Tim Durning
Barbara Katz wants nothing more than for her son, Ben, to make a life for himself. But she knows that Ben, who will turns 20 at the end of this month, needs help for this to happen.
Ben was diagnosed with a benign brain tumor when he was just a baby and had major surgery at age 2, which left him permanently disabled. Explains Katz, "He literally has half of his brain."
Despite his disability, Ben works most days, goes to school, and has a social life. He's a huge country music fan who loves to bowl and hang out around State Street. His parents hope he can live on his own when he turns 21 and have all the opportunities his older and younger brothers will have.
"I'm not going to be here forever. We've worked really hard to set up a community for Ben," says Katz, as she sits next to him on their couch at their west-side Madison home, his hands playfully touching hers. "He's always been raised to have the same hopes and dreams as his brothers."
Ben has worked in a variety of places: the VA Hospital, where he tidies waiting rooms; libraries, where he shelves books; and nursing homes, where he wheels people to appointments. "These are real jobs that somebody needed to do," says Katz. "It wasn't work that was created for them."
But, she adds, Ben "will always need support from the community," and right now that support is in jeopardy. Gov. Scott Walker's plans to erase a $3.6 billion deficit include cuts that could diminish Ben's opportunity to work, get out in the community, live on his own and receive assistance. Katz fears her son will "languish at home," sleeping and watching TV, when he "could be a productive member of society, who holds a job and pays taxes."
In his budget address in March, Walker said state government had grown irresponsibly large: "While families across this state were focused on making ends meet, the state government continued to grow well beyond our taxpayers' ability to pay. But the time has come for us to make the tough choices necessary to put our state back on the path to prosperity."
But the tough choices Walker is making appear to come largely at the expense of people like Ben Katz: people with disabilities, poor people who need health care, and families of all incomes who need help with extraordinary medical conditions.
The specifics of who will be affected and how remain vague. But many fear the worst. Says William Orth, the human services director for Sauk County, "It would not be unreasonable to imagine some people will die sooner than they would have. These are fragile populations."
Closing the deficit
Andrew Reschovsky, an economics professor at UW-Madison's La Follette School of Public Affairs, understands why people get confused about Wisconsin's budget deficit. "The concepts are complicated, and the terms get defined differently by different people."
That Wisconsin faces a $3.6 billion budget deficit does not mean the state is that much in the hole. Rather, the amount of tax revenues the state is projected to bring in over the next two years is $3.6 billion less than it is expected to spend, if all current programs remain the same.
Because these are projections, the numbers are open to debate. "It's hard to measure, and it's ambiguous," Reschovsky says. "There are no absolutes."
Recently, the state found an extra $636 million in tax revenues, because earlier projections were inaccurate. Thus the deficit got smaller without anyone doing anything.
When faced with a deficit, the state has three options: raise taxes, cut spending, or find a way to put off the problem.
The state has often used this third approach, by shifting money from the transportation fund into the general budget and then borrowing to cover highway projects already in place. Reschovsky says this approach sometimes makes sense.
"In my view, given that the economy is still recovering, putting off some of the budget deficit might not be bad policy," he says. When the economy recovers, tax returns will rise and the state will be better able to deal with its deficit.
Walker wants to close the budget gap entirely through spending cuts. And he's compounded the problem by creating $117.2 million in tax breaks, with more to come, which may mean even deeper cuts.
The biggest cuts come in the areas of education, shared revenue to municipalities, and human services. The numbers are in flux and no one knows precisely what they'll be. Says Jon Peacock of the Wisconsin Council on Children and Families, "The details aren't in the budget bill."
Peacock, who also heads the Wisconsin Budget Project, says early indications are that the governor would cut $500 million from Medicaid, a means-tested health-care program for low-income individuals and families; $111 million from Family Care, which helps the elderly, disabled and people at risk of being institutionalized; and $48 million from county-run income maintenance programs, which fund food stamps and other assistance programs.
For those who depend on these programs, the uncertainty as to how they'll be affected is already taking a toll.
"They're scared to death," Peacock says of people he's seen at public meetings. "I feel bad because I feel like some of them won't be affected, and some of them will. And I don't know which will and which won't. I can't ease their minds, because I really don't know."
Cuts to health care
According to Peacock, the cuts to Medicaid are much larger than they appear.
"Every state dollar spent on Medicaid generates about a buck and a half from the federal government," he says. "If you cut $500 million of state spending, it's upwards of a billion dollars. It's hard to nail down."
But, Peacock cautions, these aren't direct cuts to current programs, but rather, to the projected growth. "This is where it gets wonky," he says. "The cut is to projected spending, if the program would continue to be run as is."
In other words, the state needs to restrict enrollment, keeping people who need Medicaid and the state program BadgerCare, and would qualify for it under the current system, from getting it. There are different ways of going about this.
Currently, the state allows adults who live at 200% (twice) the federal poverty level to get Medicaid, Peacock says. But the state is only required to offer this care up to 133% of the poverty level. If the state only does what's required, 7,000 adults without kids and 63,000 parents would lose their health care, he says.
But the Walker administration says it doesn't want to do this. Instead, it is seeking a waiver from the federal government allowing Wisconsin to charge recipients 5% of their income in premiums, and disqualify anyone whose employer offers health care, even if the employer pays very little toward the premiums.
"The argument is, 'Doesn't that make a lot more sense than reducing enrollment?'" Peacock says. But his group is not backing this change. "We're not ready to accept the premise that those are the only two options. They've increased highway spending in the budget. We think that money would be better spent on health care."
