Health advocates left reeling after hearing budget plan

Key programs are scheduled to get sharp cuts

Several key public health programs, including the state's landmark tobacco control initiative, face sharp cuts under the state budget proposed yesterday by Governor Deval Patrick for the next fiscal year.

The $28 billion spending plan also freezes Medicaid reimbursement rates for doctors and hospitals who care for poor patients, after steep cuts made in October.

"We have a state that has been visionary in pioneering health reform and universal coverage," said Dr. Bruce Auerbach, president of the Massachusetts Medical Society and head of emergency care at Sturdy Memorial Hospital in Attleboro. "Anything we do that reduces the ability of physicians to care for Medicaid patients is going to negatively impact our pursuit of true healthcare reform."

The state's closely observed health insurance initiative, which requires most adults to have coverage, emerged largely, but not entirely, untouched in the budget blueprint. A program that provided $3.5 million to help the uninsured enroll for health coverage was eliminated, just as thousands of Bay State residents are losing their jobs.

The governor's tax proposal also touched on public health: He is seeking new levies on alcohol, candy, and sweetened beverages. According to administration estimates, those new tariffs would generate $121.5 million for public health initiatives, if the Legislature goes along with them.

Overall, Patrick framed the cuts as difficult but necessary in a failing economy, saying that "we have to make do with less."

As an army of advocates digested Patrick's complex budget proposals - which reduced 2009 spending, along with outlining spending for 2010 - concern focused primarily on the Department of Public Health, which had enjoyed a revival after sustaining deep budget cuts during the administration of Mitt Romney.

At the start of the current budget year, the Patrick administration and the Legislature had committed a total of $639 million to programs that treat substance abusers, discourage tobacco use, provide school nurses, and an array of other public health services. But because of the economy, Patrick has proposed slashing the agency's funding to $565 million, according to Tom Lyons, a Public Health Department spokesman.

"There's no way to get around this or sugarcoat it," Lyons said. "This is going to be a very stark budget year coming up."

An analysis by Tobacco Free Mass, an advocacy group, shows that spending on the state's tobacco control program will fall to $7.5 million from more than $12 million. Lyons confirmed that analysis.

"We're disappointed because this is a program with a proven record of success," said Russet Breslau, executive director of Tobacco Free Mass.

In 2007, adult smoking rates in Massachusetts dropped by 8 percent, the steepest decline in more than a decade. Breslau attributed it, in large part, to reinvigoration of the tobacco control campaign.

Figures from the Department of Public Health show that total spending on addiction and tobacco control services will drop more than 11 percent under the proposed budget. Programs designed to promote healthy behaviors, such as preventing teen pregnancy and providing dental services, face cuts totaling more than $20 million. Similarly, initiatives that aim to improve nutrition and help children and families are confronting a $20 million reduction, although some of those services will be provided by another state agency, Lyons said.

Patrick ordered that programs for nursing services to rape victims and aid to domestic violence victims be spared, Lyons said.

The cuts proposed yesterday left health advocates reeling.

"We know this administration supports public health and wants to promote prevention and a sound and robust public health system, but this is a step backward," said Valerie Bassett, executive director of the Massachusetts Public Health Association, a confederation of health officials. "It's a step no one wants to take."

Many advocates are hoping Patrick will use an anticipated infusion of Medicaid funds from a federal stimulus package to restore cuts in health programs for the poor, including safety-net hospitals Boston Medical Center and Cambridge Health Alliance. But so far the governor has not committed to doing so.

"Using federal funding as intended to restore these services is a rational and important policy solution that the community is quickly rallying around, and hoping the governor will embrace," said Mike Fadel, executive vice president of 1199SEIU United Healthcare Workers East.

Kay Lazar can be reached at klazar@globe.com. Stephen Smith can be reached at stsmith@globe.com.