those funds to providers. Many advocates believe the cut is based on an incorrect conclusion.
Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations, said because $15 million remained in the budget for the Regions, it was concluded the money was not needed. In fact, she said much of it was for projects and proposals awaiting Department of Health and Human Services approval.
"The problem is not that it's not needed; there's a problem with getting it out the door and into services quickly," Dubas explained. "Because we know the demand is there. And if it's not being spent, let's figure out why. That's what we want the governor to sit down and talk to us about, so we can figure out where the holdups are."
The $15 million will be shifted to the Lincoln Regional Center for hiring nurses and other staff. Dubas questioned how realistic it is for the center to spend this amount of money on staffing, especially when the state is facing a nursing shortage of more than 5,000 by 2025. She also questioned what will happen to any money left unspent.
Dubas stressed the Division of Behavioral Health is not the only agency losing money through this budget process.
"This administration has gone into a lot of different funds, cash funds, etc., and kind of swept out money that they perceive is not being used or is not being spent, to use to help with their property tax relief," Dubas asserted.
The Pillen administration is paying Epiphany Associates from Utah $2.5 million annually for up to four years, to find savings of up to 25% across state agency budgets.
Chase Francl, CEO of the Mid-Plains Center for Behavioral Health, which receives about 40% of its funding from Region III, said cutting programs that save the state money cannot be considered cutting "waste."
"Mental health and substance use treatment really is a prevention service," Francl contended. "If we can get this right, then people are going back to work and maybe aren't ending up in corrections. And you start restricting here, you usually are just going to be creating a greater need for more costly services down the road."
Mid-Plains served 3,200 people in Grand Island, Kearney and Lincoln last year. Francl added they currently have about 60 people on a waitlist for therapy services.
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Congress just avoided a partial government shutdown by approving a budget through the end of September, but a new blueprint is renewing debate about a key safety net program and advocates in North Dakota and elsewhere are worried.
For the 2025 fiscal year, a House caucus of more than 170 Republican lawmakers has issued a proposed outline. It includes raising the retirement age for Social Security eligibility "to account for increases in life expectancy."
Nancy Altman, president of the advocacy group Social Security Works, said, like past suggestions from the caucus, it should be considered a non-starter, arguing it essentially amounts to a benefit cut.
"You never catch up," Altman asserted. "Even if you work till age 70, your benefit's going to be about 7% lower than it is under current law."
There was no specific higher age outlined, but AARP North Dakota has also sounded the alarm about the plan, urging its members to demand "no cuts." Social Security faces financial headwinds a decade from now, but Altman supports President Joe Biden's calls for raising payroll taxes on the wealthy to help ensure the program stays fully funded. His skeptics argued it would not be enough.
However, Altman and other advocates think it is a good first step. The GOP framework also calls for reducing benefits for higher earners. No income threshold was provided but Altman suspects it would still hurt a lot of people who are not exactly wealthy in their retirement.
"It's not what many people would think," Altman contended. "They're certainly not Jeff Bezos and Bill Gates, and the billionaire class."
She predicted the people targeted for cuts would be more aligned with the middle class. Republicans insist the changes would not cut or delay benefits for any senior currently in or near retirement. North Dakota's lone Congressman, Rep. Kelly Armstrong, R-N.D., is part of the caucus behind the proposal.
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