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March 1, 2011

Balancing the budget: Making the weak pay

http://www.jewishjournal.com/cover_story/article/balancing_the_budget_making_the_weak_pay_20110301

Sylvia Mnuchen

Sylvia Mnuchen

Sylvia Mnuchen has spent her life fighting.

First it was cancer that attacked her skin, then her breast. More recently it has been an ailment that has kept her in a wheelchair, her feet swollen, her legs wrapped tight like a mummy.

But as a loyal Jewish Democrat and longtime advocate of social justice, she never thought she would find herself fighting Jerry Brown, a man she voted for three times for governor. Yet the 94-year-old is suddenly on the wrong side of Brown’s proposed budget cuts that would slash state spending by $12.5 billion, ripping a hole in numerous social service programs and eliminating others entirely.

Payouts for Medi-Cal, California’s version of Medicaid, would be reduced by $1.7 billion. The welfare-to-work program CalWORKs would be cut by $1.5 billion. Other programs assisting the elderly and disabled would be affected, too.

Legislators are working on a budget agreement with the governor and expect it to be ready for a vote early this month.

Brown has called it “a tough budget for tough times.” To Mnuchen and other social service advocates in the Jewish community, though, it would only make tough times tougher.

“It’s a terrible situation,” she said.

A former travel agent who lives in an apartment in Beverly Hills on $986 per month, she uses the state’s In-Home Supportive Services Program (IHSS), which pays for personal care assistance. She needs someone to help her get out of bed, wash herself, make her meals and prepare her many medications.

“What are they trying to do? Kill us all?” she asked. “I can’t manage. I can’t manage because I can’t be without a caretaker.”

Mnuchen’s concern is that cost-cutting measures — on top of a 3.6 percent reduction in IHSS hours enacted by the previous administration — would endanger her well-being as well as that of her caregiver, who makes only $9 an hour. Fewer hours will mean less money and tougher times for such providers.

“How can a person live on that kind of money? And then take more money from them?” Mnuchen said.

No one disagrees about the root of the controversy: a state budget gap that has spun out of control to more than $25 billion.

“I think everybody who does advocacy on their agency’s issues understands there is a shortage of dollars. It’s just that simple,” said Adine Forman, director of government affairs and special projects for Jewish Vocational Service (JVS). “The government’s short money, and it has to take it from somewhere.”

Somewhere, it turns out, could be far reaching. The governor’s proposed reductions to CalWORKs, for example, would add up to $450 million in Los Angeles County, causing tens of thousands of families to lose their benefits.

The program, known in the county as GAIN, or Greater Avenues for Independence, is administered by JVS at three sites: Palmdale, Chatsworth and Santa Clarita. It helps provide child care, case management, transportation, counseling and more, all with the goal of returning people — often single moms — to work and helping them regain self-sufficiency.

Anne Kagiri can testify to the importance of that. The mother of two moved here from Michigan to live with her sister after she lost her job and separated from her husband. Even though she had a master’s degree in human resources, she couldn’t find a job quickly and left one son in the care of her mother back in Kenya.

“I never thought I would be on welfare,” said Kagiri, 35.

But it worked. Now she has a full-time job as a case manager for JVS, has her own house, and she was able to bring her other child to live with her.

“I’m completely independent,” she said.

Brown’s budget would trim grants and cap participation in the program at four years instead of five over the course of a person’s lifetime.

JVS officials say it’s their job in this time of financial crisis to examine how the programs can be scaled back with the least damage to those they serve. Still, they worry about the stress the governor’s proposals would have on county resources as former CalWORKs participants end up on general relief. Other worries plague their minds, too.

“I think you have the potential to have a highly elevated homeless count because of it,” Forman said. “There are a lot of people that are hanging on by a thread that are on CalWORKs and living on bare bones to try and make it work.”

It may seem hard to think of number crunching and state budgets as a matter of life and death, but that’s how Paul Castro sees it. The chief executive officer of Jewish Family Service of Los Angeles (JFS) fears that some proposed reductions could leave frail elderly populations with a deadly choice: Stay at home and die or be institutionalized.

