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Health advocates fear worse

Republicans poised to make deeper cuts

State Rep. Rich DiPentima worries Gov. John Lynch's proposed budget would jeopardize mental health care. He worries people with developmental disabilities would be hurt and oral health programs for children would not be funded. He worries House Republicans will make even more drastic cuts.

But DiPentima, a Portsmouth Democrat and retired public health official, is one of just five Democrats out of 18 members of the Health, Human Services and Elderly Affairs Committee.

"We have a voice, but our voice is not heard. We're in the stark minority," DiPentima said. "Even the governor's voice is weak."

Lynch's budget proposal for 2012-13, released Tuesday, cuts nearly every state agency, bringing state spending levels to where they were before 2008. But the Democratic governor's budget hits the Department of Health and Human Services - which accounts for roughly 40 percent of state spending - particularly hard. Of 255 layoffs of state employees, Health and Human Services Commissioner Nick Toumpas told his staff 132 would come from their department, due to the closing of a New Hampshire Hospital unit and privatization of transitional housing and substance abuse programs. The Republican-led Legislature will now revise the budget, and Republicans have promised to cut deeper.

Advocates for the state's more vulnerable populations - the mentally ill, the developmentally disabled and children in crisis - say they are committed to making their cases to the Legislature and arguing that their services are cost-effective. But some acknowledge it will be an uphill battle.

"There's a huge political shift that occurred," said Alex Koutroubas, a lobbyist for the Community Support Network, an alliance of 10 agencies that serve individuals with developmental disabilities and acquired brain disorders. "We really haven't seen what their priorities are at this point, but I think the reality is there's going to be some cuts. The question is how deep are the cuts going to be."

Republican House leaders have committed to spending about $300 million less than the approximately $10.7 billion budget Lynch proposed. They also criticized Lynch's downshifting of costs by eliminating various types of local aid. Rep. Neal Kurk, a Weare Republican who chairs a division of the House Finance Committee, questioned whether the governor could impose a provision requiring state employees to save $50 million in health care costs, since that reduction would have to be negotiated with the employees' union.

"Since we believe there's less revenue available than (Lynch) does, we have to produce a budget that's smaller than the budget he produced," Kurk said. "All throughout state government, including Health and Human Services but not exclusively, will have to be reduced further."

Members of the House Finance Committee say it is too early to know where the money will come from. But there is little doubt Health and Human Services will be in the mix.

"It's where the money is," said Finance Committee member Tom Keane, a Bow Republican.

"There are no sacred cows," Kurk added. "Sharing of pain of reductions will be equitable."

Kurk said the House Finance Committee already asked state agencies to suggest reductions beyond those proposed by the governor.

Advocates for social services say they believe their strongest arguments will be that their services save the state money. Roy Gerstenberger, president of the Community Support Network, said he worries about the approximately $1.2 million Lynch would take from programs that support families in need. Gerstenberger said by helping family members care for disabled relatives, individuals with disabilities can remain at home, "which means we're not providing expensive residential services for those folks."

He said aid prevents family members from quitting their jobs to care for a relative. Cutting that aid "can be penny-wise and pound foolish," Gerstenberger said.

Lynch's budget would fund services for anyone with a developmental disability or acquired brain disorder who currently gets services, but it would not pay for new individuals. Koutroubas estimates that nearly 450 new people will need services in 2012-13.

"It's much more cost effective to serve people in the neighborhoods in the community than having an institutional type model," he said.

Similarly, Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association, the umbrella group for the state's community mental health centers, stressed that treating individuals with mental illness in the community is cheaper than treating them in the state hospital or prison. While Lynch's budget directs money toward community care, it would cut three administrative units for the mental health centers.

"Clearly, many of the items in (Lynch's budget) were shocking," Lamy said. "I think the advocates have to do a really good job educating both the House and Senate on what the key priorities are. Frankly, now's the time citizens of New Hampshire have to stand up for things that most affect them."

Lamy said the mental health system is already unsustainable.

"It doesn't solve the problem by taking two financially weak organizations and making one financially weak, large organization," Lamy said.

Jack Lightfoot, director of advocacy for Child and Family Services, said he understands the need to make cuts.

"The issues I have are, are we maintaining the basic infrastructure so when the economy gets better, we'll still be able to pick up whatever pieces are left over and march ahead, or are we losing that infrastructure and will it take a decade or more to build it up again?" Lightfoot said.

Keith Kuenning, executive director of the New Hampshire Coalition to End Homelessness, said he was upset by Lynch's decision to cut about $550,000 from the Bureau of Homeless and Housing Services.

"The quote that keeps being used, and we find appalling, is 'spread the pain,' " Kuenning said. "We don't see these cuts as spreading the pain consistently across the entire budget. It seems a lot of cuts are spreading the pain across the poor and the disabled."

Kuenning called shelter care the "very bottom of the safety net." He said he will urge lawmakers to visit shelters and meet the families there.

"With so many new legislators coming in, they feel they have a mandate from voters to make cuts," he said. "I understand people's desire to rein in government in some way, but before you start to slash the programs, you really have to understand what you're doing."

Several House Finance Committee members said they were committed to hearing testimony from the Department of Health and Human Services and the affected agencies before talking about further cuts. Keane said he would look to fund essential services that have proven outcomes.

Rep. Lee Quandt, an Exeter Republican, said he would look to cut programs that duplicate services. For private organizations with state contracts, he would examine the workload and salaries of employees and see whether they had too much administrative staff.

"Sometimes the people who get hurt are those who run programs because they've built in a miniature bureaucracy of themselves," Quandt said.

But some Democrats say they envision a debate that is more about philosophical differences than dollars and cents.

"It's a debate between what some see as the rightful purview of government - that there's no other entity that can help with some of these (safety net services) - versus government's only here to protect your liberty and property," said former Democratic senator Jacalyn Cilley of Barrington.

"Do I think social services are at risk?" Cilley added. "They've never been more at risk."

(Shira Schoenberg can be reached at 369-3319 or sschoenberg@cmonitor.com.)

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