House Budget: Funds ACA, Cuts Dental, Cuts Public Health. But It's Mostly About the Revenue.
It's all about the revenue.
Yesterday the House released its proposed budget for the upcoming fiscal year. With the House counting on much less revenue than the Governor called for, they used two strategies to bring the budget into balance: make lots of cuts, and use lots more one-time revenue sources. Although transportation and education face the biggest cuts compared to the Governor's proposal, there are some gaping holes in health care as well.
What follows is based on our first quick read of the House proposal. We'll update with some more details and links as our friends do their reviews. (UPDATE: the Mass Budget and Policy Center has very good coverage of the health care budget in their brief, here. Also, the very helpful Mass Law Reform Institute's summary is here (pdf).
ACA Coverage Mostly Funded
The House proposes to fully fund the ACA Medicaid expansion. The budget also includes the Governor's (and our) proposal to maintain affordability for people transferring from the Commonwealth Care program, by providing a "state wrap" to supplement federal tax credits. Without this wrap, these low-income adults would face major premium and cost sharing increases. We commend House Ways and Means Chair Brian Dempsey for keeping the state's promise of affordable coverage for those who need help paying for coverage.
The House also adopted the Governor's proposal to extend MassHealth coverage through the end of the month, to reduce gaps in coverage as people transition between plans, and to maintain our extended eligibility for pregnant women.
A few key items were left out of the House budget. First, the budget shortchanges the administrative staff MassHealth needs to process the applications and renewals under the complex changes that the ACA will bring. The House slices over 60% from this line item (4000-1602). Representative Paul Brodeur will propose an amendment to add back funds, which is critical to improve application and eligibility review processing times, reduce paperwork backlogs and decrease call-waiting times.
The total MassHealth budget is over $200 million less than the Governor wanted. We're not sure what the implications of this will mean for people who depend on MassHealth for their health needs. The budget also rejects coverage for a small number of legal immigrants who would not be picked up by the ACA, and a proposal to use the new, more favorable, income definitions for a group of people with disabilities who the state planned to include in standard MassHealth coverage.
Medicaid Dental Services Not Restored
The House budget continues the shameful policy of providing only limited dental benefits to adults in MassHealth, including 120,000 seniors and 180,000 people with disabilities. While the Governor proposed to restore these benefits effective January 1, under the House budget over 700,000 low-income people will face worsened overall health due to lack of good dental care. The cuts force people to use costly emergency and inpatient hospital settings and to seek temporary relief of pain caused by lack of access to restorative care. Cuts have also created a major cost shift to the Health Safety Net program. Representative Scibak will be filing an amendment to fully restore dental benefits in Masshealth, and we urge everyone to contact their Representative to support this amendment.
Public Health Takes It Again
In what has become a continuing refrain, the House again imposes more and more cuts on public health. For example, look at the DPH's funding for health promotion and disease prevention. In addition to keeping people healthy and improving the quality of life, this work is the lynchpin for reducing health care costs. In 2010 this line item received a bit over $6 million, a very small sum for the value it provides. This year, the Governor proposed just $3.3 million, a cut from last year's $3.4 million. The House proposal for this work: a paltry $2.3 million (full details from MassBudget tool here). Smoking cessation got cut, too (details), just as the state looks towards a long-overdue tobacco tax increase. The cut will reduce our capacity to provide cessation help, just when the tax increase drives demand for people to try to quit smoking.
We will continue to review the budget, which will be debated the week of April 22. But the bottom line is that without sufficient revenue, the state will be forced to make real cuts and bad choices. The long-term health of the state requires adequate investments in a broad set of basic needs. We continue to call on the legislature to reverse the years of tax cuts and the systemic, structural imbalance in our state finances, and approve a progressive tax package that allows are state to grow and thrive.