Pick your poison: Suffocating or amputating state services?

As we discussed in this recent blog post, the State Department of Health has been among the state agencies hit hardest by successive rounds of budget cuts the past two years. State appropriations have been reduced by $11.3 million, or 15 percent, since 2009. The agency has some 250 fewer staff today than at the beginning of FY ’10 as a result of attrition and two rounds of voluntary buy-outs. It has cut dental health programs, tobacco prevention programs, services for children with developmental delays, jail inspections, and other services. According to a summary of actions prepared by the Department, which is led by Commissioner Terry Cline, the cumulative effect of the cuts has been to put the state’s core public health infrastructure in critical danger:

State appropriated reductions… continue to erode the public health infrastructure across the state, impacting services that are imperatives of the department.  Specifically, infectious disease control and emergency preparedness and response depend on a minimum level of infrastructure to mount a rapid and effective response.  While the department has been able to meet the challenges presented thus far, erosion in the clinical nursing infrastructure over the past few years has left the department vulnerable.  Continued reductions in this infrastructure may result in reduced response times and the inability of the department to protect the citizenry from natural or man-made disease occurrences and disasters.

With the state facing ongoing budget shortfalls, all agencies are being asked to lay out their plans for dealing with further funding reductions in the upcoming fiscal year. Commissioner Cline created a stir in recent weeks by suggesting that rather than continue to spread additional cuts across a broad range of programs and services, he would instead eliminate entire programs. If the agency is dealt an additional cut of 5 percent, or $3.1 million, he has proposed doing away with the Office of Child Abuse Prevention, which funds and oversees 21 programs across the state run primarily by non-profit agencies aimed at promoting family stability and preventing abuse. If the agency’s budget cut reaches 10 percent, or $6.2 million, OSDH has proposed eliminating the lion’s share of pass-through funding that goes to support Federally Qualified Health Centers that provide free and low-cost medical care to the uninsured and underinsured across the state.

Child advocates and prevention service providers were startled and outraged by the proposal to defund the Office of Child Abuse Prevention. So were the Senators who attended a budget subcommittee hearing in mid-January, urging Commissioner Cline to “scrub the numbers again” and even review the fees it charges for professional licenses and regulation as a possible revenue source. But while Cline acknowledges that his proposed cuts would be genuinely painful and harmful, he has been insistent that the agency simply cannot cut more deeply without putting the public health at risk from the threat of disease and disasters.

The Health Department seems to be saying that squeezing the budget more tightly will suffocate their ability to perform their core functions. Instead of impeding their ability to breathe, they’ve decided to amputate entire limbs – which is bloodier and noisier, but may perhaps be necessary to stay alive. It’s a stark, painful choice – precisely what Oklahoma policymakers and the general public have so far preferred to avoid over the course of the state’s fiscal crisis.