heads in the sand

Last month came news that Oklahoma City Public Schools will cut 208 classroom teaching positions because of state budget cuts. Tulsa Public Schools is considering reducing or eliminating school buses for all but special education students. Other districts are imposing across-the-board teacher pay cuts to save jobs, shortening the school year, or moving to a 4-day school week. After years of strained education budgets, our public schools are long past cutting the “extras” and asking for sacrifices by adult educators — schools are now forced into cuts where they hurt our children the most.

Schools are in this dire situation even as education has been relatively protected from Oklahoma’s annual budget slashing. Going into this fiscal year (before the mid-year 7 percent cuts), appropriations for the Oklahoma Health Department were down almost 20 percent compared to fiscal year 2009. So when the next round of cuts happened, the Department announced they are eliminating a child abuse prevention program that had been providing education and support services to 700 at-risk families; they are closing five to seven county health department sites, which could make immunizations, epidemic monitoring, and other key health services inaccessible for large parts of rural and small town Oklahoma; they are eliminating the Uncompensated Care Fund, which had been a vital source of revenue for the community health centers serving many of Oklahoma’s large number of uninsured patients.

The Oklahoma Department of Mental Health and Substance Abuse Services also already made deep cuts this year that will reduce services for more than 73,000 Oklahomans. These cuts come at a time when Oklahoma has been widely recognized to be experiencing a mental health crisis even as we provide some of lowest funding for mental health treatment in the nation. Without this up-front treatment, the number of mentally ill Oklahomans in state prisons continues to rise — an outcome with enormous long-term costs to tax dollars and human welfare that could have been avoided with a better budget for mental health.

The Oklahoma Department of Human Services has received funding increases to make federal court-ordered improvements to our child welfare system. But gains in child welfare are happening alongside deep cuts in every other part of this agency’s mission — which means eliminating hundreds of positions that had been responsible for state and federal safety net programs, protective services for vulnerable seniors and adults with disabilities, and inspections of child care centers and nursing homes. Altogether the Department has cut 1,200 non-child welfare positions, a 23 percent reduction in staff. And like public schools, the Department is past its ability to limit sacrifices to staff; now DHS is making cuts like ending monthly checks for aged, blind, and disabled Oklahomans who may no longer be able to keep up with their food and utility bills.

Following lawmakers’ aborted attempt to kick over 110,000 very low-income parents off Medicaid, the Oklahoma Health Care Authority announced reimbursements to Medicaid providers would be cut 25 percent starting in June unless new revenue is found for the program. The inevitable result of cuts these large will be the closing of more rural hospitals and community health providers and many fewer physicians being willing to accept Medicaid patients. The Oklahoma Association of Health Care Providers said a cut of this magnitude could put 269 of the state’s 289 nursing home facilities out of business, and the Oklahoma State Medical Association is urging all of its member doctors to consider dropping out of Medicaid if the cut happens.

In a testimonial for Together Oklahoma, Norman nurse John Rushton gives a stark example of what having fewer Medicaid providers would mean:

I work as an LPN for a small home health agency. We mostly see Medicare patients, but I have had the occasional Medicaid patient. The conditions most Medicaid patients live under should qualify for the description of “squalid.” These are people who have no resources, and no hope whatsoever of becoming independent and purchasing their own healthcare, usually due to a combination of mental, physical and cognitive deficits. I see these patients slip through the cracks all the time, and the result is poor health outcomes – a euphemism for undignified, painful, premature death, that could have been prevented. This is not hyperbole. A middle aged man with congestive heart failure who comes down with a toothache, who can not find an oral surgeon willing to take Medicaid (there aren’t many who do already, my office has struggled to find one for patients of ours), can die very easily when the infection in the abscessed tooth moves into his heart after going several weeks without treatment. The idea that these are the people who should bear the brunt of our budget crisis is utterly inhumane.

All of these examples are limited to what has made the news. The damage of underfunded public services also bubbles up in invisible ways — in the problems that go unaddressed because we never hear about them. What abuses of tax breaks are going undetected because the Oklahoma Tax Commission lost 12 percent of its funding since 2009? What mismanagement of taxpayer dollars goes unnoticed because the State Auditor was cut 30 percent? What polluting of our air and water has gone unseen because the Department of Environmental Quality has lost 30 percent of its state funds? What preventable disasters are not being prevented because the Fire Marshal was cut 29 percent? Remember, these are only the cuts already in place before this year’s mid-year cuts and before next year’s $1.3 billion hole.

A recent Oklahoman editorial commented that, even amid this historic budget disaster, “tax increases are a nonstarter at the Legislature.” That’s certainly been the way that political winds have blown in the Legislature, but Oklahomans of all people should know that winds can change. With a disaster of this magnitude blowing down our doors, lawmakers must change their approach to the budget. We have plenty of reasonable revenue options available; the only wrong answer is not to do something.