[US Budget] Health care, education programs brace for cuts

From Sign On San Diego

Poor, disadvantaged likely to feel brunt
By Dana Wilkie
COPLEY NEWS SERVICE

WASHINGTON – Each of the 138 AIDS patients in the San Diego Hospice & Palliative Care's stay-at-home program must receive a $20 gas allowance so they can get to the doctor. Those are the state rules that come with the federal money that funds the program.

However, Washington soon will likely reimburse the hospice only $19 for each gas allowance.

The $1 reduction – which the hospice must make up if it wants to hang on to the other 19 federal dollars – may not seem like a lot of money. However, several such congressionally approved cuts are adding up to one big headache for the hospice, San Diego school principals, welfare parents and others affected by the budget the House and Senate recently passed.

"They're telling us they're cutting our pay, but we're not allowed to cut or modify services in any way," said Laurel Herbst, vice president of medical affairs for the hospice, which expects to lose $30,000 this year because of congressional cuts to Medicaid, the federal health program for the poor.

"This program is designed to keep people out of the hospital," Herbst said. "But if the program folds, these people are too sick to maintain their own care, and they'll end up in an institution."

Just before Christmas, the House and Senate approved nearly $40 billion in spending cuts over the next five years – largely in entitlement programs designed to help the poor and disadvantaged.

The reductions also will hit Medicare, the health program for the elderly; Head Start, the early childhood education and health program; Title I funds for high-poverty schools; grants to keep schools drug-free; programs that help needy families with housing and heating bills; programs that help pregnant women and small children with health care; day care, foster care and child support enforcement services; projects that help those with HIV and AIDS; and college student loan programs.

The Senate passed a similar plan that made slight changes, so the House must vote on the cuts again in early February. Some critics are pressuring lawmakers to withdraw their support by then, although the measure is expected to pass.

The White House and Republican leaders say the changes to the entitlement programs will trim the federal deficit.

"I think we're supposed to do the hard things," Bush said in a Jan. 19 speech, adding that a president "should confront problems now, and not pass them on to future generations."

Critics note that the House and Senate also have passed nearly $60 billion in tax cuts, which also must be finalized next month.

"Programs of benefit to families with low incomes, middle-class Americans, and state and local governments would essentially be cut more deeply, not to reduce the deficit, but to finance a portion of the cost of tax cuts, which primarily benefit the well-off," says the Center on Budget and Policy Priorities, a liberal think tank.

Those in San Diego who run programs that will be affected by the budget ax argue that the changes should not be called "reforms," the term used by GOP leaders.

Hospice administrators say they will lose about $150,000 from their stay-at-home program for those with HIV/AIDS. But the cuts do not come with a corresponding easing of rules. There still must be no more than 40 patients assigned to one social worker, even if assigning more patients might help stretch dollars and keep the program afloat.

"One state supervisor (told us), 'We know you can't break even. We just expect you to take the money from somebody else,' " said the hospice's Herbst. "Lovely."

California's superintendent of public instruction, Jack O'Connell, said Title I funding statewide would be slashed by nearly $68 million, Even Start programs by about $15 million, career technical education by $3 million, and Safe and Drug Free school funding by almost $11 million.

"At a time when our nation should be investing in the future of our students as never before, this budget cuts education funding for the first time in a decade," said O'Connell, a Democrat.

The San Diego Unified School District is bracing for a 6.5 percent cut in Title I funds, which means a $3 million reduction in the money that helps 53,000 children who live in poverty and may struggle with low grades and poor study skills. District principals were expected to learn this week how much money to plan on, but Bell Junior High School Principal Kristi Dean already is expecting to lose one-third of her $416,625 Title I funding.

Dean said that means she might have to cut teaching positions and make classes bigger in a school program that helps 50 children with their grades and homework.

"It's scary losing anything," Dean said. "We all know that the lower your teacher-to-student ratio, the better results you're going to get. There would not be as much individualized attention."

Across town, the Neighborhood House Association expects to lose about $1 million from its annual $82 million grant for Head Start, which helps 11,283 area preschoolers from disadvantaged San Diego homes with early education, nutrition and health programs.

The federal cuts put 400 preschool slots at risk, but the Neighborhood House and other San Diego Head Start programs hope to trim spending elsewhere before cutting children from the program.

"It has become increasingly difficult to provide the (services) . . . that Head Start standards demand," said Edward Condon, director of the California Head Start Association. "(There) are larger caseloads for Head Start social workers, fewer resources for needed health services and reduced staff training. The next round of cuts will be (children's) slots."