Monday, June 6, 2011

Joint Finance Committee Labors On

The Joint Finance Committee met again today continuing to work on budget markup. The two big items of discussion today were expenditures under the Tobacco Fund and Medicaid expenditures. The Tobacco Fund refers to money that the tobacco industry has to give states as part of a federal settlement from about a decade ago. In Delaware we have been true to using this money for health care programs. In recent years with declining General Fund revenues, we have been relying more heavily on the Tobacco Fund and drawing down the reserve. Some members of JFC expressed concern about this trend and the dependency of various health programs on the fund.

However, the discussion of Medicaid was much more involved. The Governor's budget proposed $5 million in reductions for Medicaid. A lot of attention focused on use of the emergency room for non-emergency care by the Medicaid population.

From the perspective of an observer, it seemed like there needed to be more information provided to the JFC. (Perhaps it was provided and simply not available to the public) There is no, one, homogeneous Medicaid population. A person who uses Medicaid could be a child, a paraplegic adult, a single mom, an able bodied adult who goes to work everyday in a low-wage job without health benefits, or a senior citizen who is too poor to pay for the gap in coverage from Medicare. So to say that the Medicaid population is over-using the emergency room tells one, next to nothing about what is really going on and why.

To use an example from our sample group above; the working poor often have inflexible employers who do not have "sick days" for their employees. Thus, going to a doctor's office from 9:00AM to 5:00PM is not an option; leaving the emergency room for care. (Although Acute Care clinics are beginning to fill that niche in many areas).

In any case, except for a very few disturbed individuals, people who use Medicaid are just like you and me. They are not going to sit around in an emergency room all night long just to make the state spend more money. There must be something driving the behavior for a specific demographic.

It is this kind of need for more information and thoughtful decision making that prompted the JFC to take the following two actions. First, they restored all $5 million in proposed cuts to Medicaid. Second, they have ordered a task force to study cost savings and innovation in health care and Medicaid.

A major item of interest for educators remains unresolved in the 2012 Budget, the paraprofessional pay plan. This blog has written previously about the promise made by the General Assembly four years ago to raise paraprofessional pay in three phases. The modest goal is to get the starting salary to the federal poverty level for a family of four (currently $22,350 per year). The General Assembly funded Phase I in 2008, but has not funded another phase since the bad budget years.

Given Delaware's unexpected revenues over the last few months, the Delaware State Education Association would like the State to take the opportunity to move paraprofessionals closer to a living wage.

The JFC continues to toil over the budget. They will meet again Wednesday morning.

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