New Census Health Insurance Data Likely to Show Declines in Health Coverage throughout Washington State

Tomorrow, the U.S. Census Bureau will release national and state health insurance data for 2007-2008. The data will provide a preliminary glimpse of the impact that the current recession has had on families in Washington and throughout the nation. The data will not however, capture the full impact of the current economic crisis which deepened dramatically in 2009.

The new Census data is expected to show significant increases in the share of the population that is uninsured since the early 2000’s to 2007-2008. The loss of employer-sponsored health insurance is likely to be the dominant driver behind this trend. During the current recession, the economy sunk rapidly in 2009 and many more people lost their jobs and their health insurance. So while tomorrow’s release will signal trouble, next year’s 2008-2009 health coverage data will undoubtedly be far worse.

For example, as the graph below shows here in Washington the unemployment rate jumped from an average of 5.3 percent in 2008 to 9.1 percent by July 2009. Since the start of 2009, over 64,000 jobs have been lost in the state. As a result, next year’s 2008-2009 data will show a large drop in the number of Washingtonians enrolled in employer-sponsored health coverage.

Stay tuned to schmudget tomorrow when the Budget & Policy Center in conjunction with Washington Kids Count will post an analysis of health coverage trends in Washington using the new Census data. Our analysis will highlight changes in the share of the population without health insurance over time and will detail changes in employer-sponsored coverage and public coverage in Washington State.

Editor’s note: Tomorrow’s release will also include updated data on poverty and median income. To obtain state-level estimates of these measures, however, the Census Bureau recommends using data from a different survey, the American Community Survey (ACS). The latest ACS data for 2008 will be released on September 22, 2009. That morning, the Budget & Policy Center and Washington Kids Count will post analysis of the ACS data on poverty, median income, and health coverage in Washington State.

Crosscut Article on General Assistance Unemployable

Yesterday we published an article on Crosscut about the importance of the General Assistance Unemployable (GAU) program to the economic security and health of lower income Washingtonians with disabilities who are unable to work. The article describes reforms that could be made to improve the program that would save money for the state and better serve the needs of GAU recipients.

To read the full article, click here.

Four Facts About GA-U#4: What Will Happen If It's Gone?

Today is the last installment in a special series on General Assistance-Unemployable, a state program that provides assistance to adults who cannot work because of disability and are not eligible for other programs.

We all hope that if we become disabled or struggle with a mental illness, we will have the economic security and support we need to recover, get back to work, and maintain a modest quality of life. The General Assistance-Unemployable program provides that for thousands of people in our state.

Washington lawmakers have proposed eliminating or reducing the state's GA-U program as a cost-saving measure. But what will happen in Washington if there is no General Assistance for adults with disabilities?

Recipients of GA-U have serious health problems that require ongoing medical care. The GA-U program offers health benefits in the form of fee-for-service medical coupons, or in Pierce and King Counties, a managed care plan. Without these benefits, GA-U clients are more likely to seek care in hospital emergency rooms and community health clinics which are required to provide health care regardless of a patient's ability to pay. This is not a cost-efficient choice for the state: Non-reimbursed health care in a hospital ER, for example, costs the state up to four times as much as an average doctor's visit.

The loss of medical benefits is also likely to lead to a worsening of physical and mental problems for GA-U clients. At the very least, this will prolong the time they are unable work and at worst, could lead to dire outcomes for clients.

What about eliminating the cash assistance provided to GA-U clients? Currently GA-U recipients receive $339 per month to help pay for basic needs. This includes rent for low-income housing, food, and medicine. With no income, some GA-U clients are likely to lose their ability to maintain housing, which will have an impact on their health and future employment status.

Eliminating General Assistance is not the right way for our state to go. Oregon, which got rid of its GA program in 2003, is in the process of reinstating its General Assistance program with support of the Governor’s office. Without assistance, disabled Oregonians found themselves in emergency rooms and on the streets, unable to become healthy and work. We are likely to see the same outcomes here in Washington.

Four Facts About GA-U#3: GA-U Benefit Has Not Changed in 18 Years

Today is the third installment in a special series on General Assistance-Unemployable, a state program that provides assistance to adults who cannot work because of disability and are not eligible for other programs.

GA-U financial assistance provides modest help in meeting immediate needs for housing, food, and other basic necessities. The stipend offered by the state is $339 per month; an amount that has not changed since 1991 and does not account for the increased cost of living over that 18-year span.


