Friday, July 07, 2006

DSHS LAR hearing, 2008-2009 appropriations (EIR 1)

The Department of State Health Services Council met today to hear DSHS staff present the Department's Legislative Appropriation Request (LAR) for the 2008-2009 biennium. We should be able to download the draft LAR document itself, but the DSHS site is poorly organized. My notes will have to do for now.

The first thing of importance in this appropriations cycle is that the state's leadership has directed all state agencies to submit budget requests that start with a 10 percent cut in the agency's overall funds. For HIV, such a cut will mean the following (from the LAR's Appendix A):
Funding reductions in HIV/STD and Hepatitis C Prevention would result in increased risk o fdisease transmission (HIV and other sexually transmitted diseases), illness, and premature death. The number of clients served by the Texas HIV Medication Program would have to decrease by 801 persons in FY08 and 790 persons in FY09 (a total decrease of 1,591 persons over the biennium). Decreased access to medications for HIV positive Texans will result in rapid disease progression from HIV to full blown AIDS couple with the higher costs of treating AIDS as compared to treating HIV; increased life-threatening opportunistic infections in persons with HIV/AIDS; increased HIV transmission, due to higher viral loads as a result of delayed or no treatment; increased HIV transmission from HIV infected pregnant women to their unborn children; increased HIV infection in minority communities, particularly in the African-American community which bears a disproportionate share of new cases; increased cases of cervical cancer in women with HIV/AIDS; increased costly emergency room visits due to rising morbidity in persons with HIV/AIDS; increased costly hospitalizations due to rising morbidity in persons with HIV/AIDS; increased unemployment for persons with HIV/AIDS due progressive illness (sic); increased demand for more expenside public/state assistance (hospitalization, emergency room) as a result of progressive illness and unemployment; increased premature death related to delayed or untreated HIV/AIDS. A 10% reduction would also affect our Maintenance of Effort Agreement with HRSA and could put DSHS at risk of non-compliance.

The actual reduction which would affect HIV/STD and Hepatitis C Prevention is $3,097,059 per year of the biennium ($6,194,118 total). Needless to say, the Department's first Exceptional Item Request is for restoration of these funds as well as the proposed cuts in other DSHS programs.

Discussion from the Council took a somewhat strange turn when James Springfield, a hospital administrator from the Valley, essentially argued that the Department was not getting with the spirit of the budget cuts. He was apparently of the opinion that the cuts were philosophically valid and that the Department should have looked more closely to determine which programs were "ineffective" and could therefore be eliminated as an item of expense. He expressed the notion that, even though a program is a good thing, inefficiency should not be supported with state dollars. The Commissioner and Budget Officer argued that the Department had done several things to cut expenses, had indeed evaluated programs, and had pared down the list of additional requests. Mr. Springfield seemed unconvinced.

Texas AIDS Network will support this Exceptional Item Request. We recommend that concerned members of the Texas HIV/AIDS community begin meeting with their state representatives and senators immediately to discuss this request and explain its effects on the state of the HIV epidemic in Texas. Useable talking points can be drawn from the information quoted from Appendix A.

More LAR info in next post . . .

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