Cutting assistance to the unemployable would be costly
Cutting General Assistance for very-low-income people temporarily unemployable, which Gov. Gregoire proposes to do, would prove cost-inefficient, an advocate for GAU argues
State of Washington
For months Washington lawmakers have been struggling to reconcile the state’s largest budget deficit in history ($9 billion) and not make total waste of the important programs and services that the budget funds. The magnitude of the deficit is daunting and it forces all of us to consider what matters most in public investments and which decisions, at the end of the day, we can live with.
On the chopping block is the state’s General Assistance Unemployable (GAU) program. GAU provides much-needed economic security to the people it serves. The program offers modest cash assistance and medical benefits to low income adults who are temporarily unable to work because of physical or mental disability. This could be a veteran who becomes injured in a car accident and needs time and medical care to recover from his injuries, or a woman who suffers from severe anxiety and depression and needs assistance.
Without the program, people on GAU are at risk of hunger, homelessness, and deterioration of their health problems. With GAU, Washingtonians are assured that a modest level of support will be there in the event of an unexpected illness or injury. Moreover, maintaining and improving GAU will save the state money from escalating health care and other public expenses.
Washington has long been a leader in progressive social policies. In 1988, we expanded access to health care for lower income workers through the state’s Basic Health Plan, the first program of its kind in the nation. Soon after, in 1993 Washington began providing health care coverage to children from lower income families, five years ahead of the federal government’s creation of the State Children’s Health Insurance Program. And two years after national welfare reform, in 1998 our state’s General Assistance program covered not only those who were temporarily disabled, but also pregnant women, immigrants who no longer could receive federal benefits, and certain families with children.
These days, General Assistance is limited to very low income adults who are unable to work due to physical or mental disability. There are 21,000 people enrolled in any given month in the GAU program; recipients can be found in every county in the state. Back in December, faced with a growing state budget deficit and the task of writing a balanced budget, Gov. Gregoire proposed eliminating GAU entirely, including the $339 monthly cash grants for basic needs and medical benefits.
On paper, it looks like the state would spend $400 million less. But in reality, we will still end up paying to support the health and basic needs of GAU recipients. GAU clients have complex, ongoing health problems. If they can’t go see a doctor, they will likely go to public hospital emergency rooms and community health clinics, which are required to provide care regardless of a patient’s ability to pay. This is not cost efficient. An ER visit can cost up to four times as much as the average doctor’s office visit. In addition, health outcomes are better for people who have health insurance and can address concerns before they become serious medical conditions.
Even with GAU medical benefits, clients still utilize hospital ERs to manage their health problems. Part of this is the result of the seriousness of their health concerns, and partly it is due to the fragmented health care system in which they try to get served. Many doctors do not accept the medical coupons offered by GAU patients, and there are few support services to help them find providers who do.
Instead of gutting the program, lawmakers should make improvements to GAU that will lead to better outcomes for patients and cost savings for the state. For starters, GAU clients should receive coordinated care, sometimes called a “medical home,” which allows the patient and provider to develop an ongoing health care relationship.
In 2004, a pilot program in King and Pierce counties (the two with the highest number of GAU clients) set out to examine the health and cost-saving benefits of a managed care model. Contracted through the Community Health Plan, the pilot program sets GAU clients up with a single primary care provider. The provider offers health care directly or refers the client to specialists. Currently over 5,600 people are enrolled in the pilot study. Results find that for the same price of coverage, clients have increased access to medical services and a reduction in spending on pharmaceutical drugs and inappropriate use of emergency rooms.
Despite the fact that disabling mental illness is one of the criteria for inclusion in GAU, the program currently does not cover comprehensive treatment of mental health disorders. This means that GAU clients who are experiencing acute and possibly catastrophic mental illness cannot always readily access the appropriate care. In 2007, the GAU managed care pilot program expanded to include coordinated mental health services. Although results from the pilot are not yet in, research on this approach is promising.
One recent study from the University of Washington of older adults with depression found long term health care costs were significantly reduced for patients who received mental health treatment as part of their health care plan. The study showed that initial costs were higher for the group that received the mental health services, but those costs went down over time and the net effect was significant cost savings.
In addition, substance abuse treatment can be accessed through the GAU medical plan, but available programs are often elusive. And yet, for one-third of GAU clients, substance abuse is a co-existing condition that drives up costs to the state. Emergency room use is higher among GAU clients that have a substance abuse problem than it is among those who do not. Likewise, arrest rates are higher among GAU clients who have a substance abuse problem than those who don’t. Treatment for alcohol and drug addiction can reverse these trends. A recent study from UW found that GAU clients who received substance abuse treatment had significantly reduced criminal activity compared to those with untreated substance abuse problems.
