Friday, February 1, 2002
By Richard Nangle
Telegram & Gazette Staff
Advocates for public health programs are gearing up for a long and aggressive battle against cuts proposed by Gov. Jane M. Swift in her $23.5 billion budget for fiscal 2003.
While the budget increases state spending by 2.7 percent, the state Department of Public Health faces a $50 million cut, on top of $35 million in cuts incorporated into this year's budget. More than $10 million of the fiscal 2003 cuts would come from disease-prevention line items that the administration has combined.
Included in the mix is money for hepatitis C outreach, breast cancer, multiple sclerosis, dental care for the disabled, family health services, osteoporosis, prostate cancer and smoking prevention.
All of those line items combined would have required about $17 million in funding to maintain services at 2002 levels, according to Laurie Stillman, executive director of the Massachusetts Public Health Association. Ms. Swift's budget allocates $6.3 million. The breast cancer budget alone exceeds $9 million this year.
"Essentially what they did was lump a bunch of diseases into one line item and cut that line item drastically," Ms. Stillman said.
"Any of those programs could be totally dismantled, or they could do it based on percentage," she said. "In any case, it's such a large cut, we don't know if these programs are going to survive."
"We need to protect critical direct care services today," said Domenick Ianno, spokesman for the state Executive Office of Administration and Finance. "You have to make choices."
"Those are outreach and prevention accounts, which is one area where we were looking for savings, because they are not critical direct care services," he said.
Ms. Stillman says that argument misses the point of prevention and education.
"If we don't address the disease now, we'll pay later with transplants and other expensive medical interventions that could have been prevented," she said.
The hepatitis C budget was level-funded at $2.75 million this year. Mr. Ianno said the allocation of funds to specific programs in the 2003 budget would be up to DPH Commissioner Howard Koh.
Only a small percentage of the estimated 110,000 Massachusetts residents with hepatitis C have been diagnosed. Hepatitis C is the most common blood-borne virus in the country and can lead to cirrhosis, liver failure, liver cancer and death.
Ms. Stillman said the House of Representatives has been less supportive of hepatitis C funding than the Senate.
"Senator (Mark C.) Montigny has been a hero in advocating for hepatitis C funding," Ms. Stillman said. Mr. Montigny, D-New Bedford, is chairman of the Senate Ways and Means Committee.
"If these programs don't exist, I just don't understand where these people are going to go," said Rachel Wilson, coordinator of the Massachusetts Hepatitis C Coalition. "Are they going to call the governor and is she going to give out the information on hepatitis C?"
While angered by what they say are disproportionate cuts to the DPH, Ms. Stillman and Ms. Wilson said they will not be advocating for cuts in other departments. Instead, they will be looking for state lawmakers to increase taxes, particularly on capital gains, to create new revenues.
"It is unfair that public health programs are being unfairly targeted for cuts in the governor's budget," Ms. Stillman said. "There's enough revenue at their disposal so that these kinds of draconian cuts are completely unnecessary."
Ms. Stillman thinks the combination of the many line items is a deliberate ploy by the Swift administration to make the work of human service advocates more difficult.
"It doesn't offer protection for each of the individual programs," she said. "It makes it very difficult for the advocates to speak with the Legislature about the value of the specific programs.
"And many of them have very different populations and different approaches and different goals. If the individual items are all lumped together, everybody fights for the little piece of the pie and are confused and become less effective."
"The public health system right now is being decimated," she said.
The Massachusetts Public Health Association is coordinating about 100 human services organizations into a lobbying and advocacy group called United We Stand for Public Health, Massachusetts.
Members of that group will attend upcoming legislative budget and taxation hearings.
An increase in the capital gains tax would fall heaviest on the wealthiest 1 percent of Massachusetts residents, who would supply 76 percent of the $300 million the state would collect annually, Ms. Stillman said.
"The wealthiest people need to share in this burden as much as working people do," she said.
Former U.S. Labor Secretary Robert B. Reich, a Democratic candidate for governor, has called for an increase in the capital gains tax to offset declining revenues.
Human services advocates will be urging lawmakers to use tobacco settlement money and a larger piece of the state's rainy day fund to restore Swift administration cuts. They will also call for a halt in the state income tax rollback that voters approved in 2000.
"We're hopeful they may take some political risk to help save essential services during this very challenging time," Ms. Stillman said.
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