Cuts to health care to be widely felt

Health care services in Washington are set for a shake-up as the state’s medical safety net shrinks this summer.

About 40,000 people who rely on the state’s subsidized Basic Health Plan insurance will lose coverage in the next half year as part of nearly $1 billion in health care spending cuts that the Legislature authorized. The cuts will hit hospitals and clinics, and vaccination, drug treatment, public health, elder care and nursing home programs over the next two years.

Meanwhile, layoffs over the past year are adding to the ranks of the medically uninsured, which could reach 866,000 this year, according to state Insurance Commissioner Mike Kreidler’s office. That boosts the estimated rate of uninsured to 13 percent, or more than 1 in 8 residents.

Hospitals, community clinics and county health offices are bracing for the change.

“Right now we’re trying to figure out how deeply that goes. On top of the Basic Health Plan cuts, all the (community) health centers have seen an increase in the number of uninsured they are seeing,” said Rebecca Kavoussi, director of governmental affairs for Community Health Network of Washington, a Seattle-based umbrella group for community clinics that operate in Washington.

“There are no surprises here. We’ve said what impacts we thought would happen; now it’s coming true,” Kavoussi said. “There will be longer wait times for services for people. No health center wants to say that, because they are designed to meet the needs of people.”

Hospital cuts top $300 million

Statewide, hospitals are expected to see funding reductions of nearly $310 million, according to an analysis by the Washington State Hospital Association.

Lawmakers such as Democratic Sen. Karen Keiser, of Kent, said other options were not available this year, because there was not enough support for tax increases that might pay for the health care programs being cut.

Keiser was the chairwoman of the Senate’s health committee and has taken a lead role in health care reform at the Legislature. She told the Olympian’s editorial board last week that the cuts caused many sleepless nights for legislators as they tried to close a $9 billion budget gap with more than $4 billion in cuts that affected public schools and corrections.

Providence St. Peter Hospital Chief Executive Officer Jim Leonard said the hospital is tightening up its outlays by reducing spending on “literally hundreds of things” in an operation that has 130 departments. Savings should come from sending nurses and staff members home when business lags in certain departments; reducing overtime; top-level review before job openings are posted; reorganizing management; delaying equipment purchases; reducing energy use; and using video-conferencing instead of travel.

Community clinics struggling

Community health clinics don’t have reserves or profitable surgery units to rely on as Providence does, so funding is shrinking at operations such as Sea Mar Community Health. The agency operates a network of 16 health centers in Western Washington.

Sea Mar’s regional deputy director, Mary Bartolo, said Sea Mar officials have tried not to close off access to patients who might need care. But her network of clinics faces funding cuts of $3 million to $5 million statewide, because about 40 percent of patients at the clinics are in state-paid programs such as the Basic Health Plan and Healthy Options.

“We’re hoping that by planning and not filling vacant positions and finding efficiencies, we will not have to close our doors anywhere,” she said. “I think the effects will take a while to come into play. … It could be a few months before we start seeing the real impact. I think it’s going to be significant.”

No final decisions have been made, but if needed, the clinics might reduce supplemental services that include social workers, care coordinators, health education and behavioral health services. That will make doctor exams more complicated.

Sea Mar also is expanding some services, taking over the Women Infants and Children nutrition program for Thurston County’s public health agency, which no longer can afford to operate it. Bartolo said Sea Mar is one of the largest WIC providers in the state and is adding Clark County.

David Flentge, chief executive of Tacoma-based Community Health Care, said his agency already has closed a dental clinic in the past year. The agency has cut 30 positions and hopes to avoid more reductions, but care will be delayed for some patients and new patients might not be added.

“We have limited resources, so not everybody who calls is able to get an appointment. What we will do is give them an appointment in six weeks,” Flentge said of uninsured people who call for services that are offered on a sliding scale tied to income.

Help from Congress

Despite cuts, many people who qualify as needy under the law will not see their access to care reduced – provided they are able to find a doctor willing to take a state-funded patient. That is because Congress gave the state nearly $2 billion in economic-stimulus money for health care and related uses, averting cuts to programs such as Medicaid.

About 960,000 people in Washington qualify for Medicaid, children’s health and other programs for the “categorically needy,” and they should not see reductions in services, said Roger Gantz, director of legislation and policy for the state’s Health Recovery Services Administration.

These patients might have to wait longer to see a doctor, Gantz said.

Also, he said, the state’s Apple Health program serving children will expand to cover children in families earning up to 300 percent of the poverty level. This is part of the state’s push to cover all children, which extra federal money helped make a reality; a family of four could qualify with an income of a little more than $63,000.

But payments to pediatricians who take Medicaid and state-supported child patients are being cut 37 percent. Gantz said that comes after a 48 percent increase that took effect in January 2008.

Finding a doctor who will see a government-paid patient is becoming more of a problem in Thurston County, according to Kristen West, executive director for the CHOICE Network, which helps patients find insurance and care in a several-county area of southwest Washington. More doctors are limiting the number of Medicaid patients they accept, West said. She has heard of challenges that commercially insured patients have to be seen by a doctor, too.

She also is seeing patients who lost jobs, are age 50 to 60 and have homes that disqualify them from most charity care.

“There is almost nothing we can do for them,” West said.

County cuts uncertain

Lawmakers also cut $55 million in funds for vaccinations, which means the state no longer will provide reduced-cost vaccines to doctors and clinics. Sherri McDonald, director of the Thurston County Public Health and Social Services Department, said it mainly affects vaccinations against human papillomavirus, which is linked to cervical cancer.

Those vaccines will be available through private doctor offices, but at higher costs to patients.

Funding problems at the county level already led to the transfer of the WIC program to Sea Mar and, as of June 30, an end to family-planning and reproductive-health programs. This means an end to sexually transmitted disease testing at the county clinics.

The county also is bracing for reductions in mental health and drug-treatment funding, which it awards through contracts to private providers. McDonald said the actual cuts should be clearer in a couple of weeks.

Nursing homes cutting services

Some elder-care services will be cut, including $17 million from day health programs, which provide health services to the disabled or elderly. The cuts spare those who live at home with help from family members but eliminate services for those in adult family homes. This raises the risk that they would have to move into more expensive nursing homes, activists said.

But the state also is cutting about $75 million – half of it state dollars – from direct payments to nursing homes. Nursing homes will be looking for ways to absorb the 4 percent reduction through staffing cuts, said Lauri St. Ours, director of governmental affairs for the Washington Health Care Association. It represents 420 nursing homes and assisted-living centers around the state.

St. Ours said the cuts are not sustainable and thinks nursing homes might again ask lawmakers in January to put a bed tax or fee on nursing homes as a way to capture extra federal matching money.

“The rates go in effect July 1. … That’s when they’ll start to feel the pain,” she said.