THIS ARTICLE WAS FROM 2004 ..COULDN'T FIND A CURRENT VERSION OF THE STAT'E FISCAL CRISIS...ALL THOUGH WE DO KNOW THERE IS ONE .... MANY HOSPITALS HAVE CLOSED..MANY HOSPITALS ARE FAULTERING AND STATES ARE ASKING FOR MONEY..
MY THOUGHT IS IF THE ILLEGAL ALIENS HAD BEEN PAYING THEIR SHARE OF TAXES INSTEAD OF TAKING JOBS FOR LOWER WAGES AND PUTTING CITIZENS OUT OF WORK THIS WOULD NOT BE A CRISIS....I CAN'T IMAGINE WHAT THE FIGURES ARE NOW.....

Grantmakers In Health: Audioconferences
http://www.gih.org/info-url3995/info-ur ... _id=218579

Budget and Tax Issues are Health Issues

April 15, 2004
Speakers:

Iris Lav, Deputy Director, Center on Budget and Policy Priorities
Shelley Gaballe, Co-President, Connecticut Voices for Children
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The State Fiscal Crisis

Iris Lav began the audioconference by describing the dimensions of the fiscal crisis in the states. Over half of the states are projecting deficits this year. This is a multiyear phenomenon, with deficits of $40 billion in fiscal year (FY) 2002, $75 billion in FY 2003, $80 billion in FY 2004 and a projection of $40 billion for FY 2005.

Deficits are defined as the gap between revenue and spending. In the early years of this crisis, states were able to address deficits by dipping into fiscal reserves; borrowing; and, in some cases, budget gimmicks. Now states are primarily addressing deficits through spending cuts. The crisis, however, is primarily a revenue problem, with states experiencing 10 consecutive quarters of negative tax growth. Spending is growing at rates comparable to other time periods; in fact, real per capita spending is declining.

The budget crisis has major implications for low-income families:


34 states have cut health insurance eligibility;
32 states have cut eligibility for child care subsidies or otherwise limited access to child care;
Inflation adjusted per pupil education spending for K-12 dropped in 34 states between FY 2002 and FY 2004; Tuition costs for public colleges and universities rose an average of $947 (9.8 percent) last year; and
24 states cut aid to localities in 2003 and 2004. There are multiple reasons for growing deficits.

These include:
general economic weakness, including a decline in both capital gains and employment.
state tax cuts (only half of which has been recouped from tax increases).Â*The total real decline in per capita state revenues between 2001 and 2003 was $57.7 billion. Although 30 states have raised taxes since 2001, these increases have only added back $19.6 billion to state treasuries. federal actions and failures to act.

Despite the infusion of $20 billion in fiscal relief to states last year (half targeted to Medicaid and half in general revenues), changes in federal policy has actually resulted in a decline of $175 billion to the states. These changes include federal tax policy (to which many state tax policies are tied), unfunded mandates such as the No Child Left Behind Act and election reform, and costs associated with covering services for Medicaid dual eligibles. The picture for the future is not heartening.

At the federal level, there will be caps on discretionary spending. Caps on entitlements and block grants are also being considered. State tax systems continue to suffer from structural problems. Designed to reflect industrial economies, few state tax systems reflect the shift in the economy towards service industries, corporate strategies to avoid taxing of corporate income, exemptions for some types of incomes, loss in estate taxes as a result of federal estate tax changes, and reliance on sin taxes and gambling. Moreover, even in good times, revenues do not grow sufficiently to cover cost growth.
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Ms. Lav also described efforts at the state level to slowly phase in tax cuts without the means to pay for them. Advocates of this approach call it "starving the beast," the notion being that an effective way to reduce the size of government is to take away its revenue stream. Tactics include racheting down taxes in good time and changes in budget processes to severely restrict revenue growth. The Center on Budget and Policy Priorities is working with advocates in a number of states to counter these tactics and to promote a different approach to state fiscal policy. This collective effort is known as the State Fiscal Analysis InitiativeÂ*(SFAI).
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Activities at the State Level

Shelley Gaballe of Connecticut Voices for Children (an SFAI organization) brought the perspective of how advocates in one state are working to address the devastating impact of the fiscal crisis on low-income children. Connecticut is a state of extremes. Although it has the nation's highest per capita incomes and ranks number one among the states in millionaires per capita, 10 percent of its children live in poverty. Hartford, the state capital, has the second highest child poverty rate among U.S. cities with populations over 100,000. It is also a state of extremes with threefold differences in various measures of child health outcomes between Hartford and more wealthy communities.