As a way of comparing the GA-U benefit with the rising cost of living, the graph above shows the $339 monthly stipend compared to the fair market rent for a studio apartment in Pierce County. In 1991, the stipend would have been enough to pay the rent on a modest studio apartment. In 2009, it would cover just over half the cost.

Four Facts About GA-U#2: In Fact, Other States Do Have GA-U Programs

Today is the second installment in a special series on General Assistance-Unemployable, a state program that provides assistance to adults who cannot work because of disability and are not eligible for other programs.

Yesterday, we talked about how GA-U fills an essential role in our state's health care infrastructure. Today, I want to point out (again) that similar programs exist in most other states. In fact, thirty-one states have statewide programs and another nine states have programs that are available in some counties, but not others. In total, only 11 states do not provide similar assistance.

We've blogged on this before, but I feel the need to do it again because lawmakers continue to claim that Washington’s program is unique. On Tuesday, for example, a State Representative claimed in an executive session debate that Washington is “one of very few states" that have a GA-U program. He then went on to say that "no surrounding states have this program."

Let's be clear about this:

• Almost every Western state has a similar program. California, Nevada, Idaho, Utah, Arizona, Colorado, and New Mexico all have programs statewide and Montana has county-level programs.
• In the Great Plains: Kansas, Nebraska, and South Dakota all have statewide programs and North Dakota has county programs.
• Every state north of the Mason-Dixon Line has general assistance (Wisconsin being the only one without a fully statewide program).
• Six Southern states have county-level general assistance programs: Kentucky, Tennessee, Virginia, North Carolina, Georgia, and Florida.
• Alaska, Hawaii, and DC all have general assistance.
• Twenty-nine states also provide medical assistance along with basic living assistance.

To be honest, I've never understood why the idea that other states do not have general assistance would be an effective argument against our state’s program, even if it were true. The parent in me wants to ask, "If all your friends jumped off a bridge . . ." We should do the right thing in Washington State because it’s consistent with our values, not because most everybody else is doing it. (Even though most everybody else is doing it.)

Four Facts About GA-U#1: GA-U is an Important Part of Our Health Care System

Today is the first installment in a special series on General Assistance-Unemployable, a state program that provides assistance to adults who cannot work because of disability and are not eligible for other programs.

State investments in health and economic security ensure that everyone can meet basic needs in times of financial hardship. The General Assistance-Unemployable (GA-U) program provides temporary assistance to Washingtonians that are unable to work due to disability. The program plays an important role in the state’s health care and economic security infrastructure by providing medical benefits and modest financial assistance to those who are not served by other public assistance programs.

The medical benefits provided to GA-U clients are part of a larger systemic effort in Washington to broaden access to health insurance. This effort includes lower-income workers who receive benefits through Basic Health to children who are covered under the state’s Apple Health for Kids. Maintaining funding for GA-U reflects our state’s long term goal of expanding access to the uninsured to improve health outcomes and better manage costs.

GA-U clients range from those who suffer from physical ailments stemming from injuries to others with debilitating mental illnesses. Health issues are a primary concern for clients in the GA-U program, many of whom suffer from co-existing physical, mental, and substance abuse problems. There are 21,000 people enrolled at any given month in the GA-U program and clients can be found in every county of the state.

Importantly, GA-U fills gaps that would otherwise exist in our state’s health care infrastructure. Eligibility for other assistance programs is very limited for adults who do not have children at home, even if they are unable to work to support themselves. And federal programs do not cover adults whose disability is considered to be temporary. For these Washingtonians, GA-U provides access to much-needed medical help and the chance to avoid deep poverty and homelessness.

False Choices on GA-U

The proposed budget cuts in state funding for public schools are indeed "unnecessarily deep." That's a quote from today's Seattle Times editorial. Unfortunately, the rest of the editorial argues in favor of school funding at the expense of the General Assistance-Unemployable program, which provides medical care and a bare standard of living for adults with disabilities who, as the Times acknowledges, have no other options.

Like our support for public education, our state's GA-U program reflects our priorities and values. The Seattle Times says that we currently invest in the program because Washington is "a humane state." But we can't consider ourselves humane if we provide economic security to our most vulnerable during good times and leave them with no support when times are bad.

There is a better option than pitting the elimination of state funding for school districts against core supports for people in need. These are both important public priorities. It's long past time we had a real public conversation about how to pay for them both.

Senate Budget Impairs Economic Security

The state is facing a deep recession and state programs that provide economic security are more important than ever.

