NYTimes.com Article: A Prescription Plan Hailed as a Model Is a Budget Casualty
Wed, 5 Mar 2003 07:33:31 -0500 (EST)
This article from NYTimes.com
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if oregon itself isn't a "state" of emergency, i don't know what is. "welcome to oregon, where schizophrenics and felons roam free ..."
A Prescription Plan Hailed as a Model Is a Budget Casualty
March 5, 2003
By TIMOTHY EGAN
PORTLAND, Ore., March 3 - In a state that says it is
already so short of public money it does not have enough to
keep all the schools open and prosecute many criminals,
Oregon took another drastic step this week to cover budget
shortfalls: it cut off medications to thousands of
schizophrenics, manic-depressives, drug addicts and others
who are poor and have no health care.
A decade ago, Oregon was widely hailed as a pioneer in
providing health insurance, including prescription drug
coverage, not only to the poor but also to people who make
just enough money that they do not qualify for most federal
Now, in a reversal that has stripped a once ambitious
program to its core, Oregon has pared back the insurance,
and removed prescription drug coverage for things like
mental illness and drug addiction. Most of the cuts went
into effect March 1, but others started Feb. 1, just days
after Oregonians voted in a referendum against a tax
increase to balance their budget.
And while state officials are looking for some way to
restore some of the health program, they admit that they
will not be able to offer anything like the expansive
benefits of the past.
So throughout Oregon this week, about 100,000 poor people
are suddenly scrambling for the basic medications that
allow them to function.
For Dave Cesario, 45, who is H.I.V. positive, diabetic and
on methadone to stave off addiction to heroin, it meant
going cold turkey Saturday.
"I'm just numb; I don't know what to do," said Mr. Cesario,
who lives with his disabled wife and 12-year-old son. "My
only hope is that the drug companies will have mercy and
I'll be able to get some free samples."
For Karen Hansen, 50, who has prescriptions for everything
from anxiety disorder to high blood pressure, the cutoff
means taking only the few drugs that will keep her alive.
She lives on $689 a month in Social Security disability
payments, and her monthly prescription bill, without
assistance, is $615.
"I don't buy the newspaper, I eat hot dogs that they give
out free and get other meals from the food bank," Ms.
Hansen said. "But that only saves about $200."
The step is the latest response to a budget crisis that led
state officials to make nearly $600 million in cuts in the
last two years, and will require another $2 billion in
reductions, according to projections, in the new budget
cycle that begins this June.
Hit by a harsh recession after a series of tax-cutting
measures pared the budget to the bone, Oregon, which has no
statewide sales tax, now lacks enough money for health
care, schools, prisons and criminal prosecution.
Portland schools had planned to cut nearly five weeks off
the school calendar this year. But teachers agreed on
Monday to work two weeks without pay, and that offer -
together with a plan for a temporary business tax - looks
as if it will now save the school year. But the state has
announced plans to close a number of schools.
Prisons have let out some criminals early. And starting
today, prosecutions of people arrested for theft and drug
crimes are being delayed because there is not enough money
for prosecution or legal defense. Officials say those
arrested are being released and may be tried later, in the
summer, if the legislature can come up with new funds.
The latest round of cuts came after Oregonians considered a
referendum in January on whether to raise taxes
temporarily. The measure was narrowly defeated, after
opponents of the tax increase said the state could find
ways to cut without major consequences.
Unable to raise taxes, and having cut financing for police,
prosecutors and schools, state officials turned to the
Oregon Health Plan. They ordered the board that governs the
plan to decide how and where to cut. It chose to revert to
more basic coverage, stop paying for many prescription
drugs and charge higher premiums and co-payments.
Dr. Patricia Kullberg, medical director of the health
department of Multnomah County, which covers Portland, said
she just did something she had never done in 21 years as a
family physician: she advised a patient which medications
he could stop taking and suffer the least. The patient lost
his prescription drug benefit for arthritis, depression,
high cholesterol and hypertension.
"I feel like I'm living in some foreign country where
suffering is routine," she said. "It's scary. What we're
doing is condemning people to the long-term consequences of
The hardest hit, say state officials, are the mentally ill.
Jim Underwood, a mental health specialist with Cascadia
Behavioral Healthcare in Portland, said his patient Robert
Seaman, 47, a paranoid schizophrenic, was likely to become
delusional again without his medications.
Mr. Seaman had trouble responding to questions in an
interview. "Without his meds, he has trouble with getting
food, shopping, all the basic survival things," Mr.
The legislature is working this week on a temporary patch.
The proposal would take video poker and cigarette tax money
and drain a reserve fund to make up an immediate shortfall
of $250 million. If this passes, and it appears it will, it
would restore medications for only about two months.
Mary Ellen Glynn, a spokeswoman for Gov. Ted Kulongoski, a
Democrat, said the next two-year budget could be even
worse, because voters refuse to raise taxes. "We're in real
double-bind," she said.
Advocates for the mentally ill put the issue more starkly.
David Eisen, clinical director for Central City Concern, a
private nonprofit agency that provides care for drug
addicts and the mentally ill, said people whose basic
medical needs were met by prescription drugs costing the
state about $90 a month per person, were now going to start
showing up in hospital emergency rooms, or jail, where they
will cost the state far more.
"The people who made this decision thought they could save
a few million dollars," Mr. Eisen said. "But the crime rate
will rise, emergency rooms will be flooded with people, and
in the end, the state is going to pay five to eight times
more than they would have saved."
In most states, the federal Medicaid program covers the
basic medical needs of the poor. Oregon was given a waiver
to shape its own program because it promised to provide
near-universal coverage for the poor, something only a
handful of states have tried to do. In good times, the plan
worked, and it was widely praised as a resourceful use of
limited public funds for health care.
One measure of its success was that Oregon has one of the
lowest percentages of mentally ill people in institutions.
Prescriptions and mental health clinics have allowed people
to work, or live in community settings, without presenting
a danger to themselves or others, state health officials
Critics of the plan, however, said it was allowed to grow
too fast, and even though Oregon rationed out services -
drawing up a list of what would be covered and what would
not - it still proved too generous. State Representative
Jackie Winters, a Republican, said that over the last 20
years, social services in the state have quadrupled, far in
excess of population growth.
"We expanded beyond the basics, and now we realize you
can't cover everything you want," Ms. Winters said.
Now a number of legislative committees are studying ways to
redo the Oregon Health Plan. Even if state revenues become
less anemic, the plan is unlikely ever to be as ambitious
or far-reaching as it was, supporters and opponents say.
And for now, the cutbacks mean that most people who were
given coverage have lost their prescription drugs. Some are
now wandering the streets or screaming in public squares.
About one-fourth of the 400,000 people covered by the
Oregon Health Plan lost prescription coverage in two rounds
of cuts over the last month and half.
Tony Tescara, 66, who lives on $630 in Social Security,
relies on heart medication from the state. When he heard we
was cut off - after his pharmacists refused to fill a
prescription - he says he panicked.
"It was a big shock," Mr. Tescara said. "I took extra nitro
pills, just worrying about this medical thing. I called my
caseworker and said, `What am I supposed to do now?' She
said call the doctor and ask for samples."
Mr. Tescara said he was ashamed to beg for medicine. "I
feel like I'm a lowlife looking for handouts," he said.
"I'm not. It's the first time in my life I have to ask for
State officials say relying on free samples, which
thousands of Oregonians are doing this week to get their
medications, will help only the luckiest.
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