WE ALL KNOW that Medicaid has borne the brunt of budget cuts. Headlines remind us of this almost on a daily basis. And yet itís easy to forget that thereís a human cost to these cuts.
Indeed, "out of sight, out of mind" seems to be the principle guiding most of those constructing next yearís budget for the Commonwealth. Otherwise, why would the governor and many legislators condone the recent cuts to Medicaid by leaving current levels of inadequate funding intact? Indeed, the House has proposed cutting the program even further in lieu of raising taxes to balance next yearís budget. Only the Senate has proposed restoring some of the care thatís been cut.
But Medicaid is an obvious target for budget cutters. Since 1993, state spending has increased an average of 2.1 percent annually, when adjusted for inflation. Over the same period, Medicaid spending has grown by four percent a year, according to the Massachusetts Taxpayers Foundation. Toss in the fact that the weakest members of the stateís constituency benefit from Medicaid ó the indigent, the chronically ill, the drug- and alcohol-addicted ó and the program becomes an easy mark for politicians.
But these "savings" donít come without devastating consequences. As Kristen Lombardi reports in this weekís Phoenix (see "Sentencing Addicts to Death," page 1), those who rely on the stateís patchwork of detox programs to overcome addiction are finding it harder to get the help they need. In January, the state subsidized the costs of maintaining 997 beds in detoxification centers. By this month, fewer than 500 such beds remained. By July 1, which marks the end of this fiscal year, the state will be subsidizing the costs of just 420 beds, a 58 percent drop. Advocates for drug addicts looking to get clean say that as many as 15,000 people will not get the help they need as a result of budget cuts made since January.
At the beginning of the year, Governor Mitt Romney eliminated Medicaid coverage for emergency detox centers for a savings of $7 million. He eliminated Medicaid funding for "second stage" detox treatment, in which addicts receive counseling on dealing with the psychosocial aspects of addiction and recovery, for a savings of $4 million. And he also eliminated funding for MassHealth Basic, which is a Medicaid program. The service paid for the health care of approximately 36,000 chronically unemployed Bay State residents, many of whom are also addicted to drugs or alcohol. Meanwhile, the state Department of Public Health, which has endured two straight years of budget cuts, has also chipped away at its funding for substance-abuse programs.
All told, $26 million in funding for programs related to drug detoxification has been squeezed from an already strained network of substance-abuse treatment programs. A good portion of these cuts went into effect in April. Just one month later, advocates for the drug-addicted noticed the effects of reduced access to services. Carl Alves, president of the New BedfordĖbased advocacy group Positive Action Against Chemical Addiction, says thereís been a spike in car and home burglaries, panhandling, and prostitution ó the sort of criminal activity that feeds a chronic drug habit. Meanwhile, the group recorded 10 heroin overdoses in the area in the past month; previously, the area averaged about 10 overdoses every three months.
The bottom line is that services are just harder to come by. Anyone who works in the field of drug addiction and recovery will tell you that detox services need to be available when an addict asks for help. "This population really needs service on demand. If theyíre turned away, we almost always lose them," Carol Eliadi, the director of the Worcester-based UMass-Memorial Community Healthlink detox program, tells Lombardi. Yet the program turns away 20 people each day; in January, it turned away half that number on a daily basis. The Boston-based CAB Health and Recovery Services fields as many as 75 requests for help each day. In April, it could admit only nine people per day; in January, the program was admitting 14 people per day.
It goes without saying that needs werenít being met before the most recent budget cuts were enacted. To continue to place such burdens on those who need our help the most is unconscionable. Itís too easy to balance a budget on the backs of the poor, the disadvantaged, and those who are our outcasts. But we donít have to do it this way. A favorite budget-cutting target of reformers is the Quinn Bill, a generous bonus program for police officers. In essence, officers can earn salary bonuses of 10 to 25 percent of their base pay by earning college and graduate degrees. Cities and towns shoulder half the costs of the bonuses; the state picks up the other half. The Massachusetts Taxpayers Foundation estimates that the program will cost the Commonwealth $41.5 million in 2003. Encouraging police officers to seek higher education is certainly a commendable goal. But if itís good for police officers to seek higher education, itís surely good for our educators and other public servants to do the same. Of course, we couldnít afford bonus programs that would encourage them to do so. And we really canít afford to keep the Quinn Bill in place, either. Not when you look at the numbers and see that by eliminating the program, the governor and legislators could restore the cuts made to detox programs and then some.
But our self-declared reformer governor supports the Quinn Bill. As does House Speaker Tom Finneran. The only state leader willing to talk about reforming the Quinn Bill is Senate president Robert Travaglini. This should be an easy decision for lawmakers. But it isnít when our society places little to no value on the lives of our most vulnerable citizens. And thatís a shame.
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