In the wake of spending cuts, the Idaho Legislature is now in the process of determining how the state’s revenue surplus should be spent. It’s a process of sorting out priorities, and the decisions have palpable effects. For one Medicaid recipient, for example, recent budget cuts mean an uncertain future, even if funding is restored.
Last month, Krystal Esterline made a brave decision. The then 22-year-old decided to talk publicly about recent cuts in Medicaid services, and how they’ve affected her. “With having services, I’m successful in life when I have them,” she said. “When I don’t have all my services, I’m not successful. I have issues.”
She gets out-of-control angry, she said, and puts herself in dangerous situations. Esterline is articulate, but she suffers from developmental disabilities, the result of fetal alcohol syndrome. She also has bipolar disorder. Recent cuts in the state’s Medicaid program mean she no longer gets services for both problems. Without day-to-day mental health support, she fell apart. “I lost my apartment, I went into a group home, I got my housing voucher taken away because – I got in trouble,” she said.
All of that happened last fall. When we talked last month, Esterline had just moved back into her own apartment. She was stable, and feeling good. But now, the ground has shifted again. Nikki Tangen is Esterline’s guardian. “In the last several weeks she started deteriorating again,” she says. “Getting in the car with strangers, getting dropped off at people’s houses all over Boise, and I didn’t know where she was, she didn’t know where she was. It’s been pretty bad.” Left with no choice, Tangen is trying to find a new group home for Esterline.
In the wake of budget cuts brought on by the recession, the state finds itself at a decision point. That’s how Rep. Shirley Ringo (D-Moscow) sees it. “I think we’re at a crossroads, definitely,” she says.
That’s because — as state revenues begin to come back — lawmakers can determine what to do with that money. “We’ve gone through this necessary paring down, because we didn’t have the resources to do much else,” Ringo says. “So now we’re at a point where our revenues are starting to go back up, so that we see some opportunities here to decide what way we’re going to go.”
For example, will the legislature follow the governor’s budget proposal and make tens of millions of dollars in tax cuts? Or will it choose another route, reversing the most controversial reductions in Medicaid services, or setting money aside for repairs to state infrastructure? Ringo believes this is a terrible time for tax cuts – but plenty of others don’t agree.
“There’s times in our lives when we go through tough times,” says Rep. Ken Roberts (R-Donnelly). “And it really forces us to evaluate what’s really important in life. And I think that’s what the State of Idaho has been forced to do, and I think that’s been a good exercise.”
Roberts is Majority Caucus Chair, and he’s no fan of entitlement programs like Medicaid. In his view, the recent years of tightened purse-strings did the state an odd kind of favor. Idaho has had to evaluate its priorities and make hard calls. Now, Roberts says, it’s time for legislators to focus on economic growth. He believes tax cuts are the route to take. “If we can move the dollars into creating opportunities for businesses to be successful and hire people, I would much rather spend the money there than continuing to grow a system where people are dependent on the government for their food and their shelter and those kind of things,” he says.
Not surprisingly, this discussion, tax cuts versus restored funding for spending programs, is taking place in many states, particularly those with conservative governors. Kim Rueben with the Urban-Brookings Tax Policy Center stresses that budget decisions made now will affect how states fare the next time revenues take a downward turn. “States set up their fiscal systems in periods when they have a little bit more slack,” she says, “so they’re getting more money in, and often the problems we see when budgets get tight have been set into place when they start getting some money back.”
Rueben says this is a time for states to look ahead. If Idaho cuts taxes and the bottom falls out of the economy, she says, the state will have to weather the storm with that much less revenue.
Krystal Esterline’s situation illustrates the complexity of weighing tax cuts against reduced funding for programs like Medicaid. Benefit cuts don’t always bring cost savings. Two years ago, Esterline received 40 hours of services per week, at a cost of approximately $150 per day. The average rate for a group home in Idaho is just over $200 per day. In other words, the state’s Medicaid program will pay more to take care of Esterline in a group home than it paid for the services that let her live independently. What’s more, there’s the loss, for Esterline, in her quality of life.
“Two years ago, she was a different person,” says Tangen. “She could have a conversation, she could get upset and process through her emotions, and was able to talk about how she felt and what she needed. Now we have screaming, yelling swearing – refusal to even talk about it.”
Tangen volunteers as Esterline’s guardian. The two of them met years ago, when Tangen was working at a behavioral health agency. When Esterline aged out of foster care at 18, Tangen stepped in. Now, she can’t help but feel frustration, and sorrow. “Krystal has been unwanted, thrown out. Everything’s been against her from the beginning. So when I became her guardian, I was like, “Well, I like her…” And now this. It just feels like – she absolutely cannot catch a break,” Tangen says.
The cut that led to Esterline’s loss of services could be reversed. Last week, the chairs of the legislature’s Health and Welfare Committees urged just that change. But for Esterline, it would come too late. When she moves into a group home, she will lose her housing voucher. The waiting list to reapply is now so long that it’s closed. Krystal Esterline can’t even add her name.