Health care advocates were "surprised and upset" that so many recent cutbacks and program eliminations remained static in Gov. Jerry Brown's (D) proposed budget released yesterday.
"For this year, there's very good news," Brown said yesterday at a Sacramento press conference. "But by no means are we out of the wilderness. We must be very prudent in the way we spend public funds."
Brown stood next to a bar chart with many long red bars representing the previous years' deficits, next to one small black bar that stood for the current year's surplus.
"Just because we have this little black mark here," he said, pointing to the small, lone surplus bar, "some people think we should go on a spending spree."
Jack Hailey, senior project director at the not-for-profit Government Action and Communication Institute, would not call what he wants a spending spree.
Hailey had hoped that a 7% cut in In-Home Supportive Services hours approved during darker financial times would be undone. Or that the governor might restore a 10% rate cut from 2011 to Community Based Adult Services, or eliminate a 10% rate cut made to Medi-Cal providers two years ago.
"None of that is in the budget proposal," Hailey said.
That means the cuts likely are a programmatic change, Hailey said, rather than emergency reductions made to balance a bad budget. Given the currently brighter financial picture, the phrase most often used yesterday in advocates' reactions to the new budget was "missed opportunity."
But that wasn't quite doing it for Hailey.
"That's as good a way as any to put a smiley face on this," Hailey said. "But no one really thought reductions were possible. And these are real reductions."
The health care advocacy community saw big cuts during bad times, he said, and now those same cuts are being maintained in good times, he said.
"Missed opportunity is too generous. There is no acknowledgment that the cuts of the past years were supposed to be temporary," Hailey said. "To leave those reductions all in place, with at best a [cost of living bump], is a big surprise."
Peter Hansel, executive director of California's Programs of All Inclusive Care for the Elderly -- known as CalPACE -- said the previous years' cuts have stifled any growth of the popular PACE model, and that PACE providers are scrambling to try to survive.
"We have sustained reductions for dual eligibles (those eligible for Medicare and Medi-Cal) for the past two years of 5% to 6%," Hansel said. "That's on top of four years of rate freezes. That has translated into operating losses, and providers are trying to figure out ways to cover it."
Hansel said he was hoping to go back to 2012 rates, and absorbing the cuts from 2011. But even that relatively modest $3 million in general fund dollars will have to be taken up in the Legislature, he said.
"It is possible things could change when the state implements CCI (the Coordinated Care Initiative) this year," Hansel said. "Maybe then the state will have a better appreciation of what it takes to provide for this population."
Hansel hopes the Legislature will do what the governor won't, which is similar to the optimistic outlook from Carmela Castellano-Garcia, CEO of the California Primary Care Association.
"Legislators are going to recognize the importance of [reversing] the cuts to traditional clinic programs," Castellano-Garcia said. "It's clear something needs to be done about the remaining uninsured in California. This process is just beginning."
Castellano-Garcia said the fix for these issues does not necessarily mean creating a new bill, but more likely can be handled in budget-bill negotiations.
"We do think leadership will not leave these individuals behind," she said. "We remain hopeful. The governor didn't put it in the budget. That doesn't mean we're going to sit at this point. We're going to mobilize and I've seen what can happen when people get mobilized."
Hailey said he has one other concern on that front -- that the fiscal-prudence-above-all mantra from Brown could take hold with some legislators.
"To the extent that this is a campaign document," Hailey said -- that is, in a way it's a talking point for Brown's re-election campaign -- "this may carry over a lot to legislative leadership. We'll have to see."