Finally, the state can lower costs by more accurately identifying clients in the GAU program who could qualify for federal benefits. This will happen more accurately and efficiently if clients are enrolled in a medical home model of care where their primary provider can properly diagnose their health status.
But it is not enough for the state to rely solely on federal programs to ensure the economic security and health of lower income adults with disabilities. For those who do not qualify for federal disability benefits, the threat of hunger and homelessness will be very real.
GAU is a vital part of our state’s economic security and health care infrastructure. Without it — or if deep cuts are made, as proposed by the state Senate — costs in other areas of the budget will undoubtedly rise including use of emergency rooms for health care, programs that assist the homeless, and public safety resources. Conversely, by making smart investments, the state can save money and improve outcomes for recipients.
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Comments:
Posted Thu, Apr 16, 4:43 p.m. Inappropriate
Proceed with the cut. My hope is that GAU is not being stopped simply by trying to transfer to GAX.
Each of these individuals have a mother and father, somewhere. It is by their actions the state has become a surrogate parent. Give these people back to their real parents.
It is way past time to make the case for personal responsibility AND family planning.
What are the liberals going to do when they run out of other peoples money for such socialism ?
Posted Thu, Apr 16, 9:27 p.m. Inappropriate
Wow, Steptoe.Fan. That's not exactly a realistic or compassionate way to look at things. The "every person has a mother and father" comment is completely off base. Although biologically true, many people in dire situations do not have any family resources at all, or only one parent, and obviously parents die at some point too. Your world view only accommodates Beaver Cleaver-type families.
What good is "family planning" for people living in areas without access to sex education, condoms, or contraception? What good is "family planning" for people who fall under evangelical Christian and Catholic prohibitions on contraception? I mean, the Pope last month literally just said that condoms may help spread HIV (which is wrong), probably in an attempt to prevent any kind of family planning.
Also, let's say that family planning somehow overcomes these obstacles. We will still have lots and lots of real people out there RIGHT NOW. Do you just look someone in the face and say, "Sorry, we can't help you; your mother should have had an abortion" or "Sorry, we can't help you; your father should have used a condom"?
Really, you want to live in a society where that happens?
Here are some real-life situations I am personally familiar with:
A 50-year-old man with both parents deceased and no other close relatives who suffers from advanced Parkinsons. What is supposed to become of him in your world view?
A 12-year-old autistic girl with a mother who has severe epileptic seizures and can't work. What are that mother and her daughter supposed to do in your world view?
A 40-year-old man with mild retardation who weighs 500 pounds and suffers from diabetes and sever back spasms. Yes, he shouldn't have put on all that weight. But now he weighs that much and can't work. What should happen to him in your world view?
A 45-year-old bipolar/schizophrenic woman who can work when she is taking her medications but (due to the nature of her mental illnesses) who often goes off them and then cannot work. What should happen to her in your world view?
In Nazi Germany, all of these people would have been "euthanize." Do you agree that that is wrong? If so, then you need to come up with a solution for these people.
Either we live in a society where people who authentically cannot help themselves and who authentically have no resources can still have a roof, food, medical care, and a shred of human dignity--or we don't.
I want to live in the former society.
Which society do you want to live in?
Posted Sat, Apr 18, 10:07 p.m. Inappropriate
You think this is bad a non profit group in carnation is waiting on a grant from Olympia for $162.000 so the farmers market doesn't have to operate in the rain and we can't protect the most vulnerable?
Posted Sun, Apr 19, 10:57 a.m. Inappropriate
",,, he shouldn't have put on all that weight. But now he weighs that much and can't work....."
smacgry, that's an pretty open-ended commitment, isn't it? if you drink too much or if you are addicted to pain killers, smack, cigarettes or if you have anger management problems and are practically unemployable then you become a ward of the state?
It's a big step to make that commitment, a Slippery Slope as the conservatives say. As this program matures screening for "need" will become less and less stringent. More and more people will become "eligible"; fewer people will care for their own relatives and friends; does the prospective ward have any hidden assets? income? well, it's hard to tell and the funding is available.
You will probably get the relief you want but the side effects are going to be painful and destructive. And they last forever.
Posted Sun, Apr 19, 2:46 p.m. Inappropriate
Expect to see a stunning increase of wandering, mentally-ill homeless people on our streets. You think it's bad now... wait!
Posted Mon, Apr 20, 3:29 p.m. Inappropriate
@kieth
Obesity is a very complex medical issue, usually a combination of predispositional metabolic factors, lifestyle factors, and (most importantly) psychological factors. It is akin to any addiction, actually, such as those who are addicted to pain killers, "smack" (if people still call it that), meth, or tobacco, and it is also akin to eating disorders such as anorexia. While it's difficult to imagine someone not being able to work due to a tobacco addiction, someone who has an eating disorder or a meth addiction cannot work--and cannot also not recover from the addiction without help. We can't solve problems by wishing they had never happened; the problems exist NOW and people are in bad situations NOW.
