Dr. Wade Kendall remembers the last time Washington state had to dig deep to balance its budget.
It was 2011 and the state was still in the throes of the Great Recession. Revenue projections for the biennial budgets from 2007-2009 to 2011-2013 fell in 16 out of 17 quarters, according to a postmortem authored by the Office of Fiscal Management. In total, the revenue decline hit $12.6 billion.
Lawmakers had limited options. Raising revenue was challenging due to a law later declared unconstitutional that required a supermajority to pass new taxes, forcing policymakers “to slash funding for health care, schools and colleges, and other public investments that create jobs and support a strong state economy,” according to the Budget and Policy Center.
Among the cuts was adult dental benefits through Apple Health, the state’s Medicaid program.
“It was all to do with economics,” Kendall said. “The economy had crashed in ’08, and they started looking at budgets, and for whatever reason, that was a cut they made to make the budget work.”
A decade later, Kendall and other health care professionals and advocates are worried that when lawmakers convene in January, the same thing may happen again.
In September, as the state grappled with a massive projected hole in the budget as a result of the coronavirus’ impact on state and local taxes, departments were asked to submit proposals cutting as much as 15% out of their budgets from the General Fund. The Health Care Authority (HCA), which administers Apple Health, was hampered in what cuts it could offer. Many aspects of state Medicaid programs are required by the federal government, meaning that to achieve savings on the level of 15%, “optional” programs are outside of the core insurance benefit, like hospice and maternity health programs, along with programs that are funded entirely with state funds, like health care for undocumented children.
And, yes, dental benefits for 1 million Washington adults is back on the chopping block.
“It’s a shortsighted gain,” Kendall said. “It looks good on paper right now, but in the long term you end up paying more, because what they’re failing to recognize is that oral health is integral to systemic overall health.”
Cuts to preventative care programs like adult dental will ultimately cost the system more, advocates say. Medical problems become worse if dental services are delayed, and people will be forced to use the emergency room for urgent care, said Misha Werschkul, executive director of the Budget and Policy Center, a research organization that is focused on reforming Washington’s tax system.
“These are short term savings with long term costs associated with them, and it’s sort of penny wise and pound foolish,” Werschkul said. “The evidence is very clear for that.”
And the proposals are coming down even as overall demand for health care is rising. More than 100,000 Washington residents joined the state’s Medicaid program between the beginning of the pandemic and August 2020, bringing the total number of Washingtonians covered to 1.9 million.
Cuts to optional services do not fall evenly, said Emily Brice, a senior attorney and policy advisor with Northwest Health Law Advocates, an education and public policy organization that specializes in health care access.
The unifying factor is that these are optional services for states to cover in their Medicaid program or groups covered by the state but not through Medicaid. That typically means they tend to affect people who are more vulnerable because they’re not eligible for other programs, Brice said.
People like citizens of the Republic of the Marshall Islands, the Federated States of Micronesia and Republic of Palau, who are eligible to live and work in the United States but are ineligible for Medicaid without a Washington state-funded program extending those benefits. Interpreter services to help people access medical care are also up for cuts, as is prenatal care for low-income mothers, a service that studies show improves outcomes for children over the course of their lives.
If those children are undocumented, they may also lose access to medical care — Washington currently grants those families access to Apple Health for Kids.
The consequences of deferred care are very real, said Litonya Lester, Health Policy Director with the Children’s Alliance.
Lester recalls a parent whose child had a mild stomachache. It didn’t seem too serious, but because the mother had health care coverage, she took the child in, only to discover a more serious underlying medical condition that they were able to treat.
Now, in the midst of a pandemic that is already disproportionately impacting marginalized communities, is not the time to reduce health care access, she said.
“It kind of comes down to, are we okay with living in a country and living in a state where children’s race or ethnicity is a predictor of their health, or not?” Lester said.
She hopes not. Race is not the problem, racism is, Lester said.
The cuts are not a foregone conclusion. While the HCA was asked to submit proposals to cut 15% out of its budget in September 2020, the regular session for lawmakers will not begin until January 2021, and cuts would not be anticipated to take place until January 2022, according to the HCA proposals.
There is some hope that lawmakers will strive to avoid the kind of pain that was caused during the cuts of the Great Recession, Brice said.
“People still have a memory of how painful that was and how ultimately it was a long road, but many of these did end up getting restored in one way, shape or form,” Brice said.
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Follow Ashley on Twitter @AshleyA_RC.
Read more in the Nov. 18-24, 2020 issue.