That's almost the situation right now in North Carolina as the Democratic Governor and Republican-led General Assembly are deadlocked trying to negotiate the next budget and the government's plan to spend your tax dollars.
The 2019-2020 Fiscal Year began on July 1, and without a deal, state law mandates the last budget snap into place. The last budget, however, does not include any new raises for state employees, no salary increases for teachers, no new bonds for school construction, and no new relief for hurricane victims.
Yes, the government is running, but both Democrats and Republicans agree the status quo is not sustainable for very long.
Though the parties differ on several issues, the campaign to expand Medicaid coverage continues to be the cornerstone wedge preventing a budget the legislature can pass and the governor can sign.
In this ABC11 360 report, we're bringing you a well-rounded recap of this critical issue: what it is, what it means, why it matters and what the major stakeholders have to say, so you can make up your own mind and come to your own conclusion with all of the facts.
Medicaid, Medicare and the Affordable Care Act
Understanding Medicaid Expansion first means understanding how health care works in America.
Health Care, for the most part, is not a government-run social program. Yes, Medicare provides insurance for Americans over 65 and military veterans generally also enjoy some benefits, but the rest of America predominantly relies on private health insurance offered through their employers. The exceptions are those Americans who live in poverty, who are insured by Medicaid. While Medicare is funded predominantly by the federal government, Medicaid falls more under the umbrella of state governments.
The Affordable Care Act, sometimes referred to as ObamaCare (because of its signatory President Barack Obama), was created in part to provide health insurance to millions of Americans who either couldn't afford it or those choosing not to purchase it. The theory is that if more healthy people have policies, insurance companies have more money to pay for care and thus stabilize the market and lower premiums.
The ACA created a system where Americans without access to insurance could purchase policies on a new marketplace on HealthCare.gov, and millions of Americans with certain income requirements could even earn huge tax credits and subsidies to help pay premiums. (The ACA also mandated insurance companies cover pre-existing conditions, among many other provisions that have become popular with Americans).
One shakeup of the ACA, however, was the creation of a small gap between people who earned too much money to qualify for Medicaid but not enough money to qualify for subsidies to buy insurance on HealthCare.gov. At the time, the federal government offered states billions of dollars to help close that gap, and many states over the years have chosen to accept that money. Others, including North Carolina, chosen so far chosen not to take the federal money and expand Medicaid either for partisan, fiscal or other reasons.
North Carolina's Medicaid Gap
Lynne Pierce's full-time job is to help people. A 50-year-old single mother, Pierce is the Executive Director of the Southern Alamance Family Empowerment, a community programming space and food pantry.
As Pierce devotes her time to assisting needy families, though, she is unable to adequately take care of her own medical needs, including diabetes and high blood pressure.
"Just a couple weeks ago my blood pressure has been running high and I am waiting to get paid again just to be able to afford to go to the clinic to meet the amount for that," Pierce laments. "I don't get yearly physicals. I don't get yearly exams. I don't sit around looking for a handout. I'm out here working and in the process trying to make lives better for other people too."
With a salary around $30,000 a year, Pierce is a prime example of the kind of North Carolinians in the so-called Medicaid Gap.
"I never realized how important health care was until I lost it," Pierce, a former teacher who holds a Master's Degree, tells ABC11. "I would love for the representatives to come here and have a talk with me or talk at the food pantry with people in this gap. My biggest concern is I want to be around to watch my daughter grow up and my grandchildren."
According to the North Carolina Justice Center, nearly one out of every three North Carolinians ages 19-64 with income below 138 percent of the poverty line was uninsured in 2017, and more than 600,000 North Carolinian adults are employed yet uninsured. That includes people like Pierce, who works full time, and other adults who have part-time, seasonal, or temporary jobs.
"I pay my taxes. I have contributed to society," Pierce maintains. "I come from a good family in Alamance County. I have a master's degree. I've always worked and I can't afford medical care."
Medicaid expansion could cost $3 billion. Here's why Governor Cooper supports that investment.
The 2018 Midterm Election resulted in the Republicans losing their supermajorities in the General Assembly, thus giving Governor Roy Cooper more leverage in his capacity to use a veto - which did last month with the first GOP budget.
"Many are dying because North Carolina has yet to say an important word: Yes. Yes, we will accept Medicaid expansion," Cooper proclaimed. "This budget is an astonishing failure of common sense and common decency."
Supporters of expanding Medicaid point to several factors, not least of which the fact that 90 percent of the cost of expanding Medicaid would be covered by the federal government - money that proponents say North Carolinians have been sending to Washington for years.
Those in Governor Cooper's corner also argue that providing coverage will inject needed money into health care facilities, primary care providers and hospitals in rural North Carolina.
Not expanding Medicaid, however, would lead to more people going to the Emergency Room for treatment which is the most expensive care - the cost of which is predominantly passed on to the consumer.
A different perspective - is more government the answer?
Many Republicans in North Carolina's General Assembly represent many of the rural communities struggling with their access to health care coverage. Senator President Phil Berger, a Republican from Rockingham County, agrees there needs to be what he calls "meaningful health policy reform."
Expanding Medicaid, however, is not what the conservative caucus supports.
"In other states, expansion enrollment has far exceeded projections, increasing the financial pressure on other important budget items," Berger writes in an op-ed published by our newsgathering partner, the News and Observer. "A full accounting of the facts leads to the inescapable conclusion that expanding Medicaid would be a mistake that not only will fail to solve the problems its proponents claim it solves, but will create new problems and rekindle problems that have just recently been put to rest - such as Medicaid cost overruns and yearly budget deficits."
Specifically, opponents of expanding Medicaid worry about the longevity of the federal government covering 90 percent of costs. If the federal share goes down, the state's share goes up, which Republicans say could blow a huge hole in a future budget and force lawmakers to make tough choices about appropriating monies from other sources, like education.
"Gov. Cooper would like you to believe that Medicaid expansion will solve all of North Carolina's problems, but the reality is that it's state-sponsored healthcare largely for able-bodied, childless adults that will cost the state billions once the federal subsidies dry up," Sen. Ralph Hise, a western North Carolina Republican, tells ABC11. "At the same time, we're not doing enough for the 12,000 people on a waitlist for the Intellectual/Developmental Disability Medicaid Program. Until we take care of all those people on the waitlist who truly need care, we shouldn't even consider funding health care for able-bodied childless adults."
Where does this leave us?
The General Assembly had hoped to adjourn for the summer, but the budget battle should keep them within an arm's reach of Raleigh. If there's no budget deal by August, expect the pressure to ramp up as teacher's go back to school and their raises don't kick in.
There are a series of potential compromises, including work requirements or assessing a premium on those who would qualify for an expanded Medicaid, but it's tough to predict if there are enough votes on each side to make that happen. As Republicans want to ensure no one takes advantage of an entitlement program, Democrats are weary any conditions would unfairly alienate the poor or minorities.
The negotiations could also lead to give and take on unrelated issues, like corporate tax cuts, school bonds, or specific projects that are near and dear to local lawmakers - that includes the potential relocation of some state offices to a particular county.
In the long term, health care will continue to be a volatile issue in both state and national politics, and voters will have a major impact in 2020 when the President, Congress, the Governor and the General Assembly, among others, will all be on the ballot.