program cuts that, if enacted, would deprive thousands of children of free
health insurance coverage and shutter four mental health facilities, and could
force women to pay for their own laboratory tests after rapes, according to
documents obtained yesterday by The Sun.
“It basically tells people if you are sick, leave the state,” said Sen.
Paula C. Hollinger, a nurse and chairwoman of the Senate Education, Health and
Environmental Affairs Committee. “It’s like taking health care off the
respirator and saying goodbye.”
The Department of Health and Mental Hygiene developed the list in response
to Gov. Robert L. Ehrlich Jr.’s request that agencies devise ways to cut
spending by 12 percent.
The elimination of programs, the governor has said, is the only way to
close a projected $800 million budget deficit without raising taxes.
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The governor and his aides said they had hoped to keep the proposals
confidential, issuing a gag order last month that prohibits agencies from
sharing budget requests with legislative analysts. Yesterday’s leak violated
that order.
“You hope that everyone within an administration would be on the team,”
state Budget Secretary James C. “Chip” DiPaula Jr. said. “There is a question
now that somebody might not be.”
Because an improving economy could make many cuts unnecessary, Ehrlich
staffers said they hoped to avoid the kind of outcry that followed the leak of
the health department’s budget planning document yesterday, as lawmakers and
health advocates digested the scope and specificity of the reductions under
consideration.
“These cuts are just immense and are devastating to public health, not just
in Baltimore but in the entire state,” said Dr. Peter L. Beilenson, the
Baltimore health commissioner.
The proposal would eliminate health programs for at least one in six city
residents, he said.
DiPaula would not comment on the list, saying he has yet to receive
submissions from the health department.
Ehrlich is months away from making final budget decisions before he submits
his next spending plan in January, DiPaula said.
“It’s unofficial, if not fake,” he said. “How can [The Sun] have something
that we don’t have?”
But outgoing state Health Secretary Nelson J. Sabatini acknowledged that he
asked his staff to identify programs not mandated by federal or state law that
could be eliminated.
To meet Ehrlich’s request for a 12 percent cut, the health department has
to identify about $430 million in programs, $50 million less than what the
draft list contains, he said. The department’s $3 billion-plus in general
state funds is supplemented by about $2.5 billion in federal funds.
“[DiPaula] has repeatedly said you can’t get to the level of reductions
that we are going to be facing by nibbling at the margins anymore,” Sabatini
said.
Last spring, Ehrlich launched a review of agency spending by asking
managers to complete a “strategic budgeting guide,” identifying
less-than-critical programs in the state’s $24 billion budget that could be
eliminated.
The health department proposals include eliminating a popular health
insurance program for children and pregnant women to save $47 million, and
abolishing health care for medically needy Medicaid recipients to save $115
million.
Another proposal would curtail a sexual assault evidence collection
reimbursement program, which a department budget planning document warns
“could lead to victims being billed, thereby creating a barrier to care.”
“Can you imagine a rape victim being charged for evidence collection?”
Beilenson said. “I cannot believe anybody would even remotely consider such an
inhumane budget cut.”
Revelations of cuts under consideration could renew discussions of slot
machine gambling as a revenue source, or could revive talk of scaling back the
state’s $1.3 billion education initiative known as the Thornton Plan.
At yesterday’s Board of Public Works meeting, Comptroller William Donald
Schaefer implored Ehrlich to find a way to raise more money but did not
suggest a source.
“I really believe that agencies are down as far as they can go,” Schaefer
said. “You might as well cut the agencies out altogether. … It will destroy
the morale of people.”
Pain inflicted by budget choices will be the governor’s responsibility,
said House Speaker Michael E. Busch, an opponent of expanding gambling and
Ehrlich’s chief rival in the slot machine debate.
Under Maryland’s budget process, legislators cannot add to the fiscal 2006
budget proposal that Ehrlich submits in January, Busch said.
“We obviously last year tried to find a revenue source, and the governor
rejected it,” Busch said, referring to a $670 million sales-and-income tax
package passed by the House. “Now he has to make the tough decisions.”
Other health advocates noted that the proposed health cuts would cost the
state money almost immediately. Women and children removed from Medicaid rolls
will arrive at emergency rooms for treatment. Health insurance bills for
Marylanders with coverage will rise to cover the cost, they said.
Also, a reduction in alcohol and drug treatment and mental health services
will mean more crime and an overloaded criminal justice system, they argued.
“It’s just a sham to say this proposal is going to save people money. It’s
going to cost money, in a way that hurts people,” said Vincent DeMarco, head
of the Maryland Citizens’ Health Initiative, which advocates a plan to cover
uninsured Marylanders by charging businesses that don’t provide health
insurance.
Del. Dan K. Morhaim, a physician and member of the House Health and
Government Operations Committee, agreed, calling the proposals “an illusion of
savings.”
“If a [treatment] program closes tomorrow, those people are going to end up
in the criminal justice system in a few days,” the Baltimore County Democrat
said. “Not a few years, but a few days.”
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Proposed cuts
Options for fiscal 2006 budget cuts in the state health department:
Eliminate inpatient and outpatient services for medically needy Medicaid
patients – $115 million
Eliminate health coverage for uninsured children and pregnant women – $47
million
Discontinue coverage of uninsured mental health patients – $27 million
Discontinue non-Medicaid mental health services for Medicaid patients – $16
million
Eliminate medical day care – $18 million
Reduce payments for Medicare deductibles – $12 million
Reduce payments for sexual assault victims’ exams – $400,000
Correction: In an article published Sept. 23, 2004, about possible deep cuts in Maryland health care spending, The Sun incorrectly reported that Gov. Robert L. Ehrlich Jr. had said the only way to close a projected $800 million budget deficit without raising taxes was to eliminate programs. The article should have said Ehrlich intended to use spending cuts and slower program growth to help cut the deficit.