Editorial: Providing services is the best use of surplus
Though its just a small bright spot next to the deep black budget hole that is the potential loss of nearly $400 million from the Medicaid Enhancement Tax, the state does have a $15 million surplus left over from last year.
The decision now is whether to put all of it in the rainy day fund, which is what most Republican legislators want to do, or put $8 million in the fund and give $7 million to the Department of Health and Human Services to offset past budget cuts, as Democrats propose.
Greater good, and greater fiscal savings in the long run, would result from using some of the money to fulfill the state’s neglected responsibility to those who need its help.
Last week, the Concord-based Foundation for Healthy Communities came out with a report on the delays people with mental illness face in receiving care in an appropriate setting. Some progress has been made since the 2013 settlement over the state’s failure to provide essential mental health services, but New Hampshire has a long way to go to rebuild what was once a national model for caring for the mentally ill.
How New Hampshire pays for the settlement, which would require spending $30 million over two years, remains to be seen.
Some lawmakers want the money to come out of the HHS budget, but that would only lead to a reduction of services in other areas and likely prompt yet more lawsuits. The bill appropriating money to meet the settlement passed the House but remains on hold in the Senate.
The state, for want of a willingness to spend, is in a bizarre position with respect to mental health treatment.
Inpatient care is costly and becomes a necessity far more often when a person’s mental illness goes untreated. Yet despite improvements, access to quick professional treatment in the community remains difficult.
On the flip side, once in the state hospital, patients can have a hard time getting out because they have no appropriate place to go. Children ready to leave waited an average of eight days, the elderly 21 days. The average wait for patients in specialty hospitals was 277 days.
Meanwhile, for want of beds, patients in crisis who need admission can wait for days in a tiny protective room in a local hospital, a room that would quickly have even the most stable of people climbing the walls.
On average, community-based care in supportive housing costs $297 per day. A day in an acute-care hospital averages $2,912 per day.
The foundation assessed the experiences of 38 patients who remained hospitalized after being deemed ready to leave at an aggregate cost of $1.3 million. If they could have been placed in supportive housing, the bill would have been $135,432.
“These examples of financial ‘costs’ are conservative estimates of a systemic failure in mental health care in New Hampshire,” the report concluded.
What that report and others can’t measure is the added cost in human suffering, both to patients and their loved ones, when care is unavailable or inappropriate.
And mental health isn’t the only area where, for want of adequate resources, that’s happening. Some proponents of giving some of the surplus to HHS want it to be used to restore programs that serve children at risk or living in poverty.
Again, the cost of not doing so is measured in human suffering, lost potential and a reduction in potential income that can last a lifetime.
The same is true of substance abuse programs, which are woefully in short supply.
Putting $15 million instead of $8 million into the rainy day fund won’t save nearly as much money as using some of it to provide services that save people and money.