Opinion » Editorial

Baker's budget moves remind us of Mike Pence

by Sue O'Connell
Tuesday Jan 12, 2016

Does Gov. Charlie Baker hold Massachusetts-style values? Or is he more of a Trump-Pence guy? It's a question worth asking after looking through his fiscal year 2017 9C cuts, announced in early December. And it's a question likely to be answered when he releases his proposed budget for fiscal year 2018 in a few weeks.

In anticipation of the state collecting fewer taxes than forecast, Baker cut $98 million from state agencies directly under control of the executive branch. He eliminated all state funding of the suicide prevention group, The Samaritans. He cut all funding for a reading program for low-income children and tax preparation assistance for low-income workers. Significant cuts were made to homelessness prevention services; healthcare insurance for low-income families; and substance abuse treatment and prevention programs. The cut that jumped out at me, though, was the $900,000 hit to the HIV/AIDS line item.

That's a lot of money to ask the state's already cash-strapped AIDS service organizations to absorb. Particularly when the state's Department of Public Health is working with the Getting to Zero Coalition to end HIV transmission in Massachusetts by 2020. The ambitious plan was announced at Harvard Medical School on World AIDS Day, and relies on investment from the state to succeed. But it's hard to see how that's going to work now.

Baker's approach reminded me of the public health "strategy" undertaken by Republicans in Indiana, under the leadership of then Governor and now Vice President-elect Mike Pence. Their approach resulted in an outbreak of HIV that will ultimately cost taxpayers (all of us, not just those living in Indiana) nearly $100 million to treat.

In late 2014, a resident of Austin in Scott County, Indiana was diagnosed with HIV. Over the next four months 10 more people were diagnosed. The spate of HIV diagnoses caught the attention of the U.S. Centers for Disease Control since there had only been five cases of HIV diagnosed in all of Scott County between 2004 and 2013. As 2014 rolled into 2015, the HIV diagnoses continued to mount. At one point, there were 20 new cases a week (imagine the panic if that had happened in Boston, Springfield, Holyoke, or Fall River). When all was said and done, nearly 200 people in Scott County (with most of them living in Austin, which has a population of just 4,300 people), were diagnosed with HIV.

How did this happen? Easy. Take an epidemic of opioid addiction, strip funding of the only health clinic in the county providing free healthcare to the approximately one in five people living in poverty, and then step back and see what happens. A study of the HIV outbreak published in the New England Journal of Medicine (NEJM) concluded that the whole mess could have been avoided. Which isn't a surprise considering that after Indiana lawmakers voted in 2013 to eliminate Medicaid funding for Planned Parenthood, the clinic in Scott County- which was the only place where residents could get free HIV testing- was forced to close.

With considerable understatement, the authors of the NEJM study of the outbreak note that Indiana had "fortuitously" signed up for the Affordable Care Act a/k/a Obamacare about 10 months before the first HIV case was diagnosed. If that had not happened, it's hard to say how long it would have taken before the HIV outbreak was noticed, and how the impoverished people of Austin, Indiana and their neighbors throughout Scott County would have had "access to [the] critical health care services" needed to treat HIV.

As it happens, voters in Scott County overwhelmingly supported Donald Trump for president 6074 to 2642. That may reflect the fact that despite what happened, people who live in Scott County don't place much value on having access to health care, or the implementation of opioid prevention and treatment services. But we have different values in Massachusetts, and we vote accordingly. State residents have long advocated for and supported-with their tax dollars-a robust public health infrastructure made up of private hospitals, community health centers, and nonprofit service organizations. This is one of the reasons why Massachusetts is poised to actually eliminate HIV transmission by 2020.

Baker's public health and social service cuts do not accord with these values. How long do you suppose it will take before Massachusetts voters notice?