With the federal economic stimulus bill signed, states will soon receive $200 billion. Some of the money is earmarked, but governors have been given leeway on how to spend $135 billion, according to Stateline.org. One main branch of this revenue stream that offers flexibility is the $87 billion for Medicaid. That money will flow into the states’ general funds and can be used to offset their budget cuts.

In Washington, the health care community is concerned that if too much of that money is diverted, the state’s safety net will be hopelessly frayed. The governor’s budget, released in December, calls for more than $900 million in health care cuts. Those reductions, combined with mounting unemployment, could mean that the ranks of the uninsured will grow by 20 percent. Basic Health would lose about 42,000 clients, and the cessation of the General Assistance for the Unemployable program would cut loose nearly 16,000 more.

Some Democrats in the Legislature have begun talking about a package of tax increases for the November ballot, but it would be unwise to pin health care hopes on the unlikely prospect of voters absorbing tax hikes as housing prices drop and the employment picture darkens.

It is also unrealistic to expect that all of the cuts will be restored. On Thursday, the state learned that its budget gap is $2 billion wider than the previous forecast, which nearly matches the amount of federal Medicaid money headed our way. However, health care advocates make a strong case for a significant restoration of the cuts.

First, the money is being sent via Medicaid, so Congress obviously expects the states to shore up health care.

Second, communities would incur significant costs by cutting off health care lifelines. About two-thirds of General Assistance for the Unemployable clients have drug and alcohol problems or suffer from mental illnesses. Many of them will become homeless or wind up in jail. Exacerbating this is that detoxification centers are also facing budget cuts.

Increasing the uninsured population would also put more pressure on community health centers and hospital emergency rooms, where, by law, patients must be treated. According to a 2007 survey of the state’s community health centers, nearly 40 percent of the patients were uninsured; another 40 percent were on Medicaid. So the fate of that Medicaid funding is critical. The centers note that they risk losing doctors if the level of uncompensated care continues to rise and that it is time-consuming to replace them. Hospitals already absorb significant charity-case costs, and treating the uninsured ultimately means higher health care costs for all when insurance premiums rise.

Third, spending on health care helps save and create jobs, the central focus of the stimulus package. In Spokane County, about one in five jobs is tied to health care.

Finally, compassion dictates that in times of trouble government should lend a hand to the most vulnerable people in society. Keeping the health care safety net sound is vital to that mission.