Medicaid expansion and supplemental appropriations during crisis situations

Budgetary Analysis

Process for Budgetary Policies and Assigned Legislative Committees

A government budget can be defined as an official contract or arrangement that specifies the amount of revenue to be raised, where such revenues will be sourced, and the manner in which the revenues will be utilized. In most societies, the budget is in actual fact an assortment of policy contracts that specify the tax laws and also the level of spending for particular programs; thus they are more than just a complete and inclusive document. The process for budgetary policies therefore refers to the guidelines and procedures that are employed by policy makers to frame, ratify, and implement these agreements for revenues and spending (Crain, 2004).

For state governments as well as the federal government in America, the process for creating budgetary policies is comparatively simple to define in a conventional manner. Generally, the first phase of the process is the conveying of proposals for spending and revenue. The subsequent step covers the hearing of such proposals which are thereafter debated upon. Once the proposals have been debated, different oversight committees undertake the voting process, and then voting occurs by the complete legislative membership. Once this is done, the bills on spending and revenue are taken for consideration to the chief executive. The final phase of the budgetary process for policies is similar and comparable to the other kinds of legislation. This implies that the budget bills can end up becoming law in two different ways. The first one is that after consideration, the chief executive can sign the bill and then it becomes law. On the other hand, if the chief executive refuses to sign the bill, it can still become law by attaining the approval of a super majority voting outcome from both houses of the legislature (Crain, 2004).

The budget process mentioned above is the regular process for all budgets passed. However, when a major crisis like Hurricane Katrina occurs, more individuals and families become eligible for governmental assistance such as Medicaid. This compels states to draft problematic budgetary choices; for instance, moving funds from optional programs like K -- 12 school financing to Medicaid Match funds. In reaction to this quandary, a supplemental appropriations process for budgeting is initiated. Supplemental appropriations are planned to make available extra funding to an agency or program in the course of a given current fiscal year so as to safeguard against budgetary deficits or shortages. Every now and then, supplemental appropriations make funding available for approvals that take place subsequent to the normal budgetary process, whereas at other times the appropriate authorization has been in position for a relatively short period of time (Black, 2009).

As soon as the supplemental appropriations entreaty is initiated, it is taken to the House and Senate Appropriations Committees. The President of the United States (POTUS) usually ensigns supplemental appropriations with an emergency label or title. This characteristically permits supplemental appropriations to receive less scrutiny and inquiry. In accordance to Black (2009), spending established to be for an emergency, by both the POTUS and U.S. Congress, is effectually exempted from deficit targets and budget caps requirements. In addition, it is not required of the President to take account of normal budget validation information in supporting these requests (Black, 2009).

Once the President submits a budget, the congress is expected to adopt the budget resolution. In this particular phase, the Senate and House Budget Committees are responsible for forming the Budget Resolution. This in particular institutes the new budget authority and expenditure levels for the financial period that is encompassed in the resolution. If everything goes well, every chamber of the Senate and House has Budget Committees that offer their account of the Budget Resolution for contemplation within their specific chamber (Black, 2009). Any disparities that arise between the two versions of the budget resolution are settled and taken into account in the Conference Committee. Once the Budget Resolution is ratified as expected, the House and Senate Committees on Appropriations, at that juncture, start developing the twelve appropriations bills that find the middle ground with the federal budget. Every one of the twelve bills is picked up by the different appropriation subcommittees. The allocations, also referred to as the ceilings in terms of spending, are additionally split among these sub-committees. The Committee on Appropriations, for both the House and Senate, offers up any differences to the conference committee for a compromise. Once this is done, the bill is able to be presented to the president for signing into law (Black, 2009).

Prioritized Recommendation between deficit and cuts, or a surplus and additional funding

Deficits and cuts should be recommended for prioritization over a surplus and additional funding. According to Cooper (2010), a survey undertaken indicated that seventy percent of Americans consider reduction in deficits to be very important. Additional funding and a surplus to some extent can be deemed to be stimulants to the economy. However, James (2010) indicates that for every dollar that is spent in America, 41 cents are borrowed and are actually 'debt'. This can injure the economy in the long run and therefore harm different sectors such as healthcare and education. This implies that it could affect the state and federal funding of Medicaid and Medicare.

The Political Climate of the State of North Carolina. How does this drive the agenda? How does this differ from developing legislation?

The Patient Protection and Affordable Care Act give the states in the nation two options to choose from. The first one is whether to offer a state-centered exchange for the acquisition of subsidized private health insurance, while the second one is whether to increase Medicaid (the health insurance program for the poor jointly funded by the state and federal government). Expanded Medicaid would cover all residents and long-time lawful inhabitants proximate to, or underneath the federal poverty line. Different from most original predictions, more than half the states have declined to form their own insurance exchanges, and approximately half have declined to expand Medicaid. These choices and resolutions clearly follow the political climate in these states. The state of North Carolina made the decision not to expand Medicaid (Hall, 2014).

This drives the agenda in the sense that the residents in North Carolina have fallen into a gap that has been formed out of the decisions made by the Supreme Court and the legislation in the state which is controlled by the Republicans. Given that the Supreme Court decided that 'Obamacare' was statutory, there was also the declaration that the federal government could not make it obligatory for states to agree to take one aspect of the law; in the state of North Carolina this would be an expansion of Medicaid benefits to individuals at 138% of the federal poverty level (Rubiera, 2015). The legislature of the state declined this expansion and as a result about half a million residents became stuck. This differs from the developing legislation because these 500,000 residents earn a lot of money to be considered eligible for Medicaid under the state's guidelines. However, on the other hand, in accordance with the law they also do not earn enough money to be considered eligible for financial assistance in order to acquire private insurance (Rubiera, 2015). As mentioned in the article, this causes the residents to be unable to afford health care; they are therefore forced to utilize free clinics that are operated and run by volunteer health care providers and pharmacists. Rubiera (2015) mentions that in terms of the political climate of the state, Pat McCrory, the Governor of the state, and Aldona Wos, the state secretary of health and human services, have conveyed the prospects of sanctioning the Medicaid expansion in North Carolina. However, on the other hand, the General Assembly seems disinclined to partake on the aspect.

For instance, the President of the Senate mentioned that Republican legislators do not have any plans of expanding Medicaid in the State of North Carolina as stated in the news article. The president is of the opinion that there is no good outcome that can come about, or argument made that can indicate that Medicaid expansion is of great benefit to the state of North Carolina. However, the 500,000 or more residents of the state who are stuck in the 'gap' have a conflicting argument. In addition health care centers such as hospitals, which have been drained between provisions for cost savings made in Obamacare, and also the lack of attaining new patients for Medicaid have the same opinion as the residents of the state. The same goes with economists who have observed several potential job prospects and opportunities being wasted. In the perspective of these individuals, the expansion of Medicaid is a move that would improve the health of state residents, the financial health of the budgets for health care facilities and the economic health of the State of North Carolina as a whole (Rubiera, 2015).