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State Budget Plan Is ‘Ugly Beyond Belief’

The annual conference of the Insure the Uninsured Project (“From Reform to Reality: Building Better Systems of Care in California”) was supposed to focus on Medi-Cal expansion, the rollout of the health benefits exchange and how to get insurance coverage for the 6 million Californians who go without it.

But it was pretty hard to ignore the $12 billion in cuts to state programs proposed by Governor Brown — with roughly half of those cuts impacting health services.

The national rancor over the attempt to repeal health care reform slipped into the statewide conference. Orange County is about to announce that it will not be part of the California Health Benefit Exchange.

“Orange County is not going to participate in the exchange,” CalOptima CEO Richard Chambers said. “Personally, I thought it would be good if we were not so dependent on Medicare,” he said, “but politics have prevailed, and we will not be participating.”

In terms of the state cuts, health care advocates weren’t the only ones appalled by the massive hits to Medi-Cal, Healthy Families, Adult Day Health Services (ADHS) and other human service programs. State fiscal and policy analyst Jean Ross felt the pain, too.

“When you look at specific cuts, it’s clear that some people who could live safely at home will go to nursing homes. And that some number of the 230,000 children in the Healthy Families program will become homeless,” Ross of the California Budget Project said. “It’s important for advocates, for policy people, for voters in California to understand. These are the choices on the table.”

Ross is talking about the proposed hard cap on provider visits, an increase in Medi-Cal co-payments, the elimination of ADHS, diversion of First Five money and the reduction of many other health-related services.

And that’s just the beginning, Ross said, if $12 billion in proposed tax extensions aren’t approved by state voters in the next election.

“This budget is ugly beyond belief, even in the best case scenario,” Ross said. “I hate to think about the worst case scenario.”

Ross is not given to hyperbole — she has seen a lot of state budgets come and go in her years as an analyst, and has remained matter-of-fact about most of them.

She said this budget doesn’t have the “gimmicks” of many budgets she’s seen. Now, she said, with the downturn in the economy, there has been a huge shift in what state government is capable of taking on.

“We need to figure out what we want to fund,” Ross said, “and then we have to figure out how we want to do it.”

In this case, those $12 billion in cuts are happening, and if people or organizations don’t want a particular cut made, they need to figure out what else goes.

“We need to find ways to swap it out,” Ross said. “If you want to fund adult day health, you have to buy back something else. That’s just my pragmatic read of where the Legislature is at, and where the governor is at.”

But that idea rankles Steve Barrow of the California State Rural Health Association, because the flurry of subcommittee meetings taking place now, in preparation for a Mar. 1 vote, move too rapidly for any kind of reasoned approach, he said.

“I’m concerned that there is no time to present any alternatives,” Barrow said. “There’s no time to do any cost analysis.”

Barrow was referring to the idea that a lot of the preventive measures implemented in California were done, in part, because they saved money for the state in the long run.

The notion is that simply eliminating those programs might actually cost more, by moving people out of their houses and into nursing homes, out of prevention programs and into the more-expensive emergency room, psychiatric facilities or hospitals, which could end up costing the state more.

Barrow wondered out loud whether there shouldn’t be some kind of cost analysis, to see if these cuts actually do save money.

“We’re at a time crunch because if we don’t do this by March, then we can’t put the [tax] extension on the ballot,” Michael Cohen of the state finance department said. “We just don’t have the time.”

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