You may have heard the expression, "all politics is local"; however, politics are also personal. In the business of advocacy, the relationships you develop with policymakers are just as valuable as any campaign contribution. The policy process involves a give and take between professionals, community leaders, consumers and policymakers. When these stakeholders share a knowledge base and mutually agreed upon values, manage conflict, create ownership and develop strategies to solve problems, policy change can occur. That is effective advocacy!
_______________________________________________________________________
TESTIMONY April 19, 2010 on the 2010-11 DCH BUDGET
__________________________________________________________________________
Dear Chairman McDowell and Members of the Subcommittee:
Good morning, my name is Amy Zaagman and I am the Executive Director of the
Michigan Council for Maternal and Child Health. The Michigan Council for
Maternal and Child Health is a partnership of organizations that have as their major purpose improving the health and well-being of women, children and families in Michigan.
Our board is deeply concerned that cuts to public health and prevention programs in the DCH budget undermine the growth and development of healthy families. The children of which are just beginning their path to learning, and will become future employees, taxpayers and parents.
While the Governor’s proposed budget slices only a small part of the general fund budget under public health, I want to impress upon you that we face a dangerous situation due to the repeated disinvestment in prevention programs. Over the last eight years, state funding for maternal and child health prevention programs has been cut by 80% with most of that funding re-directed as state match for Medicaid. We continue to put our scarce state resources into treatment of medical problems, most of which are preventable, and we continue to cut prevention, the only real LONG TERM solution to rising costs for medical care.
The Michigan Council for Maternal and Child Health stresses a life-cycle approach to public policy issues. Research shows the societal impact of assisting women in avoiding pregnancy when they wish to and supporting families who want to have children. There is solid evidence that among women having unintended pregnancies, dependence on welfare is greater, child abuse and neglect rates increase, that the children of unintended pregnancies have higher rates of encounters with the juvenile justice system, increased teenage smoking and promiscuity, and the costs of social programs to address these issues increase. Yet, state funding for family planning services is cut. The cuts in state funding for the current year mean 32,400 people who want access to services – people who are trying to be responsible - will go unserved.
Without access to family planning services, young people especially will have unprotected sex resulting in unintended pregnancies and/or sexually transmitted diseases. In 2006, 42% of births were Medicaid funded and we know the number today is closer to 50% and over 60% in many areas. Our teen pregnancy rates, after years of decline, are now on the rise again.
We could talk for hours about the crisis that is brewing with regard to sexually transmitted diseases. One of the primary places to detect and refer for treatment is/was the family planning clinics and school-based health centers which were cut in the K-12 budget. In 2008, 75% of Chlamydia cases and 64% of gonorrhea cases were diagnosed in young people – ages
15-24. In February of last year, DCH conducted a screening “blitz” at a Detroit high school – 306 tests were given - 8.6% of them positive for STD’s.
Coupled with the fact that we continue to cut programs for school-based health and health education, these grim statistics are not surprising – we have abandoned making health education a priority so we can teach children to value and protect their health while also cutting the resources, preventive care and early detection for treatment they need.
The average cost of a healthy birth is $11,000. If a mother does not receive adequate prenatal care and detection/treatment for any infections, including STD’s, there is a greater chance that baby will be born prematurely and the costs – and the stakes -- are exponentially higher.
Depending on length of stay a NICU stay will result in an additional $7,000 to $2 million in costs, not to mention the potential for costly chronic health issues for these children. As an example, a very recent study shows that babies born prematurely to a woman with an untreated infection are much more likely to develop asthma by the age of 8.
When a baby goes home to an environment that may not be fully equipped for/supportive of an additional family member the family often struggles. Michigan has some of the highest infant mortality rates in the country (in 2005 – 40th overall, 48th among African Americans). Efforts to combat this issue, particularly among the African American population were thwarted by $1.75 million in cuts to the program last year. How can we expect to improve such a problem when we simply disinvest in any effort to address it?
To give you an idea of the economic situation of many of our youngest citizens -- more than 53% of all infants in Michigan are currently receiving their food through the federal Women, Infants and Children (WIC) food program. A note about the possible danger of their housing situation – the Childhood Lead Poisoning Prevention Program saw over $1 million in reductions in the current year budget. As a result, fewer families in the 12 communities most at risk will receive primary prevention and fewer children already diagnosed with lead poisoning will get case management services to ensure they recover.
A number of programs that were designed to help struggling families and prevent child abuse were vetoed in the current year budget. The Council applauds the chair, this subcommittee and the Legislature for recognizing the value in the 0-3 secondary prevention program that combined general fund dollars from DCH and Department of Education with TANF dollars at DHS to fund grants to local communities. The program has seen many successes over the years and has fabulous results showing the percentage of participants who never have future contact with child protective services. The Governor vetoed not only the general fund dollars in the DCH and DOE budgets for the 0-3 program but also cut the remaining funding for the nurse family partnerships – another very valuable home visit program that teamed nurses up with at-risk families. These decisions to cut home visit programs should be revisited promptly as there is a plethora of funding opportunities for home visit programs in the federal health care reform but it will do us no good if we dismantle our programs now.
Most of these cuts I have mentioned thus far are not newly proposed, but rather continued in the executive budget. The toll is cumulative and we are turning back the clock on years of prevention efforts.
Two cuts that are newly proposed for public health are particularly troubling to us. Many of the programs I just outlined that have seen such drastic state funding cuts are administered by local public health departments. These departments have not seen increases in over 20 years and the Governor has proposed that their operations funding be cut. Many local public health departments are making valiant efforts to piece together funding sources to keep programs going, uphold their mission and meet the growing demand for services. The Senate limited these cuts to $1 million and we certainly appreciate their effort.