Peacock says people on the margins simply aren't able to pay more toward their health care: "The groceries and the utilities get paid before health care, and they're going to lose eligibility."
And advocates say that is bad news for those who have health care. People without basic coverage will wait until they're facing serious medical conditions, then go to the one place that cannot refuse care.
"The result will be more people going into emergency rooms," says Andy Heidt, ombudsman for Dane County Human Services, "and that will be covered by increases in private health insurance. Costs will hemorrhage elsewhere in the system."
Complicating the system
There are other ways to force people off Medicaid and BadgerCare, and some are already happening. This is accomplished through something conservatives usually rail against: increased government bureaucracy.
By complicating the application process, restricting access to information, making it harder to appeal denials, and making it harder to find help navigating the process, the state is already weaning people off BadgerCare and Medicaid, saving tax dollars.
Bobby Peterson, executive director of ABC for Health, says the state is dismantling systems that people have relied on to navigate the complicated and confusing system of public assistance, with its myriad regulations. As he puts it, "Medicaid is rocket science." But the state is cutting aid to advocacy groups as well as civil legal aid, in case someone needs to go to court.
"They're structuring this in a way so they can take out people who don't have any power," Peterson says. "They just don't seem to care too much. Everything they're doing is driven by such a rigid ideology to help people who are most well off in society."
The state also wants to shift all income maintenance programs - where people go to access food stamps, medical assistance and other programs - from the counties to a centralized system. It has proposed contracting this out to a private company, which would do most of the work through a website or over the phone. (Federal approval is needed to shift some of these programs, like food stamps.)
And the state's budget-cutting agenda may force counties to radically reshape the kinds of human services they offer.
Lynn Green, director of Dane County Human Services, says Dane County has "certain mandated services we have no choice but to do: protect kids from neglect, seniors from abuse. We're going to pay for those services no matter what."
But the county may have no choice but to drastically cut so-called preventative services. She says things like gang prevention, neighborhood initiatives and drug and alcohol counseling will all take hits.
Seniors will also suffer. "We hook them up with services that they can pay for so they can stay in the community and get their needs met," Green says. "If they don't have someone to help them, they may eat their way through their resources quicker and end up on public assistance. They may end up in nursing homes."
In the past, Dane County might have made up the difference through local taxes, but Walker wants to cap the ability of local governments to raise property taxes.
Sauk County is in a different bind. It recently joined the state's new Family Care system, which integrates the counties' care of the elderly and disabled into a statewide system. In joining, Sauk turned its spending on these programs - about $7 million a year - over to the state.
The new system was supposed to eliminate waiting lists. But now Walker has proposed capping Family Care enrollment.
"There will be roughly 100 people on a waiting list, when there really shouldn't be a waiting list at all," says Orth, Sauk's human services director. "They cost the county money because we have to serve them in at least some fashion. And they can get a court order to demand care."
But, he adds, "We don't have any money because we gave up the money" to the state.
What kind of people are we?
Aaron Schliem wants to dispel a myth he sees being perpetuated by conservatives: that the government services Walker wants to cut are going to lazy people freeloading off the state, and the government must apply some needed tough love.
Schliem is a successful Madison businessman, co-owner of Glyph Language Services, a small firm that produces content for websites and provides translation services for companies seeking an international web presence.
As a private businessman, Schliem says, "I always made sure we had the best insurance we could buy. I didn't care how much I paid, I wanted the best, best, best coverage."
Unfortunately, even that coverage only pays for about 90% of his medical bills - which in his case is not enough. Schliem's eldest daughter, Mati, was diagnosed with a benign brain tumor when she was 6 months old. She has had five brain surgeries and needs an MRI every three months to track the tumor's growth.
Because Mati's condition is extraordinary, she qualifies for a special Medicaid waiver, which covers the 10% of the medical bills his private insurance won't.
"Based on our income, there's no way we'd be eligible for Medicaid. I make a decent income," says Schliem. "But there's a huge difference between having a decent income and being able to take care of a major medical condition."
Schliem reckons that if it weren't for medical assistance, "we'd be in upwards of $1 million in debt" - unless he decided to pass on the surgeries, "which means my daughter dies."
Like most people needing health care assistance, Schliem doesn't know how he'll be affected by Walker's budget. But he worries his daughter will lose assistance.
"A lot of Republican arguments are overly simplistic," he says. "They have this ethos of 'You need to pull yourself up by your bootstraps like I did.' I've done everything you can expect to do to get health insurance. It's not enough. I can't pay for it."
Mita's illness has left her blind and developmentally disabled, which means she needs lots of extra help at school. She's getting it now, but with severe cuts to educational funding, Schliem isn't sure what the future will bring.
"If they cut back on school funding, it's going to put me in an adversarial position with people who want to help her," he says. "I'm going to have to resort to federal law to fight them and force them to do things they don't have the money to do."
The need to take care of his daughter has led Schliem to consider relocating to another country, as one of his employees did, to get socialized health care. Spain is one option. And if that happens, he notes, Walker will have chased a successful small business out of Wisconsin.
"I think about it more philosophically," he says. "What kind of people are we? Do we believe in taking care of basic needs? Or do we believe each man for himself and too bad if you don't make it to the finish line? Do I need to change countries and live somewhere more humanely?"
Barbara Katz has similar concerns, not just for her son Ben's future, but for Wisconsin.
"The fundamental value of Wisconsinites is they value people regardless of their abilities," she says. "That's not being respected."
