Budgets are about priorities, and it is no surprise that Gov. Paul LePage and his administration have different priorities than recent previous administrations.
In a broad sense, LePage believes government should be smaller, more effective and cost less so state taxes can be lower. He has applied this to the Department of Health and Human Services as well.
LePage and DHHS Commissioner Mary Mayhew speak frequently of helping “the most vulnerable.” What is less emphasized is that, in their budget, this comes at the exclusion of helping others.
This is where the work of legislators will be crucial as they dig into LePage’s budget proposal for DHHS. The questions aren’t whether funding nursing homes is a higher priority than temporarily helping young adults, or whether General Assistance must be cut to help young adults with autism. Lawmakers must avoid such either-or questions and let core principles guide them. Is it acceptable, for example, for some seniors to go without drugs they can no longer afford? Is an increase in homelessness OK?
DHHS has set some budget priorities that should garner broad agreement. For example, the state is long overdue in maintaining compliance with a consent decree covering clients of the former Augusta Mental Health Institute. The budget proposed by LePage would allocate an additional $14 million for community mental health services, which are sorely needed. Maine was a national leader in the deinstitutionalization movement, but too often, patients were moved from mental health institutions into their communities without adequate services. This has left many without adequate treatment and support. It runs up costs in other sectors of government, including corrections and General Assistance.
Eliminating waitlists for essential services is rightly another priority. More than 2,200 Maine people are on waitlists for home and community-based services. This means parents who care for an adult child with severe disabilities at home, for example, are left scrambling to cobble together daily care, sometimes having to quit work or consider sending their child to a nursing facility, where there can be waitlists, too.
Another welcome emphasis in the DHHS budget is primary care, which would see a continuation of higher reimbursement rates for MaineCare patients, under the proposed budget. These rates were temporarily raised under the Affordable Care Act, but now the state needs to fund them. Having MaineCare recipients build relationships with primary care providers is better for their health and can ultimately cost less money by preventing expensive emergency room visits. However, access to primary care doesn’t magically solve all problems.
Take opiate addictions. The governor’s budget would eliminate MaineCare coverage for methadone, which is given at clinics, in favor of Suboxone, which is prescribed by licensed primary care providers. While encouraging recovering addicts to get primary care is a good goal, the two medications aren’t interchangeable, and Suboxone is not effective for those with the strongest addictions.
Of course, the money DHHS proposes to spend on nursing homes, waitlists, mental health and other areas must come from somewhere. In the proposed budget, that somewhere is General Assistance reimbursements for towns and cities, the state’s Drugs for the Elderly program, spending on public health and support for immigrants. The biggest concern is that DHHS plans to continue to push people away from its services under the mantra that they can take care of themselves or find other sources of support.
The worst example of this dangerous speculative thinking is that those whom DHHS will no longer help can simply get a job after taxes are lowered.
“Part of the motivation for getting DHHS spending under control was to facilitate a lower state income tax to grow Maine’s economy and provide opportunities for the very people DHHS serves,” Mayhew said in a budget address earlier this month. “There is no more transformative hand up than a good-paying job.”
The link between tax cuts and job creation is far from direct or proven. In the recent case of Kansas, big tax cuts haven’t sparked the job growth proponents promised, and they have prevented critical public investments.
As a major recipient of state and federal dollars, debates about DHHS often focus on money. But this spending also is about people. Lawmakers must fund the department in a way that doesn’t hurt Maine people and pit one population against another.