Mike Tidmus

California is facing a huge financial crisis that Republican Governor Arnold Schwarzenegger has described as financial Armageddon. Confronted with a $42 billion dollar shortfall and the possibility having to issue IOUs to creditors, or simply not pay the state’s bills, as soon as February, the state has decided to balance its budget, in part, on backs of the people who can least afford it and who are least likely to be able to fight back: people with AIDS, the blind, the disabled, the elderly, and those who care for them.

There’s some good news, some really bad news and, as of today, a faint glimmer of hope.

First, the good news: According to Project Inform, the Governor has ordered that the AIDS Drugs Assistance Program (ADAP) remain fully funded:

Project Inform expressed mixed reactions today to Governor Schwarzenegger’s FY 2009–10 budget proposal. In the context of a $41.6 billion state budget deficit, the HIV/AIDS advocacy group thanked the Governor for proposing no cuts to HIV/AIDS programs and for fully funding the AIDS Drug Assistance Program (ADAP), which provides free HIV medications to low-income Californians. But it also expressed alarm over proposed cuts to the Medi-Cal program that would negatively affect health care for almost half of Californians living with HIV.

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ADAP will provide medications to approximately 34,000 Californians in FY 2009–10, one-sixth of whom reside in San Francisco. The Governor placed $56 million in new pharmaceutical rebate revenue into the program, bringing its total cost for the year to $418 million. The State’s share of the program will be $96.3 million, the federal government will contribute $88.4 million, and rebates paid by drug companies will contribute 233.3 million. The total cost of all California HIV/AIDS programs, including Medi-Cal, will be $1.14 billion in FY 2009–10.

Medi-Cal is the California version of Medicaid, the federal health program that, with state cooperation, provides access to healthcare for qualifying, low-income individuals and families.

The proposed cuts would deny access to needed treatment and testing to half a million Californians by lowering income eligibility to 72% of the federally established poverty level. The cuts would also entirely eliminate certain types of medical treatments, including dentistry, optometry, psychology, and in-home healthcare for 2.5 million people in California. In addition the state is proposing significant increases in costs for the blind, elderly and disabled, including people living with AIDS. *

What that means, practically, is that elderly, blind, or otherwise disabled people living on already preposterously low federal and state incomes (SSDI for example) will be on the hook for monthly deductibles (share of cost) that can approach just under half their monthly disability pay check. In other words, forget paying the rent. If you need an MRI or other expensive medical procedure, go directly to your local shopping center, steal a shopping cart, fill it with your worldly possessions, and cover them with a plastic garbage bag, because your life just took on a whole new Kerouacian dimension. Hit the road, Jack! You’ve fallen through the cracks.

Medi-Cal is an enormous, Byzantine, sloppily administered, inconsistently available, whimsically adjudicated and pigheadedly stubborn mess of an excuse for healthcare, but it’s also, for many people in dire need, their only available access to healthcare.

Seth Hemmelgarn, writing in the Bay Area Reporter, spells out the impact for Californians living with HIV/AIDS:

Citing 2006 data from the state AIDS office, Dana Van Gorder, executive director of Project Inform, an estimated 160,000 people in California are living with HIV/AIDS. People who have HIV but who haven’t been diagnosed with AIDS aren’t eligible for Medi-Cal.

Anne Donnelly, Project Inform’s director of health care policy, said in a statement that proposed cuts to Medi-Cal and other health and human services programs “would limit access to quality health care for some of the most vulnerable Californians. … This at a time when the federal government and state are redoubling efforts to assure that undiagnosed people with HIV learn their status and that HIV-positive people engage in care and treatment.”

Mark Cloutier, CEO of the San Francisco AIDS Foundation, said in a statement, “These Medi-Cal reductions will likely lead to poorer health outcomes for the most vulnerable people living with HIV.”

According to the foundation, Schwarzenegger’s proposed budget is designed to close a projected $41.6 billion budget gap through the end of the next fiscal year by raising $14.3 billion in new revenue, cutting spending by $17.4 billion over the next 18 months, and relying on borrowed funds.

As Yogi Berra put it: It’s déjà vu all over again. The state will resort to relying on borrowed funds because for years the Republicans have dug in their stubborn little heels and pledged: no new taxes.

In the real world — the world the conservatives choose to ignore, revenues, across the board, are drastically down in California due to the dismal economy, and the demand for services and assistance is up. California unemployment just hit 9.3%, as reported in the LA Times this morning. In a state with a population of 36.7 million people, that means roughly 3.5 million people are out of work. 

And, it’s not just the blind, disabled, elderly and people with AIDS that will be taking a hit. To nobody’s surprise, the conservatives are going after the healthcare providers, specifically the healthcare unions. According to Robert Cruickshank, writing at his Courage Campaign blog:

That the state would target vulnerable people in this way is an outrage – and we’re not the only ones who think so. The SEIU United Healthcare Workers West (UHW), whose members are targeted for layoffs and may see their pay reduced to the minimum wage, have decided to fight back to protect the disabled and the blind and their caregivers.

On Saturday, January 24th UHW members are going to rally in Sacramento, San Francisco and Fresno to fight these cuts. And they have asked us if Courage Campaign members will join them by signing a petition to Arnold demanding he prevent this from happening. We happily agreed.

Finally, that promised glimmer of hope: Evan Halper and Richard Simon, writing in the Los Angeles Times today:

The economic stimulus package congressional leaders are drafting would wipe out nearly a quarter of California’s budget shortfall, a potential windfall that could help end the impasse over how to close the nearly $42-billion gap. 

The House bill, which is likely to be voted on next week, would bring the state more than $11 billion in healthcare and education money that could go directly to reducing the deficit through mid-2010, state officials learned Thursday night. 

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Most of the money that California could use to whittle down its deficit would come in the form of healthcare spending. According to an analysis by the Washington, D.C.-based Center for Budget and Policy Priorities, California’s Medi-Cal healthcare program for the poor would get a $7.3-billion boost through the coming state fiscal year. The money is intended to keep states from cutting the programs as they struggle with ballooning deficits. 

However, there’s a fly in the ointment:

The amount of money slated for California could change, however. The Senate is preparing to write its own version, and Republicans are increasingly objecting to the plan, saying it would not do enough to stimulate the economy. 

Well, it’s not all about the economy, stoopid! How about a side of compassion to go with that phony conservatism?

The possibility of a signed stimulus package by President’s Day isn’t likely to thrill the recipients of California’s IOUs, but for those stuck riding California’s healthcare roller coaster, including those living with AIDS and other disabilities, it’s a step in the right direction.

* For a complete listing of the proposed healthcare cuts, see this PDF from the independent California Budget Project.