Impact of
healthcare cuts may
be long term

Public health centers,
state hospitals and other agencies
face dire financial future

By Helen Altonn
Star-Bulletin

To House Health Chairman Alex Santiago, the impact of health and human services money cuts in recent years is like a big tsunami building in the ocean.

"It's going to crash on our shores," Santiago said, stressing much higher costs as a consequence.

Santiago said he kept hearing people throughout the legislative session say, "'Cut more, cut more, cut more. . . . ' The anger that's out in the community is so high."

Vital health, human services and education programs were targeted for major cuts, but funding was restored in many cases.

State Health Director Larry Miike thinks his agency lost several millions of dollars on top of $8.5 million in executive reductions. But at least the proposed elimination of his district offices, dental division and some other functions didn't occur, he said.

"We managed to lower expectations enough that anything sounded good," Senate Health and Environment Co-Chairman Andrew Levin quipped. "But I genuinely believe we did quite a bit of good this year, especially in light of the budget constraints."

Levin cited many bills passed relating to tobacco, mental health, developmental disabilities, patients' rights, emergency care, liability protection and other health-care areas.

Although state hospitals and community health centers didn't get needed funds, Levin said, "People hopefully will be able to hang on for the next seven to eight months. If the economy turns around, we will be able to shore them up come January."

Rose Schilt, Healthy Mothers, Healthy Babies executive director, said programs serving mothers and children "appear to have reason to celebrate."

Deep cuts proposed for already "bare-bones" programs didn't happen, she said. She expects about $900,000 to be available next year through Health Department contracts to assist at-risk low-income pregnant women.

But Schilt pointed out that the eight public health centers -- a safety net for low-income families -- received only about $1 million after asking for $7 million and expecting $4 million.

Swamped with uninsured clients and low government payments, many centers are in the red. "We will find a way to deal with this," Santiago said.

The 13 state hospitals, operated by the Hawaii Health Systems Corp., also pose a challenge.

Levin said a physician and community member were added to the board and more flexibility was given to the corporation to become a business. At the same time, the Legislature is requiring that all facilities and services be retained, he said.

The corporation received $5 million in emergency funding for this fiscal year and will receive $8 million in July for the next year.

"We fully recognize $8 million will not be sufficient," Levin said, although he added that it's more than the House wanted to give.

Santiago said House members are "concerned and confused" about the corporation and what it's expected to achieve. He was asked to look into it before the next session, he said.

Both chambers have concerns about the Felix decree mandating mental health and education for special children. The Senate proposed withholding some money because of spiraling costs and accountability questions.

Santiago said the House pushed for the funding to avoid federal contempt charges and directed the Education and Health departments to begin providing adolescent mental health services on school campuses.

Health bills OK'd Health bills sent to the governor would: Start a tobacco stamping procedure Sept. 1 to try to eliminate black-market cigarettes and increase the tobacco tax Jan. 1 from 80 cents to $1. Establish a patients' bill of rights. Allow emergency care without prior authorization by managed care plans. Prohibit sale of private hospitals without approval of the attorney general's office or the state Health Planning and Development Agency. Give liability protection to police and other officials who use automatic defibrilators so long as they've had training. Extend requirements for health insurance plans to include mental health, drug and alcohol abuse benefits. Set up a lead-screening program. Give the court authority to require a Hawaii State Hospital patient to take medicine before being released. Keep Waimano Training School and Hospital open another year for transition of residents to community settings.