Consider the Multipurpose Senior Services Program (MSSP), operated locally by JFS and earmarked by the governor for elimination. It provides skilled health care professionals to give case management and supplemental services to poor, at-risk seniors who are living at home. If axed altogether, it would cost JFS $2.9 million and affect more than 650 of its clients who might otherwise be in nursing homes, Castro said.

While ending the program would trim $20 million from the budget, Castro said the state should consider the full implication of its actions. Not only are California’s dollars matched by federal contributions, the eventual cost to the state of at-risk seniors moving into nursing homes would be much greater, he said.

“The math doesn’t work,” he said. “The question becomes: Have they calculated the cost yet?”

And not just the cost in dollars. Castro said he’s concerned about people who would do anything to stay in their homes, even without the program. He sees them missing doctor appointments and meals, not taking their medications regularly and ending up in emergency rooms.

A January policy note by the UCLA Center for Health Policy Research supports his concerns about the impact of possible budget cuts to this and other initiatives, stating, “Recipients of these programs are already in precarious situations and … undermining their care networks will place them at risk of worsened health and institutionalization.”

Castro takes it a step further: “Some are just going to stay home and die because they won’t have any support system.”

It’s an argument that many lawmakers have found persuasive. Jewish State Sen. Alan Lowenthal (D-Long Beach) said he understands the role such programs play in keeping people alive.

“Somehow, we have to keep as much of the safety net in place as we can,” he said. “Right now, we’re trying to do the least amount of harm, but it’s still terrible.”

Lowenthal is a member of the State Senate’s Budget Committee and the conference committee charged with reconciling differences between the Assembly and Senate. Legislators in both chambers have indicated they will try to protect — partially or in full — various iniatives that serve the aging, poor and disabled, including MSSP.

Paul Castro, Jewish Family Service of Los Angeles

“We’re still in choppy waters, but we can see life rafts in the distance,” said Nancy Volpert, director of public policy for JFS.

Pixie Toso knows about the risks these vulnerable populations face, because she finds herself staring at them every single day. An IHSS provider from Bellflower, the 54-year-old cares for her daughter, Fawn, who has multiple disabilities and who has undergone 17 surgeries.

IHSS allows Toso to care for her daughter personally and keep her at home, something that comforts them both.

“I have tried putting her into a group home. They have neglected her,” she said.

Like Mnuchen, Toso sees the potential harm that could come of the governor’s suggestions.

“It just means that I get less pay and the people who need the care get less hours,” she said. “That would kind of hurt everybody.”

That’s a major problem for SEIU United Long Term Care Workers’ Union President Laphonza Butler. “People being able to live at home in safety and in dignity I think has to be one of our top priorities,” she said.

For some individuals, any change in support could be a tipping point. That’s what worries Sherri Cunningham, chief financial officer for the Los Angeles Jewish Home in Reseda.

“If some of the things that are now keeping people home are jeopardized, where is it that they will go? One of the places might be here, but we basically run at full capacity,” she said.

The facility has about 1,000 residents who run the gamut from independent living to those who require skilled-nursing assistance. It’s a financially needy population, with 80 percent of residents in skilled nursing on Medi-Cal, which is being targeted for significant cuts: slashing long-term care, instituting copays, reducing the amount paid to health care providers and more.

“We are at more risk from some of the changes that the government is proposing than others might be,” Cunningham said.

The total cost to the Jewish Home could come to $3 million. Cuts would be necessary to cope, and the only hope would be that they could be made without impacting care, she said.

“We’re jeopardizing the most vulnerable people in the state,” she said. “We’re jeopardizing our parents and grandparents.”

Even government officials agree that the proposals seem draconian, but the governor’s office sees little alternative.

“This is a tragic situation that requires some tough choices to be made because of the situation of the budget, and there are cuts in every sector,” said Gil Duran, press secretary for the governor. “This is not a matter of preference. It’s a matter of necessity.”

Indeed, numerous other constituencies are on the state’s cutting board, including higher education. The University of California and California State University stand to lose $500 million each.