My point remains the unchanged. Our society has people who lack resources and are in trouble. Our society has people without family, or with very troubled families who can no sooner help them than they can help themselves.
They may have gotten into trouble on their own, or they may have been victims of grooming (e.g. free drugs distributed to young teens to get them addicted), or to bad decision-making. We as a society need to have a mechanism for dealing with these people. Your solution, not to help them, basically creates a system where the only solution for these people is homelessness -> death, or in many cases suicide.
It's easy enough if you come from a middle class background with two married parents, stable income, and health insurance to be unable to imagine the lives of people who don't fall into those categories might be.
Conservatives, despite the Christian point of view that they often claim to espouse, never offer a compassionate solution for people like those I mention above. The fact is, some people need help, and we ought to live in a society where those who authentically need help can get it.
If you oppose that point of view, the logical conclusion is either what Sulaco predicts, or widespread "euthanasia" of those people. I do not want to live in that society.
Posted Wed, Apr 22, 10:59 a.m. Inappropriate
The Governor's decision-making process in cutting GAU was deeply flawed. If you look up the Priorities of Government list, 86 programs were ranked "high priority" and the next one, GAU, was ranked "low priority." What were the criteria? Assisting vulnerable populations was one. I don't know of a more vulnerable population than this one, many of whom are vets and half of whom suffer from mental illness. Without eligibility for Medicaid, cut off from their expensive meds, many will soon be wandering the streets and some will most certainly die. On TVW, in an interview, the Governor stated that GAU was "outdated," yet she cited no other program that has taken its place. A safety net is never outdated, if that's all you've got.
Republicans have tried to put a time limit on GAU. "It should be limited to one year. The current average of 18 months is too long." Yet disability does not know a time limit. The current economic environment and cuts to drug and alcohol treatment make the goal of employability further off than before.
For the past 25 years, Republicans have done everything they could to keep people off the Social Security Disability rolls, including stalling and refusing applicants for two to three years, only to find that, of those who persisted, over 80% deserved those minimal payments. President Obama has promised to adequately fund the Social Security Administration and to bring down that waiting period, and the need for two to three appeals before getting the benefits the law provides. At that point, the need for GAU may decrease. Let's hope so.
Posted Sat, Apr 25, 6:52 p.m. Inappropriate
So, once again, the libs don't answer the queston : they substitute.
What are the liberals going to do when they run out of other peoples money for such socialism ?
If you want to help any / all of your situations, go right ahead. Use your own money though, not mine. Mines is going to insure that family planning education and aids are available. Mine is for identifying individuals who have demonstrated that they are not fit to be parents and then making it clear to them that the will lose any/all benefits if they do make babies.
My money is to insure that families who are poor do not make more babies.
My effort is to reduce the mess that your compassion has created.
Posted Sat, Apr 25, 7:27 p.m. Inappropriate
The 50 year old - he lives the rest of this life in his current state, or he dies - if there is no private / church agency to maintain him as is, he dies.
the mother and 12 year old, the 40 year old and 45, see above.
You libs are so busy trying to save everybody you have lost sight of the fact that you are doing nothing to prevent more of the same. It is past time for pro active.
You libs mock the model family, dismiss it as not real world, and promote through your socialism the continued support of the dis-functional. It is a self fulfilling prophecy and you never want to talk about that factoid.
What are the liberals going to do when the run out of other peoples money for such socialism ?
Posted Thu, Dec 9, 3:49 a.m. Inappropriate
Hi everyone,No one grew up saying i want be poor,and make minium wage.But some of us do.So,If your solutions are go back to mom and dad,it makes me wonder if you've followed your own advice and helped out any of your own family members yourself,or others.Otherwise this would make a person a hipacrit.And if the libs spend other peoples money as much as you read ,how is that the wealthy make profits beyond what you and I can image and so on ? Oh ya its us minium wage workers that make that a reality for them.We are the first to take the min. wage because we like Mexicans just want a job.Lets be real here.We all can't make 20.00 plus and hour.Go back to what scriptures in days of pharoah ,when Egypts people suffered terrably at his hand.See any connections there? I do,especially with the latest news,give the wealthy a perminent tax break,WOW .Sounds like pharoah again to me,and were(the poor)the egyptians.This sounds like more of the same to me with rep. constant breaks for the pharoahs of this world .We are not lepers or throw aways either,because you have no use for the min. wage worker,and or people with serious health issues.We need to keep the GAU,as well as the GAX,though i personally have never been on it,I beleave it is the right thing to do.
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