Legislators Challenge California Governor Over 'Crippling, Cascading' AIDS Cuts
By Dan Aiello|
California Progress Report
While AIDS service providers met statewide yesterday to grapple with their "extreme shock" over Republican Governor Arnold Schwarzenegger's last minute cuts to the state Office of AIDS budget, Democrats were publicly challenging the governor's right to "blue-pencil," or veto, existing appropriations, while one legislator took aim at the administration's chief-of-staff for betraying an LGBT community to which she belongs.
Using line-item vetoes, Schwarzenegger blue-penciled more than $52 million in general fund support to OA programs, ending most testing, prevention and education efforts, altogether.
Legislators had already approved some OA cuts in the plan the legislature sent to the governor, but without the passage of more than $1 billion dollars in revenue, Schwarzenegger closed the budget gap by returning to social programs for the poor, cutting AIDS office funding in half, from $167.3 million down to $82.4 million for the current fiscal year.
Critics of the governor ridiculed his "shared sacrifice" budget for maintaining more than $2.5 billion in corporate tax breaks (included as part of the February budget) while avoiding an oil severance tax that made additional deep cuts to social programs necessary.
AIDS program advocates called the last-minute cuts, "crippling."
"We're all obviously affected by this," said Anne Donnelly, Project Inform's veteran director of health care policy, about AIDS service groups. "If it's not dismantling [the network of public and private AIDS service providers], it's certainly crippling it. These cuts will cripple the fight against HIV in California."
By all accounts, California's Office of AIDS has been a global model for effective management of the epidemic, with some counties, including heavily-affected San Francisco, seeing recent decreases in infection rates.
When reached, Donnelly had been in a meeting called to analyze how the cuts would affect county health programs, non-profit service providers and their clients. She told California Progress Report that organizations like Project Inform, which operate mostly on private donations and federal grants, will be impacted less than medical clinics and early intervention and prevention outreach groups, which will be devastated.
"We, as an agency, should not be overly affected by these cuts," Donnelly told CPR. "It's probably going to be the minority-based, smaller organizations that work in under-served communities and have been totally dependent on those funds," that will take the biggest hit.
With the elimination of education and prevention funding by the state, Donnelly told CPR, "I can't imagine how that won't have an impact," on the number and rate of new infections.
Michelle Roland, director of the state AIDS office, echoed those concerns in an interview with the Bay Area Reporter Tuesday, July 28 after the governor signed the budget and released a list of the additional cuts he made. Asked if the cuts would lead to increased HIV infections in the state, Roland said she is "certainly concerned about that possibility."
Immediately following the budget signing July 28th, Senate President Darrell Steinberg (D-Sacramento), fired the first shot questioning the legality of the governor's cuts to existing appropriations. Today Assembly members John Perez (D-Los Angeles) and Tom Ammiano (D-San Francisco) reiterated that concern.
Assembly member Perez told CPR that he had already contacted a law firm to review the governor's actions. According to Perez, his legal counsel advised him the governor violated Article 4, Section 10 of the state constitution when he blue-penciled existing appropriations.
"What the governor did this week was to go back in time and reduce appropriations that are current. He violated the law and he violated the constitution," said Perez, who believes if the governor's actions were legal, "There would have been no need for the last couple of months of negotiations."
"Look," said Perez, "he attempted to get that authority in 2005 [with proposition 76] and the voters rejected it. It's not legal."
"I understand there are folks out there who are contemplating suing," over these cuts, said Perez. "Let me be clear, there were line item vetoes that are completely legal and I don't challenge his authority to line item vetoes. But the constitution doesn't' give you that authority to retroactively veto appropriations. If the governor could do whatever he wanted to, there wouldn't be a need for negotiations [over budgets]."
Perez circulated the findings of his counsel to Democratic legislators yesterday.
Jennifer Rockwell, chief counsel of the governor's Department of Finance, responded to Perez' assertion in a rebuttal article in Fox&Hounds Daily titled, "Governor's Spending Vetoes Are Legal."
Assembly member Ammiano reserved his more pointed criticism for the governor's chief-of-staff, Susan Kennedy, an out lesbian, who stands accused of abandoning the LGBT community on the issue of marriage equality in 2007 when Schwarzenegger vetoed Assembly Bill 43.
"I also hold responsible [Schwarzenegger's] openly gay aides, like Susan Kennedy," Ammiano told the Bay Area Reporter. The freshman assembly member repeated his low opinion of Kennedy in an interview with CPR yesterday.
"She had a lot to do with [Schwarzenegger] not signing the LGBT marriage equality bill (AB 43, 2007)," said Ammiano. "She was standing right there by his side when he vetoed it. I think she's amoral. With these cuts she seems to have no pangs of conscience. She's betrayed our community again."
Of Kennedy and the governor's other LGBT staff, Ammiano asked, "Why aren't they in the trenches fighting for us? I think it is shameful."
CPR attempted to reach Kennedy for response, but was unsuccessful.
"Susan is out of the office this week and unavailable for comment," responded Schwarzenegger spokesperson, Aaron McLear, who took the opportunity to defend the governor's action. "The vetoes were difficult, but necessary, because the legislature failed to send the governor a balanced budget. That funding would not have been cut if legislators had not sent him an unbalanced budget."
"The Senate held the line and passed a budget revision package with a sufficient reserve that met the Governor's test," said Steinberg. "We will fight to restore every dollar of additional cuts to health and human services."
