Commentary

Nancy Milio: Senate budget shortchanges public health

June 10, 2014 

As a former home care nurse and teacher of community health nurses, I have seen how important in-home and community services are for elders and disabled people and their families. As a professor of nursing and of health policy, consultant, and researcher, I know how cost effective and health-supportive such services are.

A model of these services now available in five Piedmont counties, is the PACE (Program of All-inclusive Care for the Elderly) run by Piedmont Health Services and its community health centers. The program provides every form of care, both in-home, primary care, and in-patient, day care, drugs, and transportation, and more. Much of it is paid for by Medicare and Medicaid – and it saves taxpayers the higher costs of nursing home care.

The N.C. Senate’s new budget would cut these programs, among many others. It would cut Medicaid, including such services as prescription drugs, mental health, and dental care, and cut thousands of individuals from the program. Thousands of these current beneficiaries are too poor to be eligible for the Affordable Care Act; these are people who would have qualified for the federally paid expansion of Medicaid that the General Assembly and Governor refused to accept.

By cutting cost-saving, family-friendly programs like PACE, it would also be threatening the providers of health care for all low-income and other working families, because community health centers will lose those insurance dollars and do not have other sustainable sources of funds to meet their full costs.

It’s up to the House and Gov. McCrory to re-think this short-sighted budget. I urge them to think about the consequences for all their constituents, those whom they are pledged to represent – about the added burdens on families, and the all-but-certain higher future costs from emergency room and acute hospital care, nursing home costs, and the ever-mounting costs of aging and more retirees in the state. More investment in community-based services are needed, not less.

At the other end of the demographic spectrum, children and young families, many of which are underemployed, community services will prevent illnesses that otherwise would end up in higher cost hospital and specialty care – yet the Senate would cut out school nurses, along with thousands of teaching assistants who also serve as an extra pair of eyes to detect symptoms in children.

I suggest an easy answer to these budget problems: just do away with the large tax cuts for the wealthy minority; they won’t miss it, but it would be life-changing for thousands.

Nancy Milio, Ph.D., is a UNC professor emeritus.

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