Protect services that benefit the state

Saturday, Feb. 19, citizens gathered in Coeur d'Alene and around the state to let our legislators know how important it is to avoid severe cuts in Medicaid services. I was honored to speak at the gathering, and my message was threefold: protect services that benefit the state, eliminate bureaucracy, and find appropriate funding.

It is a common perception that Medicaid is an entitlement program that is solely a burden to taxpayers. It is a large portion of the state budget, however, Medicaid also protects Idaho from costs.

Medicaid aids 20 percent of our population. It attempts to meet the health needs of our most vulnerable neighbors - children, the disabled, the mentally ill and the elderly. Even at the current funding level, primary medical care is inaccessible and drugs and alcohol frequently are more accessible to our mentally ill patients than medication, drug rehab and treatment, education or job training. Jail is frequently a stepping stone to accessing help and is too often the only way into the system.

Medicaid, used appropriately to access primary and mental health care, helps prevent and shorten costly state mental hospital stays, burdensome emergency room visits, law enforcement intervention and subsequent jail or prison time on state and local dimes, and maintains overall health to prevent catastrophic medical events requiring expensive hospitalizations and interventions.

Many primary care physicians cannot afford to accept Medicaid clients because the fees don't cover their overhead costs. Mental health services, including medication management and counseling provide medical stability. Psychosocial rehabilitation services provide a safety net for people whose mental illness affects their ability to function in society. These services enable people to care for themselves, by teaching them to fish, not giving them a fish.

Federal matching adds $2.33 for every state dollar spent. This means that a $50 million state reduction will result in a loss of approximately $116.5 million in federal funds, for a total reduction of $166.5 million. This money is not "doled out" in a vacuum; it is used to pay health care workers, mental health workers, support facilities for providing care for Medicaid recipients, uninsured patients, the elderly and disabled clients. It is distributed throughout our communities to hospitals, nursing homes, mental health institutions, pharmacies, physical therapists, pharmacists, counselors, rehabilitation facilities, community health centers, physicians and nurses.

From proposed cuts, Idaho stands to lose an estimated 4,000 jobs and approximately $208 million in economic activity. The devastation from cuts to services will cost the state more than savings earned through cuts. Loss of tax revenues due to lost jobs and businesses alone could result in $30-$50 million in state funds.

Our legislature faces a daunting conundrum with an estimated $92 to $137 million budget shortfall this year. With Medicaid approximately 20 percent of our state budget, trimming the program has to be part of the solution.

But these cuts have to be targeted at the paper trail and duplicative bureaucracy at the state and federal level. Legislators should look first to cut bureaucratic malfunction, duplication, counterproductive clinical meddling and exasperating, redundant paperwork. As of now, only services are on the chopping block. Certainly the same is true on the federal level. In fact, the federal hiring and birthing of new bureaucracies is expected to continue to accelerate. Adding a $10 co-pay for Medicaid services would generate an estimated $1.2 million in revenue and an increased co-pay for those using illegal drugs could help curb costs.

Even with such reforms, more money is needed. There is no money to prevent cuts to valuable services. We need to find new, creative ways to meet these needs in our state and communities. If the new health reform act is implemented, nearly 40 percent of our population will be eligible for Medicaid, further straining our state budget. Several excellent proposals are on the table. These are simple, fair ways to raise money to prevent catastrophic cuts to our state budget that do not involve regressively taxing people for working and being productive through increased income tax.

Improving and enforcing the state Internet sales tax, as demonstrated by other states, will add more than $30 million to our state revenues in addition to putting our local businesses on a level footing with out-of-state competitors and preserving revenues and jobs here at home.

A proposed tobacco tax could increase revenues by $50 million with a $1.25 per pack tax. The same tax on other tobacco products would raise an additional $2.9 million. This revenue should be directed to enhance our state budget for primary, mental, preventive and health education needs.

The current cost of tobacco use to Medicaid alone, in our state is $83 million a year. The costs soar to $319 million a year when you consider the costs incurred for caring for the uninsured and all citizens of the state. Further, the unemployed are roughly twice as likely to smoke as the employed. De-incentivizing an expensive and destructive habit would be a step in the right direction. Chronic disease costs the nation $277 billion in health costs annually and $1.046 trillion in lost productivity annually. The cost of chronic disease in Idaho from 2003 data was just under $1 billion. The seven top chronic disease typically cited are cancer, diabetes, heart disease, hypertension, stroke, mental disorders and pulmonary conditions. Smoking is a primary cause, implicated, or a complicating factor in all of these.

This tax alone will save the state money. Adding $1.25 per pack of cigarettes will reduce youth use by 19 percent, a savings that will reverberate and magnify with generations. Every state that has significantly increased its tobacco tax has had substantial increases in revenues, while reducing smoking and its costs to society.

Please lobby your legislators to enact these reforms, and educate yourself about health, community health and mental health issues. We must think of new ways to care for each other in our communities.

Leanne Rousseau, MD, is a board certified family physician. She serves on the Region I Mental Health Board.