Reading Gov. Chris Gregoire’s proposed 2011-2013 budget is devastating. It details harsh cuts to essential services and organizations.
But as stated in the budget’s introduction, “while our costs continue to rise, revenue growth is stagnant.” Despite a harsh economic downturn, voters have again refused to support nominal tax increases which could ease some historic deficits. Therefore, deep cutbacks will be implemented in nearly every facet of our state’s government.
Extensive cuts are unavoidable to keep a semblance of balance to the budget. However, I am troubled by the trend of cutting Medicaid’s benefits for preventative care. Eliminating coverage for routine services seems counterintuitive to achieving long-term financial savings.
Nationally, the number of emergency room visits is climbing. An August 2010 article in the Journal of the American Medical Association reported that ER visits are rising and the largest increase is by adult Medicaid patients. More than 15 percent of adult Medicaid patients reported making two or more visits to an ER every year.
This upswing is likely due in part to a lack of education regarding the cost of emergency room treatment. However, it can also be attributed to a lack of available routine services.
As of Jan. 1, Medicaid will no longer provide routine adult dental care such as examinations, cleanings and x-rays. For adults age 21 and older, only emergency dental treatment is covered.
This may not seem significant. However, a 2000 study published in Pediatric Dentistry examined a three-year cumulative comparison of costs for emergency dental care versus preventative treatment. It found that it cost an average of $6,498 to manage dental-related symptoms in an emergency room environment as opposed to $660 to provide preventative treatment in a dental office.
Washington’s First Steps, Maternity Support Services and Infant Case Management programs also were proposed for elimination. These services provide assistance for low-income pregnant women and their babies. They include drug, nutrition, and childbirth education, transportation, medical care, and a system of support during the critical months of pregnancy and post-partum.
They are in place to ensure proper pre-natal care is obtained and that infants receive the level of medical attention they need.
Another program targeted for elimination was Medicaid’s pharmacy benefit. This would end coverage for prescription medications provided by a retail pharmacy for adult clients age 21 and older. Presumably this would include maintenance prescriptions such as oral insulin and drugs to lower blood pressure and cholesterol. Without coverage for such drugs, urgent care visits are inevitable.
First Steps, MSS, ICM and adult prescription coverage have been restored to the current budget. However, it should not be assumed that these programs are safe from future reductions or eliminations.
Ironically, the 2011-2013 budget mentions investments aimed at avoiding unnecessary emergency room visits such as $2 million allocated for the Tacoma Hilltop Health Center. In the governor’s 2011 policy brief she cites examples of savings initiatives aimed at improving “quality while reducing waste and inappropriate care.”
She mentions redirecting patients away from emergency rooms and toward community-based clinics. She also references a Patient Review and Coordination program which would monitor clients who overuse “high-cost services such as emergency rooms.”
And yet, some of the cuts in this budget would, by design, compel patients to obtain emergency room care.
To refuse routine care and provide treatment only on an emergency basis, we are disregarding the time-tested axiom of “an ounce of prevention equals a pound of cure.”
We must strive to keep preventative care available and a high priority for all members of society. Such a goal will assist in maintaining a healthy population and budget.
Kris Coyner is an activist for immigration justice and civil rights. She and her partner are raising 1-year-old triplet daughters near Shelton. A member of The Olympian's Diversity Panel, she can be reached at firstname.lastname@example.org.