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Mar 31, 2008 4:57 pm US/Eastern
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"People Will Die"
MIAMI (CBS4) ―
State Rep. Julio Robaina and I were discussing the state's budget crisis and the cuts being proposed to the area generally described as health and human services. Robaina is a member of the legislative committee that oversees state funding for health care and social services.
Exactly how serious are the cuts?
"People will die," the Miami Republican declared. This was neither hyperbole nor political posturing, but merely a statement of fact.
Florida is in the midst of the worst budget season in recent memory with legislators facing a $2.5 billion shortfall for 2008-2009. This is on top of the $1.5 billion they cut out of the current year's budget.
While the focus so far has been on the impact to schools, perhaps the harshest cuts will be to those who are most vulnerable, including the weak and the infirm.
Here are just a few of the recommendations by the Republican leadership in the Florida House:
Eliminating hospice care for 8,000 terminally ill Medicaid patients
Eliminating hospitalization costs for 16,000 transplant patients
Eliminating treatment for 2,300 children with cleft lips or cleft palates
Eliminating funding for the state's Pediatric AIDS Network
Cutting reimbursements to nursing homes by $278 million and reducing staffing levels at those facilities, allowing a much higher nurse-patient ratio "This budget kills people," State Rep. Kelly Skidmore (D-Boca Raton) said, agreeing with Robaina's assessment. "The cuts that we are contemplating will result in people not getting the healthcare they need and will result in deaths; it will result in people dying."
Skidmore is the lead Democrat on the same committee as Robaina and they have both been studying the budget and the proposed cuts at length.
Overall, health and human services will lose more than $1 billion in next year's budget. Some of these cuts may be averted through negotiations with the Senate. But anyone who believes that many of these cuts aren't going to happen or that they represent some sort of scare tactic is deluding themselves.
"These are the most significant cuts that I've seen in the eight years that I've been up here," said State Rep. Jack Seiler, the ranking Democrat on the House budget committee. "These are much more significant than even what we saw after 9/11."
The state's economy is in freefall. The housing bubble has burst. Unemployment is up. Consumer spending is down. There is talk of laying off 1,800 correction officers in the state prison system, cutting staffing within the courts by 11 percent, and foregoing the state's $100 million pledge toward Everglades restoration.
"They are such large numbers and they are across the board," Seiler noted. "Everybody is taking a hit and some of the people taking a hit, can't afford to take a hit."
Indeed, the cuts targeting the frail and elderly may be the cruelest cuts of all.
Let's start with the elimination of hospice care for 8,000 terminally ill Medicaid patients. "The message is, `Well, you are going to die anyway, so why should we spend money on you?'" Skidmore said. "I don't think there is anything more heartless than that. Under this proposal if you are one of those 8,000 people, you will not die with dignity. You will die in pain and alone."
The House plan calls for wiping out $168 million from the so-called Medically Needy program effecting approximately 20,000 people who earn too much money to qualify for Medicaid but can't afford the bills that come with a liver or kidney transplant.
In a logic that would make sense only in the halls of the Capitol, the proposal would allow individuals to qualify to receive a liver or a kidney. And the state would actually help you obtain a liver or a kidney. But the state won't pay for the operation to transplant your new liver or kidney.
As Skidmore says, only half-jokingly, perhaps the state will give these patients their new organs in a box and tell them to go to some other state for the surgery. Skidmore says the state is playing a dangerous game with local hospitals, like Jackson Memorial Hospital.
Federal law requires hospitals to provide a certain level of care for those who need it, regardless of their ability to pay. So legislators in Tallahassee are eliminating the funding for performing transplants, believing hospitals will perform the surgery anyway and absorb the costs.
"We're cutting the amount of money we provide to hospitals in this budget by $500 million already," Skidmore said. "So their ability to provide for their patients is already being hurt. Now we are going to expect them to pick up even more of the costs for care and treatment. How will they be able to do that when we are pulling the rug out from under hospitals as well?"
But the reality is by placing additional hurdles in the system; some folks will just give up or will wait until it's too late before being treated.
And when the emergency rooms at Jackson and Broward County Medical Center become overwhelmed, and the costs skyrocket, it will be the local taxpayers in Dade and Broward who will have to come in and bail them out.
The AARP has called the cuts to nursing homes unconscionable. Because the state is cutting nursing home funding by $278 million next year, the legislature is also planning on suspending requirements that those institutions maintain nurse-patient ratios the state mandated seven years ago.
Other proposed cuts would dramatically scale back the number of state investigators examining child abuse claims, cut millions from a program to help foster kids move out on their own when they turn 18, and close the state's only tuberculosis hospital.
The lack of humanity expressed in the state's budget, is matched only by its shortsightedness. Many of the programs being cut receive matching funds from the federal government. No state dollars mean no federal dollars coming into state coffers.
"This will have a domino effect," Skidmore explained. "It will be even worse next year when we lose all that federal money."
Added Seiler: "We are leaving dollars on the table that other states will gobble up."
And yet with all of these problems, state Republicans refuse to consider any efforts to raise revenue by closing some of the tax loopholes for special interests and corporations.
One plan, which would have prevented large, multi-state corporations like Wal-Mart, from transferring their profits out of Florida to avoid paying corporate taxes, failed on a straight party line vote. That plan, which 30 other states have already enacted, would have raised almost $400 million in new revenue.
Another idea pushed by some legislators to raise the tax on cigarettes by a dollar a pack has garnered lukewarm support. A dollar increase on cigarettes would raise $1 billion.
Hopefully as the public becomes better informed about the dramatic cuts being offered, they will pressure legislators to take a closer look at some of those loopholes and to take a closer look at their priorities.
Because if they don't, people will die.
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