Unkindest cuts in healthcare

FROM the day Massachusetts embarked on its pioneering healthcare reform law, all its supporters crossed their fingers that no recession would come along to derail the plan's delicately balanced finances. Now, the economic downturn is taking a toll on the two healthcare centers that serve the largest share of the state's poor and uninsured, the Cambridge Health Alliance and Boston Medical Center. Governor Patrick's budget cuts last month in response to the state's declining revenues hit the two institutions hard.

The stability of Boston Medical Center, and of the three hospitals and more than 20 community health centers of the Cambridge Health Alliance, is crucial to the new law's success. Together they serve more than 200,000 Medicaid patients as well as many who shift back and forth between the ranks of the uninsured and the state-subsidized Commonwealth Care plan.

Cambridge Health Alliance, in particular, provides care to many illegal immigrants, who are excluded from public programs, and to many patients suffering from mental illness or substance abuse. Cambridge attracts these patients because it offers interpreters and other specialized services. Although the healthcare law has been successful statewide in enrolling the uninsured, the alliance has seen its uninsured patients decrease by just 21 percent.

When the Patrick administration last month saw the recession shrinking revenues, it focused on cuts in Medicaid for the same reason Willie Sutton gave when asked why he robbed banks: That's where the money is. But the $55 million it is taking from the Cambridge alliance and the $114 million from Boston Medical Center will seriously hurt the institutions' ability to serve patients.

Even before the latest cuts, the Cambridge alliance was operating at a deficit and had begun to close a senior health center in Cambridge. More consolidation is in order. But the health alliance CEO, Dennis Keefe, said the most recent cuts have turned what was supposed to be a "glide path" toward reduced state support into a "crash landing." The alliance is facing a reduction of 20 percent of its work force.

One short-term alternative to the cuts would be to assess all the state's hospitals and insurers an equivalent amount for the State Health Safety Net fund. A congressional stimulus package with increased federal Medicaid spending, as Representative Barney Frank has proposed, could help. But the state should find a way to ensure this year and in years to come that healthcare for all - the promise of the new law - does not fall victim to the recession.