The other proposed cut to the public health budget we urge you to resist is the additional cut to Children’s Special Health Care Services. Many institutional MCMCH members provide the specialty medical care needed by CSHCS enrollees and are acutely aware of how any changes to the CSHCS program impact the health outcomes for these very special children.
We are very grateful for the opportunity this chair and subcommittee provided to hear concerns on CSHCS on March 24. We know you heard loud and clear that cuts to the current year budget that resulted in CSHCS program policy changes to increase fees and eliminate travel reimbursement and incontinence supplies coverage for non-Medicaid families have had drastic impacts. MCMCH members have shared with me that they are aware these cuts have resulted in families abandoning the program, and worse yet, making difficult and harmful choices about how and when they will seek care for their children’s complicated diagnoses.
As a public policy organization, MCMCH is most opposed to the way the cuts and the policy changes happened last fall. The process was unfair and even deceptive with cuts made to CSHCS in the last hours of conference committee. With no cuts to the program proposed in the executive budget and only language to propose a fee increase proposed during the long, drawn-out process last year, it is no surprise that CSHCS families and the organizations that support the program feel as though we were blind-sided by the final agreement to cut an additional $2.2 million by eliminating travel and incontinence benefits to non-Medicaid families. Those families deserved an opportunity to speak and be heard.
Many of the programs I have mentioned are part of the Healthy Michigan Fund with is far below the statutorily required level – a point that should be taken seriously but garners a “well, sue us then” response in today’s state government as the departments can only administer what is appropriated. The extremely frustrating message that we take away from recent budget decisions as well as the Executive and Senate proposals is of “we don’t want to fund prevention, yet we also don’t want to fund support programs”… all the while the attention goes to protecting education funding. We cannot expect children who are not healthy, well fed and supported at home to perform at school let alone become the college graduates that our state’s future will depend on.
The members of our Council are not oblivious to the economic climate in Michigan – quite the opposite actually as most are direct service providers who struggle everyday to meet the increased demand for services while receiving less or no compensation for doing so. So, it is with great respect for the difficult decisions that you must make regarding not only the DCH budget, but the entire state budget that we join with other voices to say that we implore you to restructure Michigan’s tax base.
Many of us have seen the presentations about how Michigan’s economy has declined, and how our revenue has declined much more sharply due to a combination of factors. The overriding theme is that our tax structure is simply outdated for today’s economy and the economic development strategy to give tax credits and incentives that now equal far more than that which we generate in revenue must be revisited.
The Council is tired of fighting our partners in health care, education, and human services at budget time. We are tired of the cannibalism that we are forced into. While we lobby primarily for health prevention services and see them as a very important first step towards a healthy future population, we cannot argue that we alone deserve the funding priority. Health prevention services are only part of the continuum of health care and health care is only one piece of quality of life.
Thank you.
Amy Zaagman
Executive Director
March 24,
2010
Dear Chairman McDowell and members of the subcommittee:
My name is Amy Zaagman and I am the executive director of the Michigan
Council for Maternal and Child Health. MCMCH has long been supportive of
Children's Special Health Care Services and a staunch defender of the need for
this program in Michigan.
Many institutional MCMCH members provide the specialty medical care needed
by CSHCS enrollees and are acutely aware of how any changes to the CSHCS
program impact the health outcomes for these very special children. MCMCH
stands with the families and other organizations here today to oppose the cuts
that were made in the 2009-10 Department of Community Health Budget as well as
those proposed in the 2010-11 budget. I will provide testimony on the
overall budget at the appropriate hearing on April 19, but I hope the example
of what has happened in CSHCS exemplifies the need for tax restructuring and a
level of revenues in this state that allows us to meet the needs of the people.
As you have heard here today and undoubtedly over the last several months,
the cuts to the current year budget that resulted in CSHCS program policy
changes to increase fees and eliminate travel reimbursement and incontinence
supplies coverage for non-Medicaid families have had drastic impacts.
MCMCH members have shared that they are aware these cuts have resulted in
families abandoning the program, and worse yet, making difficult and harmful
choices about how and when they will seek care for their children's complicated
diagnoses.
I have been told that parents are making sacrifices such as sleeping in
their cars or forgoing recommended travel altogether. After a meeting with
Director Olszewski, several of our members agreed to track the no-show rate
among CSHCS enrollees and we will work to share that data but it is not hard
for them to tell the rate has increased. The long term result of these missed
appointments may be the inability of our centers of excellence - our children's
hospitals - to attract and retain the highly specialized pediatricians
needed to provide the best care.
The same holds true regarding incontinence supplies with families, already
struggling with day-to-day challenges, they are forced to make hard and
dangerous choices about adhering or deviating from the best medical practices
for their children. It is not difficult to surmise that if children do not get
the regular care that their conditions require they are more likely to need
(costly) emergency care in facilities not equipped for their needs and more
likely to have unfavorable health outcomes as result.
As a public policy organization, MCMCH is most opposed to the way the cuts
and the policy changes happened last fall. The process was unfair and
even deceptive with cuts made to CSHCS in the final hours of conference
committee and a resulting policy change that was still soliciting
"comment" after it was already in effect. With no cuts to the
program proposed in the executive budget and only fee language even proposed
during the long, drawn-out process last year, it is no surprise that CSHCS
families and the organizations that support the program feel as though we were
blind-sided by the final agreement to cut an additional $2.2 million by
eliminating travel and incontinence benefits to non-Medicaid families.
Those families deserved an opportunity to speak and to be heard.
We are very thankful that Rep. McDowell provided that opportunity to discuss
CSHCS and the impact of the past and proposed budget decisions today and are
most appreciative of your time and attention.
Sincerely,
Amy Zaagman
Executive Director