In the area of Economic Security, the Senate budget proposal:
• Creates new barriers for families that need assistance in moving into the labor market
• Significantly reduces cash assistance to adults with disabilities that are unable to work

One of the key resources for Washingtonians in poverty is the WorkFirst program. This program is intended to provide cash assistance to families while helping them find and maintain employment. However, the obstacles to finding employment are significant in the current economic climate.

The Senate and the Governor both propose a $68 million cut to the WorkFirst program. The Governor reduces the number of families served, including punitive measures that terminate benefits. The measures the Senate is proposing to reduce funding for WorkFirst are not clear, but both proposals do not respond to the increased need for assistance and the increased difficulty of moving into the labor market. In addition, it is unclear whether this policy change will jeopardize additional federal funds that are assumed elsewhere in the budget.

General Assistance financial benefits for adults who are unable to work because of disability were eliminated in the Governor’s proposal. The Senate has a 15 percent smaller cut, and anticipates 6,000 clients will not be able to receive assistance by the end of the biennium.

As the Budget & Policy Center digs further into the Senate budget proposal we will publish short pieces on each of the following budget areas: economic security, healthy people and the environment, thriving communities and education and opportunity. (See our budget analysis in the Progress Index)

Discussing the Budget on TV

I appeared on King 5 TV's Upfront to discuss the crisis in the state budget. The conversation focused on potential health care cuts. Joining me are Paul Guppy from the Washington Policy Center and Rebecca Kavoussi from Community Health Network. The panel discussion starts at 4:10.

There are two segments that bookend the panel discussion: one focuses on the General Assistance - Unemployable program which is slated for elimination in the Governor's budget and the other focuses on the Adult Day Health program.

Community Health Centers and the State Budget

Deep spending cuts, such as those considered in the Governor's proposed biennial budget, would have severe effects on essential components of the state’s health care infrastructure, such as community health centers. Altogether, it is estimated that the Governor's budget would amount to a $250 to $350 million hit to community health center system. The table below summarizes the impact of selected cuts (click on it to see a larger version).


Community Health Centers have a unique role in the state’s health infrastructure. They provide a comprehensive scope of services to Washingtonians who would otherwise have limited access to quality affordable care. And they do so without regard to their ability to pay. In fact, 32 percent of their patients in 2007 were uninsured (see graph)


The cuts described above understate the situation faced by the community health center system because it also faces the impact of the recession. As people lose their jobs and therefore access to private health insurance, they are likely to become uninsured community health center patients. The need for these centers rises while their revenue falls.

Counting up the number of people who will directly lose coverage because of budget cuts also understates the effect on individual health care consumers. As community health centers reduce their services, it will have a detrimental impact on many more Washingtonians with lower incomes and special health needs.

Discussing the Budget on TVW

I went on the TVW show "The Impact" yesterday to discuss the state budget. My dance partner on the show was Jason Mercier from the Washington Policy Center. This is the type of reasonable discussion we should be having about the state budget.

Enjoy.

Debunking Myths About GA-U

In these difficult economic times, the General Assistance-Unemployable (GA-U) program is under threat of elimination, when it is needed more than ever. Many people who receive help through GA-U were previously employed until their lives were changed by an accident or illness. It benefits everyone in the state to know that assistance is available if the same were to happen to them or someone they loved.

Leading lawmakers have insisted that Washington State is unique in providing these state-funded benefits and therefore, we can not afford the luxury of continuing the program.

They are wrong on two counts.

First, Washington is not alone in providing general assistance to disabled adults. Our analysis of national data shows that 31 states in the nation provide similar financial and medical assistance. Benefits differ among states and some provide assistance in certain counties only, but the notion that Washington stands alone in helping disabled adults is simply not true.

But what if it were? It used to be that Washington State took pride in its innovative approaches to health care and social services. We stood out as a leader on health care reform years before the nation began addressing the issue of uninsured adults and children. We continued to make strides in this arena when the Legislature passed a bill in 2007 with the impressive goal of ensuring that all children in the state have health insurance by 2010. These are the kinds of public investments that Washingtonians take pride in.

Second, the general assistance program plays a vital role in supporting the economic security and health of Washingtonians. Contrary to some opinions, not all recipients of GA-U will qualify for federal Supplemental Social Insurance (SSI). A 2006 Department of Social and Human Services report found that half of GA-U clients transitioned to SSI between 2003 and 2004. It is not adequate to assume that the federal system will absorb the needs of this population if we dismantle the state program. In addition, there is a significant backlog of applications to the SSI program that renders wait times of up to two years. If there are no state general assistance benefits available, the costs of which are eventually reimbursed to the state, low income people who have very serious health problems will likely deteriorate.

