They hit Sacramento in force this week, hundreds of seniors and the disabled, milling in front of the Capitol Building with walkers and wheelchairs, chanting about what they want (senior health services) and when they want it (now!).
But most of the political rhetoric in Sacramento has focused on the grim reality of the $25.4 billion deficit and the need to make cuts that no one wants to make.
That includes many health services, from establishing Medi-Cal co-pays and putting a hard cap on the number of provider visits allowed, to eliminating the Adult Day Health Services program and scaling back In-Home Supportive Services. Those latter cutbacks, along with reducing cash benefits from Supplemental Security Income, have incensed and worried seniors, who see a dire future without those services.
"This is going to create some financial chaos. People will be facing medical debt, facing collections," Gary Passmore of the Congress of California Seniors said at a recent hearing. "And seniors will be facing these challenges on top of their medical challenges. Really, you're throwing thousands of people into this chaos."
At the budget hearings taking place this week throughout the Capitol Building, the legislators know these arguments all too well -- because many of the legislators in previous sessions had been making the same kind of pronouncements to fight for the very programs they're now looking to cut.
At one budget hearing, Sen. Elaine Alquist (D-Santa Clara) clearly couldn't take it anymore. She had been a good soldier, talking about the dire state of the state, and how we all need to make tough choices.
"I understand that we have to have a balanced budget or the state goes down," Alquist said. "But I think the hit is dramatically harder in health and human services."
The program she was specifically discussing was Adult Day Health Services -- a program she's been promoting and defending for years. In the past two budgets, Republican Gov. Arnold Schwarzenegger proposed cutting ADHS, and twice Alquist had argued to keep it. In the middle of her own hearing, it became clear that she simply couldn't take the thought of cutting ADHS anymore.
"I would like to make some points about adult day health care," Alquist said.
"There's no question in my mind that there's no long-term savings by eliminating Adult Day Health Services," Alquist said. "There's no savings. There are actually great costs down the line. When people go to nursing homes, that will cost the state two or three times as much. So I don't know where we're going with this."
Cuts to programs for seniors and people with disabilities are not in line with the Democrats' own plan to trim the budget. Advocates for seniors and disabled hope they can turn that understanding and solidarity with their program into the votes needed to keep funding intact for programs like ADHS -- for a third time.
Similar arguments have been floated to keep the Legislature from diverting First Five funding, imposing higher co-payments for emergency and hospital care and cutting mental health, dental, vision and other health services provided by Medi-Cal. All of the cuts are cumulative, advocates said, and would result in misuse of the health system, less reimbursement for providers, sicker people -- and more expense for the state.
"These cuts will .... force people with disabilities into nursing homes," according to Brandon Tartaglia of Disability Rights California. "Yet community living costs less than institutional care."
Long-term savings may be sacrificed to the need for short-term solutions. That doesn't bode well for physicians, hospitals and patients, Tim Madden of the local chapter of the American College of Emergency Physicians said.
"All roads lead to the emergency department," Madden said. With fewer Medi-Cal visits allowed, with co-payments initiated or raised, with cuts to mental health, disabled and senior services, more people are going to end up in the emergency room. That's not only more expensive, he said, but it means worse care for everyone, whether they have health insurance or not.
"Wait times in the emergency departments are high today," Madden said. "This affects everyone, not just Medi-Cal patients. With more medical patients, that leads to longer wait times, and longer wait time leads to worse outcomes."