| December 23, 2002
Generous health
spending becomes budget target
By REBECCA COOK
Associated Press Writer
OLYMPIA (AP) _ Sue Stauffer's teeth are optional.
So
are her glasses, her asthma medication and her cane.
Stauffer, 59 and disabled, relies on the state Medicaid program for her
health care. Many of the services she uses are "optional" _ meaning the
federal government doesn't require them, but Washington state pays for
them anyway.
As
Washington faces its worst budget crisis in a decade, lawmakers are
looking hard at these optional services, which cost about $1 billion a
year in Medicaid alone. In some cases, they're deciding the state can no
longer afford to be so generous.
"It
pains me deeply," Gov. Gary Locke said last week, explaining his
decision to recommend cuts in health care. "But we don't have the
money."
Stauffer fears she's the one who will feel real pain. Locke has proposed
eliminating vision, dental and hearing services for adults on Medicaid.
A
former office worker, Stauffer wears thick glasses and is trying to find
a dentist who can help her hang on to her last remaining molar.
"I'm blind as a bat without my glasses. If they break, I'm going to be
so housebound. I do not understand the state's thinking," she said. "If
I can't see and I can't chew. ... It's going to make me further
withdrawn from the world. I can't stand this."
Medicaid is the joint federal and state program that provides health
care coverage for about 900,000 people in Washington state: the
disabled, the elderly, and poor children and their parents. It costs the
state nearly $3 billion a year.
But
the reach of state health care extends far beyond Medicaid. Health
benefits for state workers cost taxpayers $600 million a year. And in
1993 the Legislature started the Basic Health Plan, a subsidized health
insurance plan for about 125,000 people who make too much money to
qualify for Medicaid but not enough to afford private insurance. It
costs the state about $250 million a year. Many other states don't offer
similar coverage.
Through these programs alone, the state provides health care coverage to
about one in five residents. According to Census data analyzed by the
Washington Research Council, Washington ranks third in health care
spending.
Washington's trailblazing role in health care has cost taxpayers dearly.
The amount the state spends on health care has increased 327 percent
since 1991, compared to an 89 percent increase for the rest of the
budget.
The
health care expansion climaxed in the 1990s, as economic good times
spurred lawmakers to extend low-cost care to as many people as they
could. As the state now confronts a $2 billion budget hole, those
programs might as well be marked with a big target.
About one-third of Washington's Medicaid services are optional. In
addition to dental and vision, optional services include hospice care,
organ transplants, physical therapy and interpreter services.
The
state also covers optional groups. For instance, the federal government
mandates Medicaid for children aged 6-18 with a family income below the
federal poverty level, which is $15,020 for a family of three. But in
1994 and 2000 Washington expanded Medicaid to cover kids whose parents
make more than twice that.
The
governor's budget cuts nearly every aspect of health care spending. He
proposed eliminating some optional Medicaid services and kicking 60,000
adults off the Basic Health Plan. State workers already will have to pay
more for their health insurance. While the governor's proposal is merely
a suggestion, the rate of growth in expensive health care programs
almost assures that legislators will follow Locke's lead and make some
cuts.
Although these programs may be optional, they don't feel that way to
Stauffer and other people who use them.
"You kind of get locked in," said state Medicaid director Doug Porter
said. For every cut in Medicaid, the state loses the same amount in
federal matching dollars. It's not impossible to cut health programs, he
said: "It's just real hard."
Locke says his budget protects health care for the most vulnerable
citizens. But this logic leads to uncomfortable arguments about who's
vulnerable and who's poor. Do you give health care to the asthmatic
child whose parents make $30,000 a year, or the 40-year-old with a
crippling neurological disorder who makes $8,000?
That's a choice no one wants to make. But unless Washington voters have
a strong and sudden change of heart about raising taxes, someone's got
to do the dirty work of writing the budget. |
