No Steven King novel was ever so horrifying as the new safety net cuts facing Washingtonians.
In advance of a Nov. 28 special legislative session, state agencies have proposed cuts toward a target of as much as $2 billion on top of $10 billion in cuts made since 2008. The cuts are intended to erase a projected revenue shortfall of more than $1.25 billion, which may grow in November’s revenue forecast, and rebuild a prudent reserve.
One hardly knows where to begin cataloguing the pain. Medicaid cuts are magnified by a lost federal dollar for every state dollar saved.
• A half-million Washingtonians – mostly seniors and those with disabilities – could lose Medicaid pharmacy benefits.
• Maternity support services would be terminated. So would school-based medical services for 22,000 kids.
• Child Advocacy Centers, where children suffering physical or sexual abuse receive assistance, would be eliminated as part of huge cuts in the state’s much-sued Children’s Administration. In the South Sound, that would close centers in Lacey and Tacoma.
• A cut of more than a half-billion dollars would add to the suffering of 80,000 citizens with developmental disabilities, long-term care needs or mental health issues who are served in the community. These Medicaid clients have already experienced service cuts of up to 18 percent and the delay of training for their caregivers.
• As voters debate whether to privatize liquor sales, all state-funded alcohol and substance abuse services would be eliminated for adults – excluding pregnant or parenting women.
• Boarding homes that renovated, or built, to exacting state Medicaid standards for assisted-living clients would lose the rate add-on they were promised to compensate them for those costs.
• In the “no good deed goes unpunished” category, nursing homes would join hospitals in seeing their voluntary payment of a provider fee to shore up Medicaid funding backfire. Having cut hospitals $261 million in the last session, the state now proposes to cut nursing homes $16 million.
The return on the fee was already less than one implemented in 2003 and derided as a “bed tax” in the 2004 gubernatorial campaign. While cutting nursing homes, the penny-pinching state also, impossibly, imagines it can place up to 150 Western State Hospital patients in them.
We have become a state subjecting only the sick and college students to new taxes, and cuts at the same time.
How do we triage our way through this? There are few remaining options that haven’t been tried.
Oregon is roughly three-fifths Washington’s size, yet its counterpart to Washington’s Basic Health Plan (BHP) serves more than twice as many enrollees. The BHP, again facing elimination, was “saved” by the Legislature by dropping enrollment to 33,000.
Rather than arbitrarily picking health care winners and losers through an ever-smaller BHP, a more rational policy approach may be better funding federally qualified community health centers, which experienced an $86 million cut last session. Such clinics allow all citizens lacking a medical home to access at least some primary health care outside of the hospital emergency rooms to which many turn.
Yet dismantling the BHP leaves us in a tough spot when, in 2014, federal health care reform expressly facilitates its use to insure the low-income, and bandages will not staunch hemorrhaging in the rest of our safety net.
A just society cannot allow its most vulnerable citizens – sexually abused or sick kids, those with profound disabilities, frail seniors, or even adults struggling with addiction (who we’ll pay for in jail if untreated) – to bear the brunt of this wretched economy.
Looming over this homegrown horror story is the “other Washington” – where severe federal Medicaid and Medicare cuts are being embraced by Democrats, including the president, and Republicans alike.
Political careerism must yield to engaging citizens with an honest discussion of our revenue needs. At a minimum, we must find a dedicated, stable source of funding for the vulnerable – such as a minimal payroll tax (a half-cent on every dollar earned would generate more than $600 million a year) – that takes them off the roller coaster they’re on.
Where’s the leadership?
Olympia attorney Brendan Williams is a former state representative and long-time advocate on long-term care issues.
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