Alice Kessler, chief lobbyist for Equality California, told CPR she is worried about the ramifications of the governor's cuts to all health and human service programs. "We are part of the growing chorus that are extremely shocked by the governor's actions," said Kessler, who admitted her organization is still unsure what the full impact of the cuts will be. "It's going to be deep and devastating," said Kessler, but said specifics won't be known until the Office of AIDS and the counties respond to the cuts.
Kessler said EQCA "will definitely support the legislature's efforts to restore funding," but believes their must be an outcry from the public about the cuts if funds are to be restored. "This is outrageous and we need to have an enormous response from the community," said Kessler. "There must be more of a public outcry."
"Planning is underway for protests next week in San Francisco and Los Angeles," said Phil Curtis, director of government affairs with AIDS Project Los Angeles, one of many non-profits working to understand the impact of the governor's cuts on existing programs and services.
Impact On One Agency
APLA currently cares for 9,500 registered clients. Curtis called the OA budget cuts, "Really punishing and really painful," pointing out that they come at a time when the philanthropy-dependent agency is experiencing a 25 percent decrease in private donations through events like AIDSWALK, Los Angeles. According to Curtis, APLA's operating budget traditionally counts on 55 to 60 percent private funding.
"This is a really sad time," said Curtis. "We're unraveling a safety net for extremely vulnerable people." As an example, Curtis noted that 80 percent of AIDS Drug Assistance Program recipients live on less than $20,000 per year. A significant percentage of those live below the nation's poverty level of $10,000 per year.
"California's been generous in its HIV care, and now that's gone," said Curtis, who contends that what California taxpayers got from that generosity was an early plateau in HIV infections (1993), "because of the behavior changes among groups at risk," and "care and treatment for a lot of individuals in desparate need." Curtis believes the state's OA program contained the spread of the epidemic, making it "a model of cost-savings."
According to Curtis, the full impact of the governor's cuts to the clients of his and other organizations will be known only after Los Angeles and other cash-strapped counties determine how to distribute the cuts next week. "We have this cascading effect," said Curtis of the cuts to Health and Human Service programs funded through the county, the loss of a quarter of the annual private contributions and the new cuts in state grants provided directly from the Office of AIDS. Additionally, the state's $1 billion dollar cut to Medi-Cal and the loss of the program's dental care - and additional cuts to county health services - may contribute to future service needs.
APLA clients who may be affected by the governor's cuts include:
* Prevention programs, including those for minority, youth and drug recovery groups, are in jeopardy. One program to be cut provides weekly support for recovering Crystal-Meth users, serving more than 60 clients each week. Three additional programs to be cut provide prevention outreach to under-served African-American, Latino and American Indian youth.
* Housing assistance recipients. Some, but not all, of these funds were cut.
* Clients enrolled in APLA's Home Health intensive nursing care program, which allowed critically ill patients to remain at home instead of being placed in nursing homes or remain in expensive hospital settings. The program cares for an average of 120 patients at any given time and employs approximately 10 staff, along with ancillary caregivers and home health aides.
* MediCal patients utilizing APLA's Dental Care Services - A loss $37,000 in Denti-Cal funding. The cost-effective program, which operates on a $900,000 annual budget, last year performed approximately 9,000 procedures.
Additionally, Curtis believes as many as 15 percent of APLA's staff may be laid off as a result of the governor's cuts.
The Governor's Cuts - source: Department of Public Health
Of the $82.1 million dollars, $52 million was cut with the governor's line-item vetoes. The total was eliminated from the OA budget in FY 2009-10. The total OA budget for FY 2009-10 is $487.6 million. $356.3 million of the $487.6 million is AIDS Drug Assistance, funded mostly through Federal and Special Funds. ADAP's special funds are pharmaceutical rebate funds generated by the program.
- Cut from ADAP - $25.5 million was eliminated from the ADAP program which provides medications to people who do not have adequate insurance coverage. $70.8 million in state support remains, and there are also federal funds as well as manufacturer rebates.
For FY 2009-10, this reduction will be backfilled with a "raid on the rebate funds" and there are no significant program changes anticipated. However, in coming years there will not be sufficient rebate funds to continue backfilling. The special fund (rebates) are required by statute to be spent only on medication.
- Cut from HIV/AIDS Surveillance - $1 million reduction, leaving $7.651 million in state general fund in addition to federal funds. This will enable surveillance activities performed by local health departments to continue, ensuring that CA stays competitive for federal funding.
- Education, Prevention, Counseling and Testing Programs - eliminated. $41.8 million was allocated in state and federal funds. With the proposed reduction, approximately $8.9 million remains in federal funding.
Cuts to Care and Support Programs for People Living with HIV Infection
1. The elimination of these funds includes approximately 50% of the total funding for early intervention (primary medical care and transmission prevention counseling) and home and community based care (medical case management) programs. The reductions in these areas are $13.78 million. Approximately $12.4 million remain in federal funding to support these types of program. An additional $15.3 million of federal funds are also used to support medical and support services.
2. The reduction includes 100% of the Therapeutic Monitoring Program which pays for specific blood tests for people with HIV infection. This is an $8 million reduction.
3. Approximately a quarter of the total funds used to provide housing for people living with HIV infection ($1.1 million) were eliminated
Posted on July 31, 2009