January 6, 2008
Spending on Social Programs - What Defines Compassion?
In expressing reluctance to cut social programs, some Democrat leaders in the General Assembly have placed such programs in the context of compassion.
In point of fact, Rhode Island spending on all social services in Fiscal Year 2005 was in the top third nationally [we are ranked fifteenth]. Our spending in the category of "Medicaid/Vendor Payments" was the fourth highest. Accordingly, lawmakers would have a good deal of reducing to do before they altogether "eliminat[e] whatever safety net we can provide", to quote an unduly alarmed Senate President Joseph Montalbano.
It should be noted that from FY2004 to FY2005, Rhode Island spending on social services dropped from eleventh to fifteenth. The General Assembly is to be commended for taking this step in the right direction.
Inasmuch as the operating deficit is now conservatively projected at half a billion dollars and Rhode Island taxes are the seventh highest in the country, the work cannot stop there. Spending reductions must continue across the board. Marc reports that the House Republican Caucus has suggested "5% cuts in the current year for all departments in 20 days" and "10% cuts in the 2009 budget for all departments in the first 10 days". Another goal for the General Assembly might simply be averageness in all above-average spending categories.
Returning to social spending, setting aside for a moment the question of the benefit of these programs - to the state as a whole as well as to recipients - and focusing on the matter of compassion, two issues arise. What level of spending constitutes compassion? If we were last in that spending category, would we not still be compassionate for offering such programs at all? No, says the poverty industry? How about being in the bottom third instead of the top third?
And secondly, is it possible, is it even appropriate, to discuss compassion - to contemplate compassionate programs - without bringing in the question of feasibility; i.e., affordability?
How many 'benefits' will the social workers be able to provide when the state goes bankrupt?
Maybe they should focus on serving those who truly need it, and doing it efficiently in order to be able to continue doing it.
Posted by: Greg at January 6, 2008 9:28 PMRemember SCHIP? -Known as Rite Care in RI.
Only 3 states have more ADULTS enrolled in the State CHILDREN'S Health Insurance Program.
Wanna guess who one of them is?
Not that you're surpised:
http://www.boston.com/news/nation/washington/articles/2007/11/10/proposal_to_drop_adult_schip_coverage_sooner_draws_ire/
Proposal to drop adult SCHIP coverage sooner draws ire
Move eyed as way to get GOP votes
By John Donnelly, Globe Staff | November 10, 2007
WASHINGTON - The debate over expanding the children's health insurance program has run into another battle: the coverage of adults.
The State Children's Health Insurance Program, known as SCHIP, currently covers about 6 million people, including nearly 700,000 adults.
Negotiators in Congress who are working out details about the expansion of the decade-old initiative are considering a timetable to phase adults out of the program.
Under the current legislation passed by Congress - and vetoed once by President Bush - adults would be shifted out of SCHIP, and possibly into Medicaid programs, in two years. But in an attempt to get more Republican votes and Bush administration backing, negotiators are now considering whether to shorten the timetable to remove adults. Some conservatives want them out of the program immediately.
That has drawn strong criticism from liberal Democrats and several states, including Rhode Island.
The children's health insurance bill "was designed to focus attention on the most vulnerable, the kids," Linda Katz, policy director at the Poverty Institute at Rhode Island College School of Social Work in Providence, said yesterday. "But there's lots of research that when parents are covered, it's more likely kids will be covered, too."
Bush, who has vetoed one SCHIP bill and has threatened to veto a second version passed by Congress earlier this month, strongly opposes including adults in the program even though his administration has consistently granted waivers that allow 11 states to cover low-income adults. He also wants to increase the funding for the program by $5 billion over five years, compared with Congress's bill which would increase that by $35 billion.
In one of his weekly radio addresses last month, Bush said: "When it comes to SCHIP, we should be guided by a clear principle: Put poor children first. I urge Republicans and Democrats in Congress to support a bill that moves adults off this children's program - and covers children who do not qualify for Medicaid, but whose families are struggling."
Four of the 11 states that cover adults - Rhode Island, Minnesota, New Mexico, and New Jersey - have spoken out in recent days about continuing coverage of adults for as long as possible. In some of the 11 states, more than half of those covered under SCHIP are adults. Rhode Island covers adults who earn up to 185 percent of the poverty level - or roughly $38,000 for a family of four.
Under SCHIP, Rhode Island provides health insurance for about 11,000 children and 11,000 adults. One of the adults is Laurie Heltman, 49, of Providence, a single mother. Her 16-year-old daughter is also covered by the program.
Heltman said in an interview yesterday that she applied for SCHIP coverage "because it was becoming more and more expensive to pay for medical insurance, to the point where we couldn't afford it anymore. My kid got very, very ill. She had Lyme disease, and it was misdiagnosed for a very long time. For 10 weeks, she was on an IV in our home.
"Without this program, even if we had to do just the copays, I would have been broke. I would have ended up quitting my job and going on welfare."
Heltman, who runs a small laundry operation out of a storefront, said: "I work really hard, and I do everything I can not to ask anybody for help. But if it's going to cost me $1,000 a month for medical insurance for me and my child, that's impossible. Sometimes people need a little bit of help."
Still, said Nina Owcharenko, a healthcare policy analyst at The Heritage Foundation, a conservative think tank in Washington, the debate should be focused on SCHIP's purpose.
"I think it's a question of whether you want to let SCHIP remain very focused and targeted on children, or does it become a quasi-Medicaid program," Owcharenko said. "States are using SCHIP as a vehicle to expand coverage to other populations."
Rhode Island, like other states, asked the federal government for permission to expand the SCHIP program to adults because the reimbursements were greater than under Medicaid. For adults receiving Medicaid coverage in Rhode Island, the state receives 53 cents for every $1 spent. Under SCHIP, the state receives 67 cents on the dollar.
If SCHIP coverage ends for adults, the additional cost to Rhode Island to cover them under Medicaid would be $8 million, according to Katz, the policy director at the Poverty Institute.
She said there is no guarantee that the state would cover that cost in a tight fiscal year; Rhode Island is facing a possible deficit of more than $200 million in the current fiscal year.
That fiscal uncertainty in Rhode Island and the other states prompted the response late this week to the possible early loss of adult SCHIP coverage.
"We certainly understand this has caused a lot of questions and concerns with people," said Amy Rosenthal, program leader at New England Alliance for Children's Health, a Boston-based advocacy group. "But I think there's a lot of different tools with SCHIP that have proven to be successful, including covering adults."