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On a Budget Brink BY ERNESTO CORTES JR. TEXAS STANDS on the brink of shredding its already weakened safety net for the state’s most vulnerable citizens. The budget presented to the Senate by the ting roughly $1.4 billion from current levels of social service programs. What this means, among other things, is that if these cuts are made medical care will no longer be available to some of the poorest children in the state. Thus, no matter how high the fever, how painful the earache, or how infected a cut becomes, the parents of these children will no longer be able to take them to the doctor. Many poor pregnant women will no longer have access to medical care, and neither will their infants. Medical care for these, and other population groups, would be eliminated not because such care is no longer necessary, but because it is seen as an “optional” part of Texas’. health and human services programs. Complete elimination of certain programs and the reduction of eligibility and services for others punishes the state’s most vulnerable citizens: Children, pregnant women, the elderly, and the disabled. We are all committed to higher education and the maintenance of infrastrucsacrifice, and sacrifice has clearly been called for in this biennium, then the sacrifices should not be borne by the most needy and most vulnerable of Texas’ citizens indeed, those on whom our future depends. Children are our most important asset, and they are the responsibility of all our citizens. At a time when the nation is calling for change, Texas is changing in the wrong direction. In his inaugural address, President Bill Clinton called on America to provide for “the world to come … the world to whom we bear sacred responsibility.” The state of Texas will not be fulfilling its sacred responsibility to the world to come if it makes the proposed. cuts in health and human services. Already, Texas ranks 48th in cash assistance to povertystricken, single-parent families. Forty-eighth in women receiving adequate prenatal care. Forty-seventh in Medicaid spending per capita. Forty-third in children living above the poverty line. Fiftieth in adequate immunizations rates for two-year olds. The only thing more disturbing than these statistics in our “New Texas” is that they are about to get worse. Some of the proposed cuts are outlined below: Proposed cuts in Aid to Families with Dependent Children would limit eligibility to Ernesto Cortes Jr., executive director of the Industrial Areas Foundation, a grassroots orga nizing group, wrote this at the Observer’s request. only those with annual incomes below $1,600 14 percent of the 1992 federal poverty level. This would drop Texas from 48th to 49th in the cash assistance to single-parent families. The national average AFDC threshold for a family of three is $5,196 44.3 percent of the federal poverty level. Not only will approximately 7,000 caretakers and their children be left without cash assistance entirely, but the grant to those who still qualify will be reduced from $57 to $45 per month. In addition, those 7,000 children and single parents \(predominantly they happen to fall within one of the other rapidly shrinking Medicaid eligibility categories. Medicaid eligibility for pregnant women and infants would be cut from 185 percent of the federal poverty level to 133 percent Children in two parent families with annual incomes below the AFDC eligibility line \(either $2,200 or $1,600 per year, depending on cuts for Medicaid. Cuts in eligibility for pregnant women and infants alone \(as separate from leave approximately 28,000 women and children without access to medical care over the next biennium 16,000 to 18,000 of whom are infants less than a year old. Eliminating services for the second category of children would eliminate health care for 17,000 additional children in each year of the next biennium. This category of children was originally made eligible for Medicaid not because the state had excess revenue, but because children whose families have an income of $183 per month do not receive medical care. Imagine the harsh decisions parents have to make under these cirvide for their family each month. We are now considering withdrawing that medical care, because it is an “optional” category for Medicaid. Are these children an “optional” part of Texas’ vision for the future? Proposed cuts would also eliminate all state funding for the WIC nutritional program for pregnant women and infants. This cut is being considered despite the fact that every dollar invested in the WIC program saves between $1.92 and $4.2.1 in Medicaid expenditures for newborns and their mothers. has demonstrated that prenatal WIC benefits reduce the rate of low birthweight births by 25 percent saving state and local entities countless Medicaid, uncompensated hospital care and special education dollars. Welfare-to-work transition programs would be cut back to 1986 levels of funding. At a time when we are called on to define a vision for our future to take responsibility for our children and our communities the state of Texas is considering cutting welfare-towork transition programs back to 1986 levels of funding. According to the, LBB budget summary, this cut would eliminate job training, employment, child care, transportation, and educational services for “the majority of AFDC clients” attempting the transition from welfare to work. In addition to eliminating critical services for the state’s most vulnerable populations \(and the descriptions above represent only a tiny portion of the cuts under consideration, the proposed budget would also lose millions of federal matching dollars that are drawn down by the state’s contributions to federally sponsored programs. AFDC cuts and elimination . of Medicaid eligibility for certain pregnant women and children alone would cost Texas almost $400 million in matching federal funds. This figure represents only the dollars immediately lost. Comptroller John Sharp estimates that every dollar spent on health and human services means $2.38 to our communities cut of the size proposed by the LBB could amount to a $4 billion reduction in business activity. At the same time our local communities are losing these business dollars, they will be called on to provide more and more of the revenue to compensate for services for which dip state is cutting resources and losing even more federal funds. Texas communities are virtually assured increases in the costs of corrections, uncompensated health care \(particularly in light of the LBB’s proposal to eliminate state compensation for indigent and so forth. Naturally the state will not be immune to the future consequences of these cuts either. Acceptance of the cuts under consideration, and of the lack of leadership proposing a solid source of revenue for the critical safety net serving our children, elderly and disabled, means that the legacy of the “New Texas” is going to be a retreat from all the reforms of the last 10 years. The reforms in indigent health care programs initiated by Helen Farabee in 1985 are also at risk in the LBB budget. Given that the entire state of Texas has honored Farabee for her work in health care reform, it would be the ultimate hypocrisy for the Texas Legislature to allow the memory of her vision to be obliterated by endorsing the, health and human service budget cuts under consideration at this time. This is a time for courage, leadership, decisiveness and basic decency. We must recognize the hard realities these cuts represent for 8 FEBRUARY 12, 1993