Governor’s budget erodes the safety net

At first, I was prepared to give Gov. Malloy a whole lot of rope on his budget.  I understand the need to cut spending and raise revenue, and I’m prepared to do my part.

But then I read the fine print.  I still understand the need to address the State’s deficit, but to do so on the backs of the poor, elderly and disabled – this would be a huge mistake.

The governor’s budget would impose copays in the Medicaid program.  It would clamp down on what’s considered a “medically necessary” dental service, substituting the judgment of the Department of Social Services or some insurance company it hires to administer Medicaid for the State for that of the treating physician.  There are huge cuts to community-based care, and greatly increased copays for the Connecticut Home Care Program for Elders.  It would provide a less “generous” benefit package to low income adults.  The Governor’s budget also would reduce the number of people who can participate in the HIV/AIDS waiver, and eliminate funding for AIDS drugs.  I could go on; sadly, there is more.

The governor promised to protect the “safety net.”  Adding copays for people on Medicaid – up to 5% of a household’s income and up to $20 per month for drugs – will erode that safety net, encouraging people to skip care, to forgo their medication.  We know this.  A recent report from Moody’s Investors Services says higher deductibles and copays in the commercial insurance market has resulted in lower utilization of health care.  When people don’t get the care they need, though, it’s an illusory, short-sighted savings.  When you stop taking your medication, your illness only gets worse, until you are so sick that you end up needing far more expensive care in an emergency room or in a hospital.  Indeed, Pitney Bowes has proven that eliminating medication copayments increased adherence and, thus, reduces health care costs.  Why, then, does it make sense to anybody to increase copays, especially for the poor?

Of course, Connecticut is not the only state that is cutting health care for the poor; indeed, compared to other states, Gov. Malloy’s budget is kind.  Earlier this week, the United States Department of Health and Human Services told Arizona that the federal government doesn’t have the authority to stop it from cutting 250,000 low income adults from the Arizona Medicaid program because the waiver under which they are covered is expiring, and states are not required to renew waivers.  That’s 250,000 people who will be cut off from their sole source of health care financing.

President Obama talks about winning the future through innovation, education, and building our infrastructure.  That sounds great, but what does that do for the Medicaid recipients with chronic illnesses for which they no longer will be able to get care?  What do we expect these people – sick people – to do when they cannot get the care they need?

We can talk about the economics of all of this until we’re blue in the face, and even the economics militates against these sorts of cuts.  But none of that addresses the heartbreak and dejection that comes from being faced with a world that is cold and hard and harsh in the face of illness and poverty.  It’s not just that we will add to the ranks of the disabled as people struggle to go without health care, getting sicker and sicker until they no longer can be productive.  It’s also that, in America, we shouldn’t cast sick people aside like yesterday’s trash.  That’s not the world I want to live in.

It is incumbent on all of us to find ways to manage deficits without depriving people of health care that allows them to remain productive and as pain free as possible.  Period.

In the world in which I want to live, we treat each other with compassion.  We understand that it’s only through great good fortune that we are not she.  We must never forget that.  In the world in which I want to live, we find a way to care for each other.  Not only because it’s economically sound policy, but simply because it’s the right thing to do.

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