Health advocates, health staff and Washington residents watch with trepidation as the state makes devastating cuts to such "optional services" as maternity care and family planning, leaving them to wonder what's next.

Low-income pregnant women, women who rely upon Medicaid for family planning and other reproductive health care, and children in Washington state will soon feel the force of a crippling recession and a budget which desperately needs balancing.

The Department of Social and Health Services (DSHS) in Washington announced budget cuts last night, across the board, for what are deemed “optional” services. From Take Charge, the family planning program which provides free birth control and family planning to low-income women and men, to Maternity Support Services, which covers one out of every three pregnant women in the state, Medicaid programs are being slashed. Included in the cuts are subsidized health insurance coverage for children, pharmacy benefits and dental care for adults, hospice care and much more. According to The Olympian, state Medicaid director, Doug Porter, considers the cuts “devastating” and “radically altering the face of the medical programs” created by Medicaid.

Washington state’s pro-choice Governor Gregoire may have little choice but to move ahead with these cuts. The state is facing an immediate $520 million budget shortfall and with a state mandate to have a balanced budget, this round of cuts is just the first. Governor Gregoire will review the cuts proposed by DSHS and make her announcement sometime between October 1st and October 15th.

It’s hard to imagine, however, how the state’s most vulnerable women and children will access crucial health care otherwise. When it comes to prenatal care for pregnant women, including referrals for domestic violence services, drug treatment, breastfeeding, nutritional services and more; as well as family planning programs; and health care for children, the initial investment saves money down the road. Will these cuts to critical interventions mean short-term savings with no long-term benefit?

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MaryAnne Lindeblad, Director of the Division of Healthcare Services for DSHS in Washington State, told Rewire, in essence, that may be true:

“The state has a constitutional requirement to operate a balanced budget and we have to make cuts to get to the end of the fiscal year. Medicaid is even more limited. Cutting optional services is our only choice. It’s hard to quantify but there will be outcomes from that, which will end up costing us in the long run. It’s hard to put a number on it, but yes.”

But Planned Parenthood of the Great Northwest’s political action arm, Planned Parenthood Votes! Washington, as well as Public Health of Seattle and King County can put specific numbers on it.

According to Planned Parenthood Votes! Washington, cutting the state’s Take Charge program will will save, reportedly, only $1.2 million per year, but will result in new costs of $50 million per year associated with unintended pregnancy. Cutting this family planning program for those who are not eligible for other Medicaid programs and who do not have insurance, also means turning down federal matching dollars. The Washington State Take Charge program receives nine dollars in federal funds for every $1 the state invests. Without the state expenditure, the state will no longer receive federal funding for Take Charge.

Who will feel the brunt of the cuts to the Take Charge program?

The 43,000 women and men per year who rely on the family planning program to avoid unintended pregnancy. Since 2001, 400,000 Washington residents have used Take Charge to protect against unintended pregnancies. According to the Guttmacher Institute, without the program, this translates into approximately 17,000 abortions per year.

And while Lindeblad told Rewire that some of these clients can still utilize community health centers, family planning clinics or purchase contraception over-the-counter at pharmacies, there are sliding-scale payments or full payments associated with all of these options, if Take Charge isn’t available. If one’s options are “choosing” between paying for food, rent and clothing for ones’ family or paying for contraception, it’s not hard to see the impact of slashing a program like Take Charge on the lives of Washingtonians. In fact, notes PP Votes! Washington, this program “supports families teetering on the edge of poverty, for whom the costs associated with an unintended pregnancy could mean hunger, homelessness or worse…”

The proposed budget cuts to family planning, therefore, mean more births and more births to those women living in the lower income levels of the state, which means more women who must rely on Medicaid funding for prenatal services, costs associated with childbirth care, and postpartum care. However, funding for the First Steps Program (which includes Maternity Support Services (MSS), Childbirth Education and Infant Case Management) is also being cut.

According to DSHS, they have proposed $6.4 million dollars in cuts from programs designed to help low-income pregnant women and their infants in the state. One out every three women who give birth in the state receive support from MSS. In 2009, the program served 30,000 women in one single county alone. The program helps ensure better birth outcomes by providing a range of services for pregnant women including nutritional services, physician referrals, childbirth education, health screenings, tobacco cessation assistance, drug treatment and more. These sorts of programs are also crucial to improving infant health, preventing low birth weight births and lowering infant mortality rates. Cutting funding for this program places women and infants at risk.

And, as with Take Charge, Maternity Support Services receives federal matching dollars. Without the state funds for this program, millions of federal dollars which help support low-income pregnant women and families in the state also disappear.

It’s a dire situation and one only expected to get worse. The one sliver of hope, however, might be found in a state income tax proposal on the ballot this November. It’s backed by two of the state’s wealthiest – and most well-known names – Bill Gates, Sr. and Bill Gates, Jr.

Currently, public health funding in Washington state has no dedicated funding stream. It’s why cuts seem to be continually coming down the pike when it comes to health care (and education, as well). In 2009, maternity support services were already cut. And, when the state’s biennium budget is proposed soon, more cuts will likely be included.

There is no income tax in Washington state. Initiative 1098 establishes an income tax for the wealthiest citizens of Washington state, taxing individual incomes above $200,000 and couples with incomes above $400,000. It would raise approximately $2 billion in sorely needed funds for both healthcare and education in the state. While opponents argue that the lack of an income tax is partly what attracts talent to local companies like (ironically) Microsoft and Amazon, proponents say the time is not just right – it’s far past time. Under this current round of cuts, for example, 27,000 children in the state of Washington will lose health care coverage.

Most of the proposed cuts, if agreed upon by Governor Gregoire, are scheduled for January 2011, while some requiring legislative action won’t be in effect until March 2011.

For public health advocates, public health staff and Washington residents who rely on these programs, the cuts announced yesterday will have a devastating effects on people’s lives. With a multi-million dollar budget shortfall, however, many are wondering what’s next.