Blue Mass Group

Reality-based commentary on politics.

Cuts that bite

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These are cuts that will have teeth: The Senate's budget contains cuts for “non-emergency” dental care for 600,000 people; and health care for legal immigrants is out.

From MassBudget.org: (no longer have to read pdf's — thanks!)

The budget proposed by Senate Ways and Means includes significant cuts to funding for health care, although the committee asserts that this budget maintains open enrollment in the MassHealth and Commonwealth Care health insurance programs. Nevertheless, the SWM proposal removes from the Commonwealth Care program people who are not citizens of the United States. This would include certain special status immigrants who are here legally, but are not citizens. There is also language in the budget proposal that would eliminate non-emergency adult dental services and adult day habilitation services from coverage.

 I don't think it's controversial to state that dental care is health care. And by cutting non-emergency care, it makes it a heck of a lot more likely that they will be paying for emergency care. No Deamonte Driver's here, but still … this is pound-foolish. 

We know the budget situation is catastrophic (pace David Tuerck, who at the very least ignores the fact that we've got near-universal health coverage to pay for.)  The Governor, Senate Prez and Speaker all seem to recognize we need new revenue streams, and we may need all of them — not just a sales tax increase. (And it ought to go without saying that we need $1 worth of value for $1 raised — pass those reforms!) Maybe these things will get restored. In any event, health care damn well should be a sacred cow.

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  2. during the dot com bust, Romney et al cut the dental benefit for masshealth, then when things recovered the State brought it back.

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    p>Little changed, mainly because so few dentist perform work for MassHealth reimbursement.  Even today, only about 1300 of the 5000 dentists in the state accept MassHealth:

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    p>

    Dr. Rapisarda participated in MassHealth for almost 20 years before discontinuing eight years ago because he was losing money. He said not only did he not make a profit, the fees paid by the state did not even cover his overhead. And, more than a third of the MassHealth clients who booked appointments failed to show up, which also caused him to lose money.

    In addition, when he submitted a claim, administrators of the program would find the slightest technicality for not paying, he said.

    “What it amounted to was the work I did, just the act of seeing a state patient, meant I was losing money. If you’re a businessman in the private sector, you can’t go on like that for very long,” he said.

    Dr. Rapisarda said he will not consider rejoining MassHealth unless the fees are equal to what private insurance pays. For instance, he charges $68 to clean a child’s teeth and $88 for an adult. MassHealth pays $47 and $65 respectively. The state is required to make annual increases in fees paid for children’s dental services. New rates, not yet determined, are scheduled to go into effect Oct. 1.

  3. try laying off state workers.  I contend that 30% of these employees are “excess”, and I’m being polite using “excess.”

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    p>When will you (a) stop falling for the draconian, show-boating cuts in firemen, police, and teachers and (b) stop using the resulting cuts in benefits as an argument to raise taxes?

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    p>The Turnpike tried this on Mother’s Day.  Maybe the taxpayers will wise about about the rest of the inefficient state payroll machine.

    • It may not be so much the State employee costs, but the cost of the programs they administer that breaks the State bank.  Instead of a blanket condemnation of the employees, a serious assessment of the many programs the State is involved in could produce significant savings for the Expense side of the ledger.  How many health agencies are expanding and competing for the ever-increasing tax dollars allocated to health?  Health services, as necessary as they are, cannot continue to take more and more from our economy.

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      p>And before raising the tax rates on those currently footing the bill, it may be useful to look at those who are not paying, and boost Revenue without tax rate increases.  The State has closed some “loopholes” while planning a general rate reduction for businesses that provides some revenue increase, but what about the individuals who avoid taxes?  How much “cash” business is conducted in the State without reporting it as income by the seller?

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      p>The Legislature has been very disappointing in their responses to the crisis.  Local aid is what helps pay for police, fire and education, but that is the first thing on the table for budget cuts.  They must address the issues that irritate the public, such as pension give-aways and no-show jobs, but they must go beyond that and review programs that don’t provide return on the investment and be willing to cancel them and eliminate the State positions that administer them.  And they have to look for revenue within the current bounds of taxation, as there is probably a good amount that is going uncollected.

    • 30% excess. OK, prove it. Hell, I’d love it if it were true. Which 30%? I want details, charts, budgets … shoot, anything at all, other than your gut.

