A Balanced Approach to the 2010 State Budget

Raise sufficient new revenue to protect the effective health care safety net programs upon which hundreds of thousands of Washingtonians depend. Prioritize funding for Community Health Services (CHS) grants, Basic Health, General Assistance-Unemployable (GA-U) and children’s coverage. Maintain Medicaid adult dental coverage and the Maternity Support Services program.

An all-cuts budget would eliminate health coverage for 100,000 people virtually overnight, raising the uninsured total in Washington to nearly one million. It would eliminate services for 50,000 high-risk pregnant mothers and 120,000 adults in need of dental care. Just as the number of uninsured people is rising, an all-cuts budget would also eliminate state grant funding that helps offset the costs of their primary medical and dental care.

The ongoing recession means the state has fewer resources to help meet the growing needs of struggling families. Without new revenue, the health care programs that form the fabric of our state’s health care safety net will disappear. We need a balanced approach to our state budget that puts both families and our state’s economy on the track to recovery as soon as possible.

The 2009 Session devastated the primary care safety net. Washington’s community health center (CHC) system is already at the brink. Last year the state balanced the budget deficit on the backs of the working poor, cutting basic services to the bone. These deep cuts financially destabilized the CHC system at the same time the number of uninsured patients dramatically increased.

As a result, many CHC patients are experiencing longer wait times. CHCs have also had to make other painful choices that hurt their communities. During this biennium, over 85% of CHCs are laying off staff and 75% are reducing or totally eliminating cost-effective programs like maternity support or behavioral health. This creates additional work for our primary care providers and exacerbates the difficulties we face in retaining and recruiting them, which in turn limits patient access to care.

Washington’s health care safety net cannot sustain further cuts. Although we have sought every efficiency possible to shield our patients from feeling the impact, the elimination of virtually every health care program in Washington except the core Medicaid medical program would be devastating.

• Eliminating Basic Health, GA-U and coverage for children who would otherwise go without care will cut access to primary, specialty and emergency health care for 100,000 people.
• Eliminating CHS grants will limit access to cost-effective primary care for the uninsured across the state and threaten our ability to keep our doors open.
• Eliminating vital Medicaid programs like Maternity Support Services and adult dental will not make the need disappear—it will simply make treatment more costly. There will be an increase in low birth weight babies. People suffering from excruciating dental pain will miss work and end up in overcrowded emergency rooms.

Cuts cost us all more. The question isn’t whether we will pay for the growing costs of caring for the uninsured as a State, but how we will pay. We can pay for comprehensive programs that build the health of people and communities or we can pay via:

• increased and inappropriate utilization of hospital emergency rooms and/or urgent care clinics for primary care;
• longer hospital stays due to people presenting with progressed clinical illness;
• increased community morbidity and mortality due to, for example, babies born with life-long disabilities; and
• higher insurance premiums (including for state-funded state employee coverage).

The wisest investment the state can make in these turbulent economic times is in its community health center and public insurance program infrastructure. These investments will ensure that our communities receive the right care, at the right time, in the right venue and in a proven cost-effective manner.

We need a balanced solution. If Washington is to pull out of the recession soon, another all-cuts budget is not an option. It’s time to identify resources to help struggling families and our economy weather this storm. The Governor has unequivocally stated that cutting our way out of the problem is not a solution that Washington can live with—and we agree.

For over 25 years, our system has provided solutions to some of the state’s most intractable problems and made positive contributions to the state’s health care system. Our system is now struggling to maintain its viability and serve the one-tenth of the population that relies on us for health care. The proposed cuts would dismantle much of the health care infrastructure built over the past 30 years just on the cusp of national health care reform.

The Legislature must join the Governor in committing to raising sufficient new revenues to protect our safety net and communities. We are already building the public will for a balanced approach that puts both families and our state’s economy on the track to recovery as soon as possible.