Like other states, Connecticut began experiencing large general fund deficits in FY 2002 after many years of surpluses. Ms. Gaballe described what she called a perfect budget storm. The booming economy in the late 1990s generated temporary surpluses that made it possible for the legislature to enact tax cuts, even though fiscal analysts were concerned that structural defects in the state's tax system would lead to deficits. When the economy went into a downturn, there was an increased demand for state services and a sharp decline in state tax revenues at the same time as federal help to the states began to dry up and more costs were being imposed related to homeland security. All the painless one-time budget solutions (such as tapping into the rainy day fund, transferring cash reserves of other funds, easy spending cuts, and borrowing ) were quickly used up, but deficits continued to grow.

Ms. Gaballe described efforts to raise taxes beginning in FY 2003, but these were accompanied by deep cuts in Medicaid and other health programs. The cuts proposed for FY 2004 would further reduce health benefits and increase cost sharing for Medicaid and other public insurance programs. Noting that such cuts are short sighted, Ms. Gaballe described how Connecticut Voices for Children has worked with the Connecticut Health Foundation to try to turn the tide on state budget choices generally, and health care cuts specifically. Activities funded by the Connecticut Health Foundation have included:


commissioning a report by the Center on Budget and Policy Priorities on Connecticut's restrictive spending cap and reform options (completed when the state still enjoyed budget surpluses);
providing a grant to Connecticut Voices for Children to get technical assistance on message framing and strategic communications on state tax and budget issues and to implement the strategic communications plan devised by the public relations firm; and
commissioning four policy briefs by researchers at Georgetown University and Connecticut Voices for Children on the impact of proposed budget changes on affected individuals and the states's economy, releasing these reports to the press, and holding private briefings on key findings for legislative leadership and media.Discussion
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During the discussion period, Patricia Baker of Connecticut Health Foundation was able to elaborate on the organization's work with Connecticut Voices for Children. The foundation sees financing as a critical to the availability of health services and thus work on state budget issues is a fundamental strategy. Martha Katz of Healthcare Georgia Foundation described how it is working to develop an SFAI organization in the state, recently releasing a request for proposals to get analytic projects started. Leslie Reed of the Missouri Foundation for Health described how her foundation began working with an existing organization, the Missouri Budget Project, to strengthen its work on Medicaid defense and the value of Medicaid to the state, both in terms of economics and health outcomes.

Contact Information

Iris Lav
Deputy Director
Center on Budget and Policy Priorities
820 1st Street, NE, Suite 510
Washington, DC 20002
202.408.1080
www.cbpp.org

Shelley Gaballe
Co-President
Connecticut Voices for Children
33 Whitney Avenue
New Haven, CT 06510
www.ctkidslink.org/
203.498.4240

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SOME OF THESE GRANTS ARE BEING USED FOR SPECIFIC PEOPLE ONLY...CHECK AND SEE WHAT YOUR STATE IS DOING....

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BULLETIN
He l p i n g g ra n t m a k e r s
i m p rov e t h e h e a l t h o f a l l p e o p l e
JULY 9 , 2007

Robert Wood Johnson Foundation
(Princeton, NJ) announced the establishment
of New Jersey Health Initiatives:
Expecting Success in Cardiac Care, a two-year, $3.5 million initiative to reduce
racial and ethnic disparities for heart disease among New Jersey residents. The
initiative is a statewide replication of the foundation’s existing national program
Expecting Success: Excellence in Cardiac Care. Program objectives are
to improve cardiac care for African Americans and Latinos, develop effective
strategies and models for improving the quality of cardiac care, encourage dissemination of these strategies and models to
other areas of care, and communicate lessons learned to policymakers and
health care providers. The program will involve 10 New Jersey hospitals to form a learning network, which will be administered by the Quality Institute of the New Jersey Hospital Association. For more
information, visit www.rwjf.org.

Milbank Memorial Fund (NewYork, NY) and the Department
of Social Development at the Development Research Center of the
State Council of P.R. China
copublished Regulating Medical Services in
China, which describes problems in access, quality, and cost of health care
during the transformation of China to a market-oriented economic system. The
report emphasizes the causes and effects of the absence of effective regulation
of medical services in China. It also describes how experiences in other countries could inform senior officials of the Central Government of the People’s
Republic of China as they reform regulatory policy. The report is the result of
conversations involving officials of Chinese ministries responsible for
aspects of health policy with counterparts from Australia, Canada, Scotland,
and the United States. For more information, visit www.milbank.org
and select “Milbank Reports.â€