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      p>Great quote: “I’ve been listening to my gut since I was 14 years old, and frankly speaking, I’ve come to the conclusion that my guts have @#$% for brains.”

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      p>So instead of making stuff up, how about helping us out here?

      • except plenty of hours at DEP, MBTA, MTA, and Housing/Community Development.  Real estate deals.  (I’ll leave the BRA out of it for the time being.)

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        p>Stroll through the Transportation Building during an afternoon, as I have after a meeting.  You’d think an Ebola epidemic had hit the place. Plenty of empty offices.

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        p>Department of Revenue … I once WANDERED through a floor in the Saltonstall Building (IIRC) looking for someone, anyone, to accept a tax payment.  Anecdotal but the only other place I’ve seen this is in now-defunct-insurance-company offices.

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        p>The Registry of Deeds.  Name your county.

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        p>Recently was in the Hurley Building.  Perhaps it’s too large for the number of folks working there, but there’s more empty space than filled offices.  Maybe we should get rid of these excess state buildings that are half-filled, if that’s the problem, which I don’t think it is.

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        p>What is the cost to operate the Mass Turnpike?  What is the cost to collect tolls?  One could save $200 million annually by tearing down the tolls, and increasing the gas tax.  Revenue neutral but with $200 million cost savings.  The only thing preventing this?  Entrenched unions, Turnpike employees with politicians for relatives, a recalcitrant legislature, and a spineless governor.

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        p>Private businesses have laid off 15% or 20% of their employees as revenues tumble.  Why not the state?

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        p>State employees and their protectors on Beacon Hill are the biggest interest group there is.

        • The MBTA and MTA aren’t on the same budget as the Cuts that bite.  It’s no different than arguing we could fix our state budget by trimming waste in the Duxbury budget or by reducing the number of hours people for the Federal Homeland Security Agency work.

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          p>

          Private businesses have laid off 15% or 20% of their employees as revenues tumble.  Why not the state?

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          p>Say it with me.  Government is not a private business.  The goal is different, the shareholders are different, the stakeholders are different.

        • The formula to determine what percentage bostonshepherd’s recommendations would save the budget:

          <

          p>(A(b-c) / D) * 100

          <

          p>where
          A = the amount of money bs imagines state workers are paid  
          b = the number of people bs counts someplace that he thinks work for the state
          c = the number of people working for the state bs thinks should work there
          D = the amount of money bs thinks is in the state budget

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          p>Too bad he can’t work the entrails of farm animals in there someplace.

      • you can’t keep going back to the taxpayers to increase revenue.  Look at California.  It will be the first state is US history to declare bankruptcy.  

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        p>Now MA isn’t is such dire shape, but if progressives keep increasing increasing increasing taxes, people will revolt.  I know Prop 1 failed by a wider margin last cycle, but the time before it lost 55/45.

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        p>Who’s saying it won’t pass next time?

      • 30% excess. OK, prove it. Hell, I’d love it if it were true. Which 30%? I want details, charts, budgets … shoot, anything at all, other than your gut.

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        p>Ok, let’s start with, say, transitional assistance, just to pick a Department..  48,000 cases and a budget of $68 million in 2009.   2010 proposed by Senate, $114 million.

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        p>Wait! That can’t possibly make sense.  There must be some comparable differene to explain the increase.  Maybe the HW&M number of $52 million is the comparison for a 23% cut.

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        p>Wonder how many heads are in that department?  Hmm…looks like 1593 people. Wait, that doesn’t make sense either.  That would mean that the average of 1593 over a $68 million dollar budget is only $32.6K per person, even assuming that the Department does nothing other than pay salaries.  

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        p>Maybe benefits, transfer payments are a different line item.  Who knows?

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        p>Wonder what the average salary is?  No idea how to find that out.  I’m not even sure how to ask the question.  Or, of whom.

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        p>1593 people over 48,000 cases.  That’s 30 cases per person.  That’s nothing.  As a lawyer, I handle hundreds of cases per year.  Most social workers handle hundreds.  Wonder if I did that statistic right?  who to ask? Who knows.

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        p>Oh crap!  Not only does Transitional Assistance pay monthly assistance, it provides homeless shelters, food stamps.  Where in the budget are those numbers?

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        p>Guess I can’t help out after all.  The Department budget is as clear as mud.  My gut tells me it’s doing everything right since I can’t figure out if it’s doing anything right or wrong.

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        p>Carry on.

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