The Human Services Budget Haze
March 26, 2007
Governor Culver signed the tobacco tax legislation Thursday, March 15. The dollar a pack hike was heralded in the legislature and around the state as a funding source with a mission: save lives through the prevention of smoking and improve the affordability, access and quality of health care for Iowans.
The Senate Democrats have publicly voiced support for applying the $127 million in new revenue to the state's under-funded health care programs, but the Democrats’ promises are not finding their way into Senate budget bills. We have yet to see any legislation that guarantees that all of the new tobacco tax revenue will be used to fund health care.
Sure, there’s time left in the session and we might see a Senate Democrat proposal for spending all the new tobacco money on health care before the end of April – I’m not going to hold my breath.
Unlike past years when most committee time was used to discuss the budget, the Appropriations Subcommittee for Health and Human Services spent the first five weeks of this session dissecting Senator Jack Hatch’s efforts to reinvent Iowa’s health care system. That left only three weeks to formally address this year’s Medicaid and human services budget, which is still under the cloak of darkness in a Senate Democrat’s locked box. I have to assume it is still a work in progress or we would have seen it by now.
Senator Jeff Angelo, Ranking Republican on the Senate Appropriations Committee, writing in his blog, The Angelo Angle, summed it up this way:
Senator Jim Seymour took the Senate floor this morning to point out that work has not yet begun -- with five weeks left in the session --.on the Health and Human Services budget.
This is notable because Republicans continue to ask when a plan will be released by Majority Democrats on how they will spend the $127 million generated by the cigarette tax. I continue to be suspicious that the promises to spend the money on providing affordable quality health care to Iowans will be broken.
Senator Seymour pointed out that a Republican amendment to raise Medicaid rates to our local hospitals has been rejected. He informed the body that Iowa hospitals are losing $119 million a year treating Medicaid patients.
The $1 increase was pushed by the Governor to make his budget work. I fear we will be going down the same path we have gone before--promising to "dedicate" increased revenues to a specific purpose (example: did gaming money go to education?) and pulling a "bait and switch" as budget deals are being made.
I think Senator Angelo is on to something, we might very well be looking at a “bait and switch” plan where new tobacco money initially promised to fund health care ends up funding anything and everything else in the Democrats’ agenda. This past Thursday, Rep. Ro Foege, the Co-chair of Health and Human Services Appropriations Subcommittee, hinted at the Democrats’ candy store strategy when he indicated that none of the new tobacco revenue would go towards an increase in health care provider rates, leaving hospitals, doctors, dentist, nurses and other professionals providing more care with less money.
Senate Republicans tried to amend the tobacco tax bill to include language that dedicates the new revenue to health care. In addition to offering amendments increasing Medicaid rates, we proposed more money to smoking cessation programs, tax credits for small employers offering employee health coverage, establishing a Health Savings Account Loan Fund, and providing more insurance coverage for low-income children. Senate Democrats rejected these proposals using the rules of the Senate, which, of course, they made up at the start of this General Assembly in January.
It seems Senate Democrats have their own plans for that money and are not interested in sharing those plans with Senate Republicans or anyone else. I am sure we’ll have the opportunity to look at their tobacco tax spending proposals at some point, perhaps when it ends up as a last minute amendment on the last spending bill this session.
Mary Lundby is the Iowa Senate Republican Leader. She represents Senate District 18, the northwestern portion of Linn County including Center Point, Hiawatha, Marion and Robins. Additional information about the Iowa Senate Republican Caucus is available on the web @
http://www.iowasenaterepublicans.org/