The state health department has drafted a $480 million list of potentialprogram cuts that, if enacted, would deprive thousands of children of freehealth insurance coverage and shutter four mental health facilities, and couldforce women to pay for their own laboratory tests after rapes, according todocuments obtained yesterday by The Sun.
"It basically tells people if you are sick, leave the state," said Sen.Paula C. Hollinger, a nurse and chairwoman of the Senate Education, Health andEnvironmental Affairs Committee. "It's like taking health care off therespirator and saying goodbye."
The Department of Health and Mental Hygiene developed the list in responseto Gov. Robert L. Ehrlich Jr.'s request that agencies devise ways to cutspending by 12 percent.
The elimination of programs, the governor has said, is the only way toclose a projected $800 million budget deficit without raising taxes.
The governor and his aides said they had hoped to keep the proposalsconfidential, issuing a gag order last month that prohibits agencies fromsharing budget requests with legislative analysts. Yesterday's leak violatedthat order.
"You hope that everyone within an administration would be on the team,"state Budget Secretary James C. "Chip" DiPaula Jr. said. "There is a questionnow that somebody might not be."
Because an improving economy could make many cuts unnecessary, Ehrlichstaffers said they hoped to avoid the kind of outcry that followed the leak ofthe health department's budget planning document yesterday, as lawmakers andhealth advocates digested the scope and specificity of the reductions underconsideration.
"These cuts are just immense and are devastating to public health, not justin Baltimore but in the entire state," said Dr. Peter L. Beilenson, theBaltimore health commissioner.
The proposal would eliminate health programs for at least one in six cityresidents, he said.
DiPaula would not comment on the list, saying he has yet to receivesubmissions from the health department.
Ehrlich is months away from making final budget decisions before he submitshis next spending plan in January, DiPaula said.
"It's unofficial, if not fake," he said. "How can [The Sun] have somethingthat we don't have?"
But outgoing state Health Secretary Nelson J. Sabatini acknowledged that heasked his staff to identify programs not mandated by federal or state law thatcould be eliminated.
To meet Ehrlich's request for a 12 percent cut, the health department hasto identify about $430 million in programs, $50 million less than what thedraft list contains, he said. The department's $3 billion-plus in generalstate funds is supplemented by about $2.5 billion in federal funds.
"[DiPaula] has repeatedly said you can't get to the level of reductionsthat we are going to be facing by nibbling at the margins anymore," Sabatinisaid.
Last spring, Ehrlich launched a review of agency spending by askingmanagers to complete a "strategic budgeting guide," identifyingless-than-critical programs in the state's $24 billion budget that could beeliminated.
The health department proposals include eliminating a popular healthinsurance program for children and pregnant women to save $47 million, andabolishing health care for medically needy Medicaid recipients to save $115million.
Another proposal would curtail a sexual assault evidence collectionreimbursement program, which a department budget planning document warns"could lead to victims being billed, thereby creating a barrier to care."
"Can you imagine a rape victim being charged for evidence collection?"Beilenson said. "I cannot believe anybody would even remotely consider such aninhumane budget cut."
Revelations of cuts under consideration could renew discussions of slotmachine gambling as a revenue source, or could revive talk of scaling back thestate's $1.3 billion education initiative known as the Thornton Plan.
At yesterday's Board of Public Works meeting, Comptroller William Donald Schaefer implored Ehrlich to find a way to raise more money but did notsuggest a source.
"I really believe that agencies are down as far as they can go," Schaefersaid. "You might as well cut the agencies out altogether. ... It will destroythe morale of people."
Pain inflicted by budget choices will be the governor's responsibility,said House Speaker Michael E. Busch, an opponent of expanding gambling andEhrlich's chief rival in the slot machine debate.
Under Maryland's budget process, legislators cannot add to the fiscal 2006budget proposal that Ehrlich submits in January, Busch said.
"We obviously last year tried to find a revenue source, and the governorrejected it," Busch said, referring to a $670 million sales-and-income taxpackage passed by the House. "Now he has to make the tough decisions."
Other health advocates noted that the proposed health cuts would cost thestate money almost immediately. Women and children removed from Medicaid rollswill arrive at emergency rooms for treatment. Health insurance bills forMarylanders with coverage will rise to cover the cost, they said.
Also, a reduction in alcohol and drug treatment and mental health serviceswill mean more crime and an overloaded criminal justice system, they argued.
"It's just a sham to say this proposal is going to save people money. It'sgoing to cost money, in a way that hurts people," said Vincent DeMarco, headof the Maryland Citizens' Health Initiative, which advocates a plan to coveruninsured Marylanders by charging businesses that don't provide healthinsurance.
Del. Dan K. Morhaim, a physician and member of the House Health andGovernment Operations Committee, agreed, calling the proposals "an illusion ofsavings."
"If a [treatment] program closes tomorrow, those people are going to end upin the criminal justice system in a few days," the Baltimore County Democratsaid. "Not a few years, but a few days."
Options for fiscal 2006 budget cuts in the state health department:
Eliminate inpatient and outpatient services for medically needy Medicaidpatients - $115 million
Eliminate health coverage for uninsured children and pregnant women - $47million
Discontinue coverage of uninsured mental health patients - $27 million
Discontinue non-Medicaid mental health services for Medicaid patients - $16million
Eliminate medical day care - $18 million
Reduce payments for Medicare deductibles - $12 million
Reduce payments for sexual assault victims' exams - $400,000
Correction: In an article published Sept. 23, 2004, about possible deep cuts in Maryland health care spending, The Sun incorrectly reported that Gov. Robert L. Ehrlich Jr. had said the only way to close a projected $800 million budget deficit without raising taxes was to eliminate programs. The article should have said Ehrlich intended to use spending cuts and slower program growth to help cut the deficit.