A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Governor Proposes Budget: "fiscal responsibility is not simply about aggregate budget numbers but also the values embedded in our budgets"

Governor Proposes Budget: "fiscal responsibility is not simply about aggregate budget numbers but also the values embedded in our budgets"

January 27, 2010

Governor Patrick released his H. 2 budget proposal today, for fiscal year 2011, starting July 1. The budget continues the Governor’s strong commitment to health reform and the state’s vital health infrastructure. There are some cuts, including some painful cuts that we will do our best to overturn (there are also some important increases). But given the extraordinarily challenging economic situation, we profoundly appreciate the Governor making health a top priority for his administration. To the extent cuts are proposed, the Governor and EOHHS Secretary Bigby have made clear that these are temporary cuts that will be restored as revenues return.

As usual, the administration has provided a wealth of information online, making the Massachusetts budget proposal among the most transparent in the country. Key health-related resources include a detailed examination of the health issues in the budget, and a budget briefing on health reform.
As always, the
best instant analysis comes from the Mass Budget and Policy Center, including a concise summary of the health care proposals.

The budget includes several of we have long termed “win-win” policies. These are revenue proposals that both provide needed funds for health needs and improve the public health by discouraging consumption of unhealthy products. The public health impacts also reduce the cost of health care in the state, further benefiting the state budget. This strategy has been a successful tool, and we strongly applaud the Governor’s bold steps.

First, the Governor proposes to remove the sales tax exemption from candy and soda. This policy would put us in line with 40 other states, including Connecticut, Maine and Rhode Island, which do not exempt candy and soda from their sales tax, and it attacks obesity, a critical health crisis. Second, the budget closes a loophole that exempted cigars, smoking tobacco, and smokeless tobacco from the 2008 cigarette tax increase. By closing the loophole, the Governor’s budget discourages harmful tobacco use, particularly by teens. Revenue from both of these changes is earmarked for health care programs.

The budget also anticipates the extension of enhanced Medicaid funding, now scheduled to end on Dec. 31, 2010. Given the strong, bi-partisan support for extending the increase in state reimbursement rates (ours increased from 50% to 61%), this is an appropriate, prudent step that forestalls deep cuts that would have been damaging to the state’s economy.

With these revenue measures (along with others), the Governor is able to recommend a budget that continues our success in health reforms. Funds are provided to allow MassHealth enrollment to grow by 3%, including a substantial strengthening of children’s mental health services. The Commonwealth Care program is also slated to expand, by some 20,000 people. While there is much to cheer in the budget proposal, we highlight a few of the specific issues that jumped out on a first read:

MassHealth Adult Dental Care: The Governor proposes restructuring adult dental benefits for adults in MassHealth and Commonwealth Care, similar to the unadopted proposal from last fall. MassHealth would continue to cover preventive and emergency care, excluding restorative services. These would be available at Community Health Centers through the Health Safety Net, though the CHC dental system does not have the capacity to absorb all of the demand for services. This cut will have serious long-term impacts, including increased costly emergency room visits, job loss, and poor overall health for Massachusetts. We will work with the Administration to ensure all enrollees can access and afford the care they need.

Legal Immigrant Coverage: The Governor proposed a substantial increase in funding for the temporary “Bridge” program for special status legal immigrants. We commend the Governor for his ongoing efforts to provide benefits for this group, yet we also believe it is fundamentally wrong to separate a population based on immigration status. We strongly support full reinstatement of legal immigrants into Commonwealth Care, and we know the administration agrees with this goal. Until these funds are available, we will work with the legislature and the Administration to ensure that all immigrants have access to the temporary Bridge program, and that services are fully available to all enrollees.

Prescription Advantage, the state sponsored prescription assistance program for low-income elderly and some disabled individuals had yet another reduction in its budget. We were pleased that funding was allocated for outreach grants, thought a surplus in the Connector’s budget, and funding was increased for the DPH tobacco control program.

As the budget moves through the legislative process, we will keep our eyes on the big picture and small details that matter for vulnerable people dependent on our collective efforts through state government.