The Governor took out his metaphorical veto pen today as he approved the state’s budget for fiscal year 2010.

Saying, “Health care for all means health care for all,” at his press conference, the Governor proposed partially reversing the proposed cut to some 30,000 legal immigrants (listen Governor Patrick budget statement.

Under the Massachusetts Constitution, the Governor can “line item veto” individual items in the budget. The item is then not operative, unless the legislature overrides the veto by 2/3 vote in both branches. He can also return a provision to the legislature with a recommended amendment, which has the effect of blocking the implementation of the provision until the legislature either approves the recommended amendment or insists on its original language. All of these options were used on health-related matters today.

Outright vetoes
The line-item vetoes total $147 million. Among the funds reduced are the Betsy Lehman Center (about $1.2 million); the Quality and Cost Council ($133,000) and over $50 million in MassHealth spending, including $2.3 million for children’s behavioral health. No cuts were made in MassHealth eligibility or benefits, including dental coverage. Funding was eliminated for the academic detailing program.

He also vetoed a provision calling on a raft of state authorities to continue to make contributions to state programs. One effect of this veto is to eliminate the requirement that the Connector and HEFA contribute $500,000 and $2 million respectively, for outreach and enrollment grants. If this veto is not overriden, no funds would be available for community outreach assistance.

Immigrant Provision Returned with Amendment
The Governor returned with a recommended amendment (text here) the legislature’s provision ending Commonwealth Care coverage for some 30,000 legal immigrants who are not eligible for federal funding. The Governor highlighted his concern for this population:

The conference committee budget terminated Commonwealth Care health insurance coverage for approximately 30,000 legal immigrants, a successful feature of our health care reform experiment.  This would be a major step backwards from our progress at a time when the eyes of the nation are focused on this groundbreaking initiative.  I am accordingly proposing an additional $70 million in funding to continue state-subsidized health insurance for these residents – and ensure that our state continues to lead the nation in offering high-quality, affordable health care to all.

The provision as drafted by the Governor envisions the immigrants retaining their current coverage for the month of July. Their coverage would end for August. During that period, some would be eligible for MassHealth Limited, which covers emergency care only. Most would also be eligible for the Health Safety Net Program, which covers hospital and community health center services. Then in September, a new program, costing $70 million, a bit more than half of the current annual cost, would be made available for these immigrants. The program would either be run by MassHealth or the Connector. The provision is temporary, lasting only one year.

About half of the $70 million comes from increased federal Medicaid funds the state is now expecting as a result of the higher unemployment rate. The other half depends on the legislature sustaining some of the line item vetoes, thus freeing up other funds. The Governor filed a separate appropriations bill allocating the $70 million to this new coverage for these legal immigrants. What the program would cover and how it would run is left up to the Connector and MassHealth.

The next step is for the Connector and MassHealth to settle on a plan, while the legislature considers the Governor’s proposal. While we strongly oppose ending coverage for these legal, taxpaying member of the community who meet all other eligibility standard for health coverage, if this plan is moving ahead we urge MassHealth, the Connector and the legislature to consider:

• the impact on continuity of care and trust in the system that could result from someone having 3 different types of health coverage over a 3-month period
• the strain this scheme will place on providers, particularly vulnerable safety net providers who are committed to providing care regardless of the type of coverage a patient has.
• the need for additional outreach and enrollment assistance, especially for a group that is more likely to not speak English or fully comprehend the bureaucratic requirements for a new program.
• the need for close consultation and involvement by immigrant organizations, health providers and advocates in formulating and implementing any new program.

We appreciate the Administration’s effort to work hard and find a solution during some of the most difficult financial times many of us have ever seen and we believe the Governor and his team are committed to the gains the state has made since health reform passed three years ago. The people affected are our neighbors, our family members, and our co-workers. We think all of these residents should be covered, not only because they are eligible, but because coverage keeps our communities and workforce healthy and productive.

We will use the blog and our web site to keep people informed as this process unfolds.
-Brian Rosman