Friday, February 14, 2003.

Budget Knife Facing Delicate Cuts


Circumcisions or hearing aids?

It may come down to that choice in Utah's Legislature this year, with the state facing the worst economic downturn in more than a decade.

Thursday, an advocate for low-income residents suggested sacrificing Medicaid coverage for circumcisions may be the only way to restore audiology services, which were cut last year.

Squirming House Republicans giggled during a caucus when Judi Hilman, of Utah Issues, said, "While we're not entirely comfortable with cutting circumcisions. . . . "

But Hilman was deadly serious -- and so is the financial crisis facing Medicaid, the federally subsidized, state-run health care insurance that serves 260,000 low-income Utahns.

Circumcision, while a long-standing cultural custom for newborn males, "is not medically necessary," she noted. "Audiology is, especially if that person is to live and work in the community."

The value judgment isn't an easy one for Hilman, who is Jewish and thus steeped in the religious requirement of circumcision. "I feel very ambivalent about it."

But it's the kind of tough decision that lawmakers are being forced to face this year.

Advocates say the state needs to come up with $50 million just to shore up and restore Medicaid to its basic service level. It's a life-and-death issue for many, they warn.

But lawmakers say they will be lucky to come up with a little more than half that.

"We're hoping to get $30 million," said Vernal Republican Rep. Jack Seitz, House chairman of the Health and Human Services budget committee. "It costs $20 million just to cover increased utilization and replace one-time funding" used last year to temporarily plug shortfalls.

The makeshift financing wasn't enough to keep the program intact. Along with cutting audiology services, Medicaid overseers have in recent months cut dental and vision care, physical therapy and some services for HIV and tuberculosis patients.

Effective next month, more than 5,000 Medicaid patients will be booted off, said Hilman, as eligibility requirements are tightened.

Instead of covering everyone up to the federal poverty threshold, the state will accept only those at 75 percent of poverty-level income.

The runaway price hikes on prescription drugs and health care, combined with the swelling ranks of poor are fueling huge Medicaid increases in Utah, just as in most states.

"Eventually," said Seitz, "it's going to catch up and break us."

(File prepared 17 February 2003)