State budget crises are impacting healthcare in almost every community in the United States. Legislators and healthcare officials have been forced to make hard decisions about where and how much to cut, and the results aren't often pretty. Here are some examples from diverse states.
DELAWARE
Nearly 43,000 state government workers and pension recipients will see their healthcare premiums rise by 50 percent starting July 1. The premium increase is part of Gov. Jack Markell's (D) effort to balance the state budget. The increases are projected to save the state $22.5 million next year. The average state employee in Delaware not covered by Medicare now pays about $54 a month in medical premiums, and the maximum for the most comprehensive family plan is $129 monthly.
IDAHO
The state of Idaho will no longer be offering free vaccinations for every child. Statewide budget cuts effective July 1 will limit the program to children who are uninsured, underinsured or who qualify for Medicaid.
Idaho is currently last in the nation in childhood vaccination rates, and the end of this free program will certainly not improve those numbers.
As a result of the cuts, the state's healthcare providers will have to prepay for their private stock of vaccines, and some may opt not to offer vaccinations at all. Smaller providers are considering forming purchasing groups to get bulk discounts from vaccine manufacturers.
KANSAS
State legislators in Kansas have cut administrative expenses at the Kansas Health Policy Authority by 10.6 percent and are proposing further cuts of administrative expenses of 2.5 percent under a Senate budget plan, and 5 percent under a House plan. According to KHPA's deputy director Andy Allison, those cuts would hurt the agency's ability to provide Medicaid services to low-income Kansans. The budget cuts would also likely cancel an expected expansion of the State Children's Health Insurance Program, which would have provided coverage to 8,000 additional children. The proposed cuts come in response to an estimated $328 million revenue shortfall in the state budget.
NEVADA
Charles Duarte, the state of Nevada's Health Care Financing and Policy administrator, told the Nevada senate's Finance committee that potential changes in the state's Disproportionate Share Hospital program have been put on hold for a year. The changes to the DSH program were initiated after new federal rules took effect in January.
The proposed changes in the funding formula would reduce the amount of money that goes to the two largest recipients - University Medical Center in Las Vegas and Renown Health in Reno. Of the $107 million in DSH funding, UMC currently receives $78 million and Renown gets $5.1 million; lesser amounts are spread among 11 smaller hospitals around the state.
Clark County - where UMC is located - provides over $60 million in funding for the DSH program, and county officials do not want UMC to receive less money than the county puts into the program.
Duarte said the decision on DSH changes is being delayed to give the various parties time to work out a compromise.