Cutting GA-U out of the state budget will not ultimately save costs to the state. It will simply divert costs to other parts of the budget that cover such areas as emergency rooms visits and public safety. A smarter approach would be to streamline our investments in the program. Our in-depth analysis of GA-U found that the state is likely to save money by providing comprehensive mental health and substance abuse treatment to GA-U clients. The state should also consider a managed care or “medical home” model of health care for everyone in the program and better screening of clients who may qualify for veteran’s benefits.

Clearly the economic crisis at hand is very serious and will require thoughtful consideration of all our options. State leaders should urge Congress to support President Obama’s plan (contained in his budget proposal) to to speed up federal administration of SSI claims, which will help move eligible Washingtonians into permanent disability benefits. But not all GA-U clients will be able to make that transition and the results would be harmful to them and costly to the state. Maintaining the GA-U program aligns us with the majority of states in the country.

General Assistance: New Strategies for a Vital Program

Today the Budget and Policy Center released a new policy brief on Washington State's General Assistance - Unemployable (GA-U) program. The paper, entitled, "General Assistance: New Strategies for a Vital Program," outlines the value of GA-U, which offers economic security and health care to over 20,000 working-age adults with disabilities in our state. The Governor has proposed eliminating the program, a proposal that would have a very detrimental effect.

In addition, the paper discusses how GA-U could better serve clients through implementing strategies that will improve outcomes and reduce costs. Included in these proposals are:

• Provide a medical home for every GA-U client
• Expand coverage for mental health and substance abuse treatment
• Improve state facilitation of eligible GA-U clients to federal programs

To read the full text, go here.

In Most States, GA-U Fills Gaps in Economic Security and Health Care Systems

We all hope that if we were ever to face disability, we would have the supports necessary to maintain our economic security. The General Assistance-Unemployable (GA-U) program is designed to help fill that need for thousands of people in our state. It is an essential component of Washington State’s efforts to ensure economic security (pdf) and access to health care (pdf) for all residents.

GA-U provides financial and medical assistance to adults who are unable to work due to disability and are ineligible for other programs. For these adults, GA-U fills gaps that would otherwise exist in our support systems:

• Unemployment insurance and workers’ compensation benefits often expire well before longer-term disability benefits become available.

• Eligibility for other assistance programs is very limited for adults who do not have children at home, even for adults who are unable to work.

For these Washingtonians, GA-U provides some protection from deep poverty and homelessness that would otherwise not be available.

Governor Gregoire has proposed (pdf) the complete elimination of GA-U, including both financial and medical assistance. Such a decision would have a detrimental impact on the Washingtonians who rely on the program. As shown by a number of studies, it would also add significant costs with regard to health care and public safety systems in the state.*


The proposed elimination would put us out of step with the rest of the country (see map). Most states in the nation recognize the importance of meeting this need. Thirty-one states across the country have statewide GA-U programs with financial and/or medical benefits. Another nine states have GA-U programs available in some counties, but not in others. In total, only 11 states (Oregon, Wyoming, and nine Southern states) do not have comparable programs.

This post is available as a one-page pdf handout.


* For example, see Mancuso, David, Ph.D., and Sharon Estee, Ph.D., Washington State Mental Health Services Cost Offsets and Outcomes: Technical Report, Washington State Dept. of Social and Health Services, Research and Data Analysis Division, Olympia, WA, Dec, 2003 and Wickizer, Thomas, Ph.D., M.P.H., The Relationship between Chemical Dependency Treatment and Criminal Activity among Clients on General Assistance-Unemployable (GA-U), Oct. 2005 (working paper).

UPDATE: Governor's Budget Proposes Deep Cuts

The Governor’s 2009-11 budget released today proposes deep cuts in all areas of the state budget, including state-funded health care, assistance to people with disabilities, and education. The Governor’s reliance on budget cuts and resistance to options of increasing revenue and ending certain tax exemptions severely limits our ability to pursue important priorities during these difficult economic times.

UPDATE

During a time of broad economic insecurity, the impact of these budget reductions will fall disproportionately on lower income people who are employed or are unable to work due to disability. Twenty percent of the $3.4 billion in cuts in the Governor’s budget focus on two important programs:

• Currently, about 100,000 people receive health insurance through the Basic Health program. The governor’s budget would cut this program by 42%, suggesting that 40,000 or more people would lose health insurance. This cut in Basic Health would mean a reduction of $275 million dollars

• The General Assistance for the Unemployable Program provides health care and cash assistance to 20,000 adults who are unable to work because of disability. This program is entirely eliminated, saving $400 million.