A Healthy Blog

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



April 16, 2009

The House Ways and Means Committee released their proposed FY2010 budget today. The budget cuts deeply into health priorities, including prescription drugs for seniors, public health prevention programs, mental health, and other areas. Without restoration of these cuts and new revenues to rebuild our health infrastructure, these cuts will harm the health of vulnerable Bay Staters.

Deep Cuts
Public health programs took wrenching cuts. The House Ways and Means proposal calls for cutting nearly a quarter of the DPH budget compared to the FY09 budget, and some areas were cut deeper. Compared to FY 09, these are the budget cuts proposed in the following areas:

  • Health Promotion/Disease Prevention – 50%
  • Oral Health – 41%
  • Domestic Violence Prevention and Services – 37%
  • Smoking Prevention and Cessation Services – 37%
  • Infection Prevention and Control Program – 32%
  • Early Intervention, a cost-effective program serving children birth to three with developmental delays – 27%
  • School Health Services – 23%
  • Teen Pregnancy Prevention – 22%
  • Substance Abuse Services – 21%
  • Communicable Disease Control Program and State Laboratory – 15%

Cutting these prevention programs will only add to the cost of health insurance, including health reform programs. More detailed analysis will come from the Mass Public Health Association in the coming days. We will be working with MPHA and others to reverse these cuts which continue the dismantling of the public health system we all rely upon.

Other cuts directly affect health access for poor people. The Prescription Advantage Program, which fills in the severe deficiencies in the federal Medicare drug benefit, is set at almost half last year's level. Mid-year cuts have already hurt seniors dependent on this vital program, and further cuts will inevitably lead to higher acute care costs when people have no way to pay for medically-required medicine. We will be working with AARP and other senior groups to reverse the damage. Cuts in the Healthy Start program appear to imperil pre-natal care for very low income women. And elimination of the MassHealth Outreach and Enrollment grants will leave thousands of vulnerable people, particularly those without English skills or with special needs, without any assistance in trying to navigate the complex eligibility and renewal process. Many will simply drop off the rolls, losing access to care they are entitled to.

Moving Backward
The budget also moves backward on many of the hard-won achievements of the past year. Despite passage last year of landmark children's mental health legislation, funding for the mental health consultative services program, which has been proven successful in reducing the rate of expulsions from preschools, was completely eliminated. Also, funding for child and adolescent mental health services was reduced by $3.4 million and earmarked funding for the Massachusetts Child Psychiatric Access Project was eliminated. Despite a major federal funding opportunity complementing the state's commitment to electronic health records, funding is eliminated for the E-Health Institute required to access the federal funds. Gains in health quality, exemplified by the recent infection control enforcement, will be reversed by the cuts to DPH and Betsy Lehman Center's work.

Counterproductive Cuts
While most of these cuts can fairly be described as only leading to higher long-term costs, some of the cuts will lead to immediate increases in spending or losses of revenue. Funds are completely eliminated for the Prescription Drug Academic Detailing program, authorized in last year's cost control bill. This program has been demonstrated to provide immediate savings that far exceed the cost of the program. Funding for the Bureau of Substance Abuse Services is below the amount required to continue receiving level federal funding and will force the state to forego millions in federal revenue.

Brightish Spots
Not all the news is bleak. The House proposal makes no explicit cuts in MassHealth eligibility or benefits, and funds the Commonwealth Care and Health Safety Net programs. The budget increases to $10 million funding for the Masshealth medical home pilot program, which is establishing patient-focused primary care systems in health centers. Legislative language increases flexibility for the Children's Medical Security Program, allowing for benefits to be improved.

Federal Funds Transparency
The Mass Budget and Policy Center rushed out a comprehensive overview of the proposal, including the health provisions. They critique the budget for substituting federal relief funds for planned draws on the state's stabilization, or rainy day fund:

[T]he cuts recommended in the House Ways and Means budget are deeper than they would need to be if the state were to use all of the federal stimulus money to maintain services – as Congress intended – rather than also to reduce draws on the stabilization fund. The American Recovery and Reinvestment Act distributed billions of dollars to state governments to achieve two goals: to protect vulnerable people and important investments from excessive budget cuts, and to stimulate the national economy by giving states money to spend in their local economies on goods and services that their people need. If states use a portion of the federal money not to maintain spending on essential services, but rather to avoid spending their own reserves, it would lessen the impact of the federal stimulus, potentially undermining the national recovery effort and lengthening the recession.

We echo this call, and also strongly object to the lack of transparency on the use of the federal Medicaid stimulus funds (from the increase in the Federal Medical Assistance Percentage (FMAP) reimbursement rate). There is no indication how the House uses these funds, intended to forestall cuts in health programs. Just today, Republicans attacked other states for shifting the Medicaid funds to other programs. We call on the House to deposit all additional federal FMAP funds in an identified account, so that the public can have assurance that the funds are being used for health care as intended.

And finally, we underscore again the need for revenue - both targeted efforts like closing the loophole that allows non-cigarette tobacco products to face lower excise taxes than cigarettes, or by improving health and raising revenue by removing exemptions for alcohol and junk food - and long-term consideration of progressive taxation that funds the programs we all depend on.

We will be working with legislators on both restoring cuts and finding new revenues. Details on the specifics will be posted on this blog, and the HCFA web site. Debate on the budget starts April 27.
Brian Rosman