The Budget Breakdown: Amid budget crisis, hard health-care decisions: Where to cut?
People who are poor, mentally ill or disabled, and the community clinics that serve them — they're all facing serious hits as lawmakers looking to trim nearly $5 billion from the next state budget home in on a huge area of spending: health care.
Seattle Times health reporter
For more information about health programs in Washington:
Washington Health Program: www.washingtonhealth.hca.wa.gov
Pre-existing Condition Insurance Plan: www.wship.org/PCIP-WA/about_us.htm
Washington State Health Insurance Pool: www.wship.org
Basic Health Plan: www.basichealth.hca.wa.gov
People who are poor, mentally ill or disabled, and the community clinics that serve them — they're all facing serious hits as lawmakers looking to trim the state budget home in on a huge area of spending: health care.
Advocates for the poor argue that cuts to this part of the two-year budget would ultimately push costs to taxpayers as patients end up at emergency rooms or at publicly supported Harborview Medical Center.
But that's talking about the future, and the hard reality is happening now, as lawmakers this week begin the unhappy task of paring nearly $5 billion from the next state budget, bringing it down to just over $32 billion.
Health care is a huge state expense — at close to $10 billion, it's nearly a third of the two-year budget that will end June 30. It also involves many government entities and services that range from epidemic control to maternity care for at-risk moms to safety-net health insurance for working poor.
That number also includes nearly $2.5 billion for health-care costs for state workers, teachers and retirees.
Like the really big guy in the weight-loss group, the health budget looks to some critics like it could pare down without suffering too much. Senate Republicans have listed about $600 million in possible health-care cuts, along with $125 million in savings that could be achieved in part by making Medicaid patients pay part of their own costs.
A joint federal-state program, Medicaid provides health or nursing-home coverage to certain low-income people, including children, pregnant women and people with disabilities, among others.
Many of those cuts are also in Gregoire's 2011-2013 budget, which is now in the hands of lawmakers.
Among the governor's proposed cuts or eliminations:
• The state-funded Basic Health Plan, which insures 56,000 working-poor people — and has a waiting list of more than twice that number that grows by 300 people a day.
• Disability Lifeline, which provides grants and medical care for those temporarily disabled and unable to work.
• A medical-interpreter program.
• Care for undocumented kids.
• Grants to community clinics.
To save money for the rest of the current biennium, some services have already been stopped. Others — including Basic Health and Disability Lifeline — are set to end on March 1, leaving nervous patients and medical providers in limbo.
"If enacted, these cuts will be felt for years to come and will create enormous instability in our state's health-care system," with uninsured patients further crowding emergency rooms, says Washington State Hospital Association's Cassie Sauer.
Bev Ceccanti, 62, a Basic Health Plan patient from Tacoma, is worried.
Ceccanti, who once sold real estate, always bought private insurance and considered herself secure.
"I always thought, I'm a good salesperson, I will always do that," she says. But real estate cratered, and efforts to run a business and to retrain as a pharmacy tech didn't work out.
"Thank God I got into this Basic Health program," she says. "I don't have a skill that's marketable now."
Now, frightened by the program's precarious future, she compares the prospect of losing her coverage to playing Russian roulette with her life.
For some, the uncertainty has been even more unnerving. Ronald Cain, a printing operator from Randle, Lewis County, was laid off in 2007.
Now on Basic Health, he's in the midst of eye surgeries doctors say he needs to save his sight. The next was planned for mid-March — after the plan is to close.
"I'm on the ragged edge," says the 64-year-old Cain. "I'm stuck in limbo."
He worries about people with life-and-death issues but knows he's got a lot at stake, too — "whether I see or I don't see for the rest of my life."
March 1 deadline
Lawmakers must juggle deadlines, dollars, expectations and politics and have precious little time to do it.
A few threatened programs have already won temporary reprieves, with Gregoire recently rescuing — for now — hospice end-of-life care and prescription-drug coverage for adults.
She also restored coverage for noncitizens with potentially terminal conditions such as cancer, failing kidneys or who need post-transplant drugs.
And she's asked lawmakers to restore some Medicaid services that ended Jan. 1, including dental coverage for seniors and pregnant women, and hearing and vision care for adults.
Last week, the federal government agreed to provide additional Medicaid money the state can use for part of the expenses of patients now on Basic Health and Disability Lifeline. But the federal funds may not help save Basic Health beyond March 1, when it would close, according to Gregoire's proposal.
That's because "we don't think we can now even afford the state share for people currently on the program," says Doug Porter, who oversees the state's Medicaid programs. In any case, the new federal money wouldn't allow adding anyone to the program.
And it won't help Dennis Foucher, a 63-year-old former Basic Health Plan patient who had to drop the plan when premiums rose drastically a few years ago.
In addition to earlier surgeries for heart and artery blockages, blood clots and a hernia, he was recently hospitalized and diagnosed with diabetes. "I've got a pile of bills," says Foucher, a former cook.
Basic Health director Preston Cody says: "We've gotten a lot of letters from people in cancer treatment, asking what they can do after March 1. We have to say, 'We'll help you research other options.' That's the reality."
For some, the Washington Health Program, for people who can't afford individual policies, may work. Although unsubsidized, it's relatively inexpensive because it limits coverage to $75,000 or $100,000 a year.
Other patients may be able to afford state or federal high-risk pool coverage or may ultimately be covered by other federal health-overhaul programs set to roll out over the next three years.
Clinics at risk
It's not just patients who would be cut.
Gregoire's budget would cut $98 million from state grants and payments to community clinics which, counting federal matches, means losing $184 million.
"We're at risk of losing about a third of our budget," says David Flentge, CEO of Community Health Care, which runs medical and dental clinics in Pierce County.
Porter estimates that more than 400,000 new adults will begin signing up for Medicaid in 2014, when more people will qualify under the federal health-care law. "The clinic infrastructure will be critical to the state's capacity to care for these folks." If cuts force closures, that's a "very serious and credible threat."
Sen. Joseph Zarelli, R-Ridgefield, Clark County, the ranking Republican on the Senate Ways and Means Committee, argues that lawmakers' first step should be to make sure programs exclude patients whose incomes are too high or who aren't legal residents. "Then we can do more with less."
Zarelli also believes the state could save millions if Medicaid patients, whose health care is largely free to them, began paying co-pays or shared in other costs.
Porter, the Medicaid director, tried more than eight years ago to require cost-sharing by Medicaid patients who used emergency rooms for routine care or insisted on brand-name drugs when generics were available. The plan was trashed not only by advocacy groups but by both the state's congressional delegation and Legislature.
Is it an idea whose time has come — again?
"I learned a long time ago not to predict what the Legislature is going to do," Porter says. "I have no idea how this is going to shake out."
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org
Information in this article, originally published Jan. 13, 2011, was corrected Jan. 14, 2011. A previous version of this story incorrectly stated the position of Sen. Joseph Zarelli, R-Ridgefield, Clark County. He is the ranking Republican on the Senate Ways and Means Committee.
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