Sense of Austerity Goes Beyond Budget, Hits Legislature

The sense of austerity in California this spring isn’t limited to talk of next year’s budget. A pervasive penny-pinching mood has settled over both houses of the state Legislature.

When the Assembly and Senate Appropriations Committees met before Memorial Day, both groups moved more bills to back burners – or off the stove entirely – than they have in recent memory.

The Senate Appropriations Committee held a record number of bills in committee, passing out fewer than one-fifth of the bills on the Senate suspense file, a sort of interim holding cell for bills calling for money from the state’s general fund. From a slate of 158 bills, only 33 were passed out of committee. The total cost of the bills approved, not including legal settlements, was less than $2 million.

The Assembly Appropriations Committee was asked to consider bills seeking a total of $2 billion in funds. The panel approved bills that would cost the state $23 million, a record low for the decade, according to Assembly records.

“This is a tough year – the state is out of general fund money,” said Sen. Tom Torlakson (D-Antioch), chair of the Senate Appropriations Committee. “We worked hard to be fiscally responsible and hold as many bills as possible.”

“California is struggling to pay its bills and meet our existing needs,” said Senate President Pro Tempore Don Perata (D-Oakland). “We were judicious in making sure that only the most urgent bills move forward. This is the best example to illustrate how deep the problem is: politicians aren’t spending money.”

Health Care Bills Shelved

Pecuniary consciousness in committees carried over to the Senate and Assembly floors last week, where lawmakers were wary of passing any bill with a price tag — large or small. Among the bills shelved or defeated were several dealing with health care, ranging from the very expensive — a $7 billion plan to improve prison health care — to a modest bill seeking dental screenings for elderly, low-income people.

“Very few Senate health care bills survived the fiscal review process this year because of the state’s $17.2 billion deficit,” said Sen. Elaine Alquist (D-San Jose), chair of Budget and Fiscal Review Subcommittee No. 3 on Health, Human Services, Labor and Veterans Affairs.

“The Senate Democrats understood that it would not be appropriate to approve bills that added to the state’s costs by creating new programs when we, at the same time, may have to cut critical programs like Medi-Cal provider rates, eliminate dental coverage for Medi-Cal patients, and increase the co-pays for participation in the Healthy Families Program,” Alquist said.

Bills that did make it through fiscal screening tended to be revenue neutral or close to it. Alquist amended her bill, SB 1058, aimed at stemming hospital-acquired infections, and it passed the Appropriations Committee.

“I was able to get my bill through the fiscal review process by narrowing the bill and making it entirely fee supported so that it would not have an impact on the state’s general fund,” Alquist said.

Her bill, which pays special attention to methicillin-resistant staphylococcus aureus, a particularly virulent hospital infection, requires hospitals to clean and disinfect a variety of fixtures ranging from televisions to cardiac monitors. It also calls for hospitals to report hospital-acquired infection rates to the state Department of Public Health.

Modest Dental Screening Bill as Example

As an example of how tight times are, consider this relatively inexpensive, innocuous and mostly unopposed bill, AB 2229, by Assembly member Jared Huffman (D-San Rafael).

Called the Mary Keel Dental Screening and Early Detection Act, AB 2229 would provide one dental examination per year for Medi-Cal beneficiaries living in long-term care facilities in California.

Dentists would be reimbursed $15 for each screening. State officials estimate there are about 285,000 seniors living in long-term care facilities who qualify for Medi-Cal. Huffman’s office estimates 10% to 30% of them would follow through with the benefit and get a dental screening each year.

Total cost for the state would be somewhere between $425,000 and $1.2 million per year, according to estimates from Huffman’s office. The Assembly Appropriations Committee estimate was similar: Total cost of the program would be between $1.2 million and $3.2 million, half of which would be paid with federal Medicaid funds.

‘A Death Sentence’

In early 2007, Mary Keel, a 76-year-old Alzheimer’s patient in a convalescent hospital in Petaluma, died from an easily preventable dental infection. She had been in the nursing home for 19 months and received no dental care during that period.

In Huffman’s eyes, she was a victim of a decision made by California lawmakers who, in 2002, elected to make several reductions in Medi-Cal services. It was a time similar to this spring — the state was facing a budget deficit, and legislators were looking for ways to save money. One was to reduce benefits in the adult portion of the state Denti-Cal program. Starting in 2002, Denti-Cal has allowed only one initial dental exam and no periodic exams for adults.

“We were trying to replace that benefit that was taken away in 2002, and we even narrowed the scope of people who would be eligible to those living in long-term care,” said Paige Brokaw, a legislative assistant in Huffman’s office.

“Historically, senior citizens have a lot of problems with oral infections, but most of them can be dealt with successfully if you catch them in time. And the only way to catch them is to have regular screenings,” Brokaw said.

“This seemed like a pretty logical, inexpensive way to do it,” she added.

Huffman’s literature for his bill says that while the original cutback “saved a few dollars as a stop-gap measure in 2002, it has had the unintended result of increasing overall health care costs for seniors living in long-term care facilities. For people like Mary Keel … it has been a death sentence.”

Low-income people, especially elderly low-income people, have more dental disease, more missing teeth and more difficulty obtaining dental care than any other member of the general population, Huffman said. He said research indicates correlations between poor oral health and a variety of systemic health problems such as coronary artery disease, diabetes, respiratory illness, stroke and other heart disease.

“Exploring what can be done to remedy the poor state of oral care in skilled long-term care facilities needs to be a priority for our most vulnerable citizens,” Huffman said when introducing AB 2229 earlier this year.

His bill was rejected by the Assembly Appropriations committee and “is essentially dead for this year,” Brokaw said.

“If things look better financially next year, we might try again in January, but I don’t know … things look pretty grim right now,” Brokaw said.

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