Organize die-ins to protest human services cuts?
We need to organize public die-ins. Pioneer Courthouse
Square in Portland would be a good place. So all those
comfortable middle-class people who walk around downtown
would have to watch people dying because they weren't
willing to vote for a tax increase. Really rub their noses
Cuts to balance state's books will turn lives upside-down
The morning after Oregon voters rejected a tax increase, the state reprogrammed its computers for dozens of health and social programs due to shrink or vanish at midnight.
Somewhere in that software, it says the state will no longer pay for John Hoefer's 17 prescription drugs, including three that keep him from rejecting the kidney transplant he received in 1987.
"Without my medicine," said Hoefer, 59, of Aloha, "I lose my kidney -- or my life."
Hoefer is among thousands of Oregonians whose state aid runs out today, leaving them on their own to pay for medications, long-term care, clinic visits, child care and emergency shelter.
"These are very real cuts that will impact people . . . and we're going to see them hurting," said Jean Thorne, Department of Human Services director.
The end of the Medically Needy Program, which covers Hoefer and about 8,900 other low-income Oregonians with unusually high health costs, is just one of many cuts.
Among other casualties: the General Assistance Program for 2,700 disabled and low-income Oregonians unable to work; round-the-clock mental health crisis service in most counties; and care that keeps older Oregonians out of nursing homes.
Falling tax revenue has squeezed $140 million out of the Department of Human Services budget since the last legislative special session.
Of 92 program cuts made by the department in the past two months, 70 take effect Saturday. Others loom on March 1 or April 1.
Pills, bills and questions The latest cuts reach past election rhetoric into the Aloha duplex where John and Faye Hoefer live.
Next to the poinsettia on the dining table is a clutter of medicine bottles -- 17 prescriptions and five over-the-counter drugs. A zip-lock bag contains 46 pills -- one day's worth. For blood pressure, kidney damage, skin cancer, depression and pain. And to keep his only kidney working.
Hoefer has had kidney disease for 43 years and was felled by a stroke nine years ago. He walks with difficulty and cannot drive or work.
His total bill for 164 prescriptions filled last year at the Safeway pharmacy was $17,086.28. The Medically Needy program picked up all of the cost.
The unsigned letter Hoefer received from the state this month was short but not sweet: The Medically Needy Program was about to end.
"If you start paying more medical costs because of this change," the letter advised, "call your worker. You may be eligible for more food stamps."
"I like that 'if,' " Hoefer said dryly. "Food stamps don't do a lot of good if you're dead."
Hoefer's wife of 38 years, Faye, also is disabled by a stroke. She has diabetes, kidney damage and glaucoma.
Their only income is his $1,141 monthly disability check from Social Security. That pays the rent and food bills, but it also disqualifies Hoefer from the Oregon Health Plan.
The Medically Needy Program is for people who are aged, blind or disabled but don't qualify for the Health Plan. About 30 states have such programs. Oregon's began in 1986, the year before Hoefer had his transplant.
Doctors with patients losing Medically Needy coverage are trying to negotiate deals with drug companies and hoarding free samples from pharmaceutical sales representatives.
"More and more, I'm going to my sample cupboard, and I'm giving patients medicines based on what I have samples of," said Hoefer's physician, Dr. Leslie Steed, a kidney specialist at Northwest Renal Clinic in Portland. She hates doing that but sees no alternative.
"It's awful," Steed said. "You study and learn about how to take care of people, but so many of the techniques are cost-prohibitive. And here I am handing out medicines from a sample cupboard."
Transplant patients need about $1,000 a month in anti-rejection drugs for the rest of their lives.
Medicare, the federal health plan for people older than 65 and the disabled, now pays 80 percent of the cost of anti-rejection drugs to kidney transplant recipients for at least three years. But that change does not apply to earlier recipients such as Hoefer.
Elderly, disabled feel cuts, too Along with the medically needy, the state is eliminating services for 9,000 older adults and people with disabilities in long-term care, a quarter of those served. For more than 2,500 of them, that means they must leave their adult care homes, assisted living or nursing homes. The first wave of cuts occurs tonight; the second hits April 1.
"Oregon became a frightening place to live if you're old today," said Jim Carlson, executive director of the Oregon Health Care Association, the trade group for for-profit assisted living centers and nursing homes.
Hundreds of elderly people and their supporters packed the front steps of the Capitol in Salem on Thursday to protest the cuts.
Members of the sometimes ornery crowd braved a steady drizzle to hear Gov. Ted Kulongoski and a parade of speakers sympathize with their plight. But they heard little that brought them hope of financial help any time soon.
"The truth is," Kulongoski said, "the vote on Tuesday was a setback for all of our citizens who are in need of their government."
Kulongoski has said he doesn't want to revisit the cuts that Measure 28 was meant to avert, but he said he's working with legislative leaders and state financial planners to try to save services for some of the most vulnerable people who receive state aid.
"Don't try, do it!" several in the crowd yelled.
The impact of the latest cuts is compounded because they must be squeezed into the remaining five months of the fiscal year.
"These are the kinds of policy decisions you normally take two years to plan," Human Services Director Thorne said. "We're doing it in three months."
Another complication: 70 percent of the human services budget goes for programs that are required by federal regulation or attract hefty federal matching funds. For every state dollar cut out of the Oregon Health Plan, for example, the plan loses more than $2 to spend on people.
Lawsuits contest cuts The state also faces a flurry of lawsuits challenging cuts in coverage of long-term care, housing for the disabled, and medications.
Although every area of social services is hurt by cuts, child protection and welfare services escaped with the least harm because a larger percentage of their budgets is federal money.
Nearly every mental health agency across the state has started laying off workers and informing clients that, come Saturday, they won't be eligible for help they need to stay out of psychiatric hospitals.
Most communities are closing their 24-hour crisis services as well. Only a handful have enough reserves to keep them open.
"Now when someone calls a crisis center, it will be closed or there will be nobody to dispatch to help the person," said Gina Firman, executive director of the Association of Oregon Community Mental Health Programs.
The cuts range from the indefinite delay of a new Oregon State Hospital ward to elimination of all community mental health aid, including prescription coverage, for 10,450 adults and 3,730 children not eligible for Medicaid.
Case managers across the state say they are frantically helping clients fill out applications for limited free prescriptions from pharmaceutical companies and scrounging for drug samples to keep the chronically mentally ill stable.
"We have some samples, but they're not going to last long," said Bob Furlow, mental health director for the Douglas County Health and Social Services Department.
The mental health cutbacks are especially painful, Thorne said. They fly in the face of efforts to improve care -- and curb long-term costs -- by keeping chronically ill patients out of the hospital.
"I think you'll see backups in hospital emergency rooms," she said.
About half of the 600 patients treated at the HIV/AIDS clinic at Oregon Health & Science University are on the Oregon Health Plan or the Medically Needy Program.
"It's a nightmare," said Dr. Mary O'Hearn, an HIV specialist at the clinic. Taking away coverage of drugs that help keep the AIDS virus in check not only threatens the lives of patients but also is "a foolhardy way to lower costs," she said.
"To cut medications in very ill patients is only going to increase their visits to doctors and hospitals," O'Hearn said.
Heidi Jolson, a mental health therapist and case manager in Multnomah County, said about half of her 70 clients will be cut from services.
"I walk out of here every day feeling like I've ethically violated my clients," Jolson said. "We're trained to offer services to people who medically need it. This has forced us to refuse those services.
"There's no way to feel good about that."
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