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Tuesday, May 23, 2006

Circumventing the Process

Senator Sheldon Killpack
Co-Chair of the Health and Human Services Appropriations Subcommittee

Senator Lyle Hillyard
Co-Chair of Executive Appropriations

In the course of the 2006 Legislative Session, the Health and Human Services Appropriations Subcommittee heard countless requests for the funding available. They spent long, sometimes heartbreaking hours carefully prioritizing competing requests. Medicaid dental didn’t even make the list.

Now, somehow, it’s on the special session agenda.

Utah is unique in the fact that every legislator has the opportunity to sit on an appropriation sub-committee. Some legislators have the distinct opportunity to sit on the Health and Human Services Sub-Appropriation Committee. Many will argue that this is by far the most difficult committee on which to serve because you will simply never be able to meet everyone's needs.

Because human needs are so desperate and the resources are limited, the PROCESS becomes key in deciding what is funded and what is not funded.

Prior to the past legislative session we learned that – due to inflation, case load growth, changes in Federal funding, and utilization - we needed over sixty million dollars to keep programs whole as they already existed. During the session we learned that the Feds were going to deliver twenty million less than we anticipated for the 2007 fiscal year and 10 million less for the 2006 fiscal year for the Department of Human Services.

The committee spent several meetings listening to testimony from department heads, advocacy groups, industry leaders, and state and local leaders (not to mention six hours of public testimony). What resulted was a prioritized list of needs that was passed along to the Executive Appropriations Committee. To their credit our priorities were funded pretty much in the order the committee placed them.

However, many of our priorities were not funded at the level we hoped and some items were not funded at all.

Many worthy programs compete for the same funding. The following state needs were all prioritized ABOVE the Medicaid optional dental program:
  • Mental Health funding,

  • Ongoing additional funding for the medical examiners office,

  • Utah Birth Defects Network,

  • Additional DCFS caseload workers,

  • Etcetera.
Which one of these programs are less important than Medicaid dental? There certainly needs to be some rationale we can explain to advocates of other programs as to why they should not all try to short circuit the legislative process.

In some areas the very basics of the Medicaid program are in trouble. Providers are becoming leery of giving assistance to Medicaid patients because the reimbursement rates are so low. Increasing payment to providers was a priority to the committee - a higher priority than dental - but it was not funded.

Weighing and comparing competing priorities is incredibly important. There is a line a mile long of other optional Medicaid programs that did not get funded. It is bad policy and bad precedence to circumvent this process.

This would have been a bit more palatable had the Governor’s office given us any indication that this was important to them during the legislative session.

This move must be incredibly frustrating to those who play by the rules.


Anonymous Anonymous said...

It is sad to see these leaders standing behind process to justify a poor outcome. The choice is not between one health care service and another, the choice is between serving people and not serving them. Money is fungible. The legislature has chosen to treat road construction as an on-going expense, but health care as a one time expense. That is poor process, and illogical. The choice could be between emergency health care or creating a "Life Elevated" slogan.

5/24/2006 4:13 AM  
Anonymous Anonymous said...

What is really sad is that our Governor spends more time posturing then thinking through what he says and does. He says we are moving the prison to gain favor with some builders but the price is too high. He says cut income tax to up his approval rating but the numbers do not match up. He says drop sales tax but almost every program is under funded.

It is time for Huntsman to say that the people of Utah are more important then his photo in the newspaper.

5/24/2006 10:23 AM  
Anonymous Demosthenes said...

Your points are very valid. Yet, choosing to go without funding transportation, infrastructure, education, economic development, and a myriad of other vital functions would be reckless. Health care services are critical, but so is the revenue we use to pay for it - our taxes.

Investing in Utah's economy will provide those who are in need of State assistance with improved access to resources, broader funding of necessary services, and a bridge to self-sufficiency.

5/24/2006 11:02 AM  
Anonymous Anonymous said...

I haven't heard anything yet about the fact that approximately half of the money put into Medicaid last year still has not been spent because very few providers will accept Medicaid patients. Why put $2 million more in the fund that is not being spent, while neglecting other important needs?

5/25/2006 10:28 AM  
Blogger Kevin said...

I think that if everyone had a gym membership, took vitamin supplements, bought more fruits and veggies and went to sit down restaurants instead of fast food restaurants ... their health would be a lot better.

The government knows best tact would require universal gym memberships, government subsidies for fruit intake and additional tax credits for eating out.

It seems to me the realist approach is to realize that health decisions should be made by people. The government should be retreating from funding health projects and trying to find ways to help people be in the position to afford better care.

Everytime the government makes our health decisions, the individual people seem to end up with fewer, less desirable choices.

5/31/2006 9:21 PM  
Anonymous Anonymous said...

Kevin - "It seems to me the realist approach is to realize that health decisions should be made by people."

That is why we elect representatives... to speak for the people.

6/01/2006 8:45 PM  

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