The process some lawmakers call "blood letting" is about to begin.
Next week, members of the Health and Social Services Joint Appropriations Subcommittee are going to have to take their $100 million-plus "wish list" of building blocks for programs that serve - or would serve - thousands of Utahns and prioritize them, eliminating dozens of programs because there isn't enough money to meet the need.In fact, there probably isn't enough money in the whole state to really meet the human service needs.
During the past few weeks, senators and representatives have listened for hours as different people shared their lives, their worries, their desperate needs.
It's been a strange process because, from the beginning, everyone has known that the money will be available to support very few of the many programs. In effect, the lawmakers have acknowledged that all of the needs are serious and deserving and have given them the right to hang in until the final decision. It's been a little like voting to put a name on a slip of paper in a hat, to be drawn at a later date.
The departments have set priorities in their requests. Various citizen groups have explained their choices and the reasons for them. And each legislator has expressed particular interest in one program or another. It's impossible to know what combining those factors will produce.
I'm glad I'm not on the committee. Just attending the meetings has been a heart-wrenching process. But I can walk away