State budget's unhealthy effects
The New Hampshire Nurses Association, which represents the interests of over 19,000 registered nurses in the state, registers its deep concerns about the state budget that has passed the New Hampshire House and is now being reviewed by the Senate. NHNA believes that this budget does not adequately provide for the health-care needs of our citizens who must rely on the state for medical assistance. In addition, these budget cuts come after years of significant retrenchment and program reductions. This budget may be eliminating payments for medical care, but it is not eliminating the need for that care.The budget reduces or eliminates a significant portion of services to the poor and those in need, and makes drastic reductions in payments to hospitals and nursing homes. These cuts are certain to have dire consequences for the citizens of the state.By way of example: Medicaid, by definition, provides funding for medical care to the most needy of our fellow citizens. By cutting Medicaid reimbursements, the state is guaranteeing that some of the most sick and financially disadvantaged people in the state will be receiving less in the way of health-care services.Hospitals and nursing homes, which already provide care for the state's Medicaid population at a fraction of what it actually costs to provide that care - and at far less than it would cost for the state to provide that care on its own - will see extensive additional reductions.This almost certainly will mean that these facilities will have to cut services and result in cost-shifting to other, more expensive, forms of care such as emergency room and intensive care treatment.Deep cuts in areas such as mental health services, developmental disabilities and brain injury services will result in people not receiving appropriate care.What is more, many of these cuts will also result in cost-shifting to other, more expensive forms of care. For instance, a reduction in beds and outpatient follow-up at New Hampshire Hospital has historically meant that more people with mental illness will be incarcerated in our jails and go to hospital emergency rooms for treatment.This is a grim prospect for the mentally ill, and also bodes very poorly for hospitals, which are having their state reimbursement for uncompensated care reduced by over $200 million by this budget.NHNA is also concerned about cuts proposed to the Board of Nursing budget. This budget will force the board to drastically reduce its services to the public and to the nursing community far below the level in effect in 2008. It does not, however, reduce nurse licensing fees. This means that licensing fees are even more disproportionate to services provided by the board.As a result, this budget not only brings down the level of public protection, but it effectively taxes nurses in an effort to balance other areas of the state budget. The nursing board is fully funded by nurse licensing fees, and preservation of the board's services will protect the public health while causing no drain on the state's general fund.The NHNA hopes that our legislators will undertake a "from-the-ground-up" type of review that will look not only at the cuts which the governor and Department of Health and Human Services suggested, but also at the other parts of the budget that have not yet been examined.Until that type of budgetary review takes place, it cannot be said that the health care cuts in the current budget are really fiscally responsible.Judith Roy, R.N., is chairperson for the New Hampshire Nurses Association's Government Affairs Commission.