Last week, Gov. Jay Nixon vetoed or froze more than $1.1 billion from the state budget in response to what he called a "dangerously-out-of-balance" budget approved by the Republican-led Legislature. These cuts could negatively affect the programs from the departments of mental health, corrections, social services and health and senior services, officials said.
The budget contained $846 million in spending restrictions and $276 million in line-item vetoes. These restrictions and vetoes will cause the termination of approximately 286 full time employment positions, 157 of which are from the Department of Mental Health (DMH). The Department of Social Services (DSS) will lose 24 positions and the Department of Health and Senior Services will lose nearly 8 1/2. However, one position being eliminated does not necessarily mean only one person being fired.
"If 157 positions are being eliminated that could easily be more people," said Debra Walker of the DMH. "Because one position could have multiple employees. Cottonwood Residential Treatment Center has 88 positions, but there are 95 people working them."
The reduction in full-time employment positions is not anticipated to change, Linda Luebbering, state budget director, wrote in an email.
The vetoes and funding restrictions reflect a continuing environment where the state is harming health care in the state, health officials say.
"To summarize the problem we are seeing right now, and this is not exclusively about the withholdings, is the state is currently not doing the things it needs to do in the healthcare sector," said Dave Dillon of the Missouri Hospital Association.
Dillon said the governor's withholdings will affect hospitals, but it is combination of that and the refusal to expand Medicaid that has hurt the state's hospitals, and in turn their patients.
"We are not getting the new revenue from Medicaid, but we are taking the cuts that the federal government made to pay for the Medicaid," Dillon said. "The Affordable Care Act was designed around more people having insurance, and how they designed it was to cut payments in Medicare and increase the number of people on Medicaid. And so they made the cuts to Medicare, and then Missouri didn't opt in to the program to get true Medicaid expansion."
The failure to accept the Medicaid expansion has also left approximately 800,000 Missourians without insurance, Dillon said. When the first week of July is over, Missouri hospitals will have paid more than $1 billion to treat uninsured patients. In other words, he said, the state will have lost $1 billion due to not expanding Medicaid.
He continued to explain that this has also caused nearly 1,300 people to lose their jobs at hospitals across the state and that his organizations has repeatedly warned lawmakers and the governor of these consequences to cutting the budget and not expanding healthcare programs.
"The governor's actions are understandable, but also lamentable," said Jeanette Mott Oxford, executive director of Missouri Association for Social Welfare. "We may have a particularly challenging budget situation because in our political system there is a lot of rivalry, and there is not a lot of civility."
Oxford voiced her concern that the state's lawmakers have had their hands tied by legislation such as the Hancock Amendment that limits the amount of new annual revenue that the Legislature may raise in a year without voter approval, as well as an anti-tax sentiment that exists.
She then suggested retouching the states Motor Fuel Tax or hosting public debates about raising taxes to see how much tax money would be enough to relieve the burden on the state's residents and still safely fund the government.
"We should be thinking about taxing as investment in the common good and thinking about the fairest way to pay for these things," Oxford said. "The way the system is set up right now really hurts the people on the bottom, and right now the richest 20 percent and the richest one percent pay very little. The system is unfair and outdated."
Withholding the funding from social programs could lead to unsafe, as well as unintended, consequences. In the Department of Corrections, there will be $2 million withheld from community re-entry grants that reduce recidivism among recently released offenders. These programs are not paid through taxes, but through fees that parolees pay while they are a part of the probation and parole program, said Carleen Reck, director of the criminal justice ministry of the Society of St. Vincent DePaul.
"I don't know how we are going to make it (with the cuts)," said Reck, who runs multiple government funded re-entry programs."When people get released from prison and are dropped back into the same community, they are at a huge disadvantage. The chances of them not succeeding or not successfully re-entering the community are vast."
Without the re-entry programs in place, the rate of recidivism rises and so does the rate of crime. Programs like Reck's Release to Rent have less than 10 percent recidivism, meaning less than 10 percent of the participants in the program reoffend and go back to jail. Also the price for sending one offender to the Release the Rent program is a $8,500 one-time fee, compared to the $20,000 per year it costs to house one inmate in a Missouri prison, Reck said.
"It is not a poor investment," Reck said about the re-entry programs. "It is a bad idea to not invest that modest amount for this kind of help."
The DHSS and the DSS declined to provide a statement about the vetoes and expenditure restrictions.