While Duran said it’s evident that many people will feel the cuts deeply, no credible alternatives have surfaced. As to the possibility that they would lead to more ER visits and institutionalizations among the frail elderly, he said there is no conclusive analysis to support this.

And don’t assume that the massive size of the proposals is a ploy simply to be used as a negotiation tool. “Look at the budget,” he said. “Look at the hole.”

It’s a hole that could get much bigger. Brown is counting on California residents to vote in a special election later this year to extend temporary tax hikes that would raise additional billions.

If those aren’t approved, things could get really ugly. Assemblyman Bob Blumenfield, a Jewish Democrat from the 40th District in the San Fernando Valley, said he sees no alternative to closely following the governor’s proposal if the state is to avoid a catastrophe, even though it contains some cuts that he finds abhorrent.

He is helping to lead the Legislature’s response to the governor’s proposal as chair of the Assembly Budget Committee and of the conference committee on which Lowenthal serves.

Blumenfield’s response to the issue has been more than just political. When he spoke to the Progressive Jewish Alliance in Woodland Hills on the topic “The Budget As a Moral Document” recently, he found inspiration in the Talmud.

“Talmudic scholars would say the only time you’re allowed to take a life is if you could save a life, and, in many ways, by making some of the awful cuts in putting this budget together, we’re actually preventing something far worse,” he said.

For its part, Los Angeles County is “anxious and prepared” to work with the state to help address the crisis, according to hearing testimony posted on the blog of Zev Yaroslavsky, L.A. County supervisor for the 3rd District.

It stated that he is concerned about realignment proposals that would shift some program responsibilities from the state to counties, but added, “Our county has publicly and privately conveyed to state officials, including the governor himself, that as distasteful as the proposed cuts are, we are prepared to equitably share in the burden of those cuts — or, more appropriately, to ask the citizens who rely on county services to share in the burden of those cuts.”

Assemblywoman Holly Mitchell (a Democrat, whose 47th District includes West Los Angeles, the Fairfax district, Culver City and more to the south) chairs the budget subcommittee on health and human services. Mitchell said she has been in touch with Jewish leaders and recognizes both sides of this difficult issue.

“I understand that we are all living in a broke state. I mean, there is no way of getting around that very harsh reality,” she said. Yet, she continued, “I wouldn’t want to live in a state, nor be a legislator in one, that was willing to throw [the frail elderly, disabled and low-income children] under the bus. And so we’re going to have to figure out a compromise.”

In some ways, Brown’s proposals are the continuation of others that have been put on the table for years. This time, though, something is different.

“In the past, they were proposed by a Republican governor. Now they’re proposed by a Democratic governor,” said Cliff Berg, legislative advocate for the Jewish Public Affairs Committee in Sacramento.

“I think it makes the fight more difficult because the new governor has obviously got a lot of good will. I think people are pleased generally that he seems to be dealing seriously with an actual effort to solve the state’s budget problem,” he said. “Unfortunately, in this particular area, the proposal really is penny-wise and pound-foolish.”

Berg’s primary concerns are the Adult Day Health Care and MSSP programs, which keep seniors in their homes and out of nursing homes.

No matter what ultimately happens, The Jewish Federation of Greater Los Angeles says it’s ready to help. While it wouldn’t be impacted directly by any of the cuts, its goal would be to soften any blows suffered by its partners and the people they serve, including a significant number of Holocaust survivors.

“It’s not just that a lot of these programs they’re looking to cut are programs that impact Jews in need. It’s specifically many of them are Jews in need that are elderly, and that’s a serious concern for us,” Federation President Jay Sanderson said.

If massive cuts come to fruition, Federation’s goal would be to raise additional funds in an attempt to continue some programs locally as much as possible.

Like many involved in local social services, Sanderson recognizes the state’s harsh economic reality. That doesn’t change his feelings that legislators in Sacramento need to include more than numbers in their calculations.

“When times get tough, it’s our responsibility to take care of the most vulnerable,” he said. “I think it’s a tragedy if these cuts actually happen.”

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