Washington state health safety net strained by cuts

Growing budget deficits and voter approval of anti-tax ballot initiatives have led Washington Gov. Chris Gregoire and state lawmakers to implement or consider cuts that could force certain community health centers to close and increase the state's uninsured population by tens of thousands of people.

Gregoire and the Washington Legislature have proposed or approved more than $4 billion in cuts over the next 2½ years. Cuts to help close the fiscal 2011 deficit include:

• Revising the payments for federally qualified community health centers to save $20 million.
• Ending Medicaid dental, vision, podiatry and hearing services for most adults, saving nearly $9.5 million.
• Ending school-based medical services for special education students, a $3.3 million cut.
• Eliminating state co-pays for Medicaid enrollees who also are eligible for Medicare drugs, saving $3.2 million.

"The safety net will be stretched thin in some places and eliminated entirely in others," Gregoire said in a statement. "For the functions that government no longer will be able to provide, we must turn to neighbors, private charities, faith-based organizations and other local programs."

Other cuts enacted by Gregoire are scheduled to take effect on March 1 or in the fiscal 2012-13 budget, but they still could be reversed or amended by the Legislature, said Washington State Medicaid Director Doug Porter.

In addition, Gregoire proposed cutting Basic Health, a state health insurance program covering nearly 60,000 low-income residents who don't qualify for Medicare or Medicaid. The program would end on July 1.

The state's budget options are limited by tax-reduction ballot initiatives approved by about two-thirds of voters in November 2010. "They're really in a bind," said Len Eddinger, senior director of legislative and regulatory affairs for the Washington State Medical Assn.

Porter said the reduced health center pay could cause some of them to close. Most community health centers operate on margins that would be erased by the state cuts, Porter said.

"The governor made choices that will literally cost people their livelihoods and even their lives," said Rebecca Kavoussi, assistant vice president of government affairs for the Community Health Network of Washington, a statewide health plan administered and served by community health centers.

Porter said Gregoire resisted cutting physician Medicaid pay because the state pays only about 50% of Medicare rates. But doctors now will be responsible for providing interpreter services to about 70,000 Medicaid enrollees who need them.

"That's kind of a rate cut to them if they continue to see patients that don't speak English," he said.

Many physicians are reacting to the uncertainty by aligning themselves with large clinics and hospitals, said Dean Martz, MD, president of the Washington State Medical Assn. "The people of the state really have made it pretty clear that they want the government to work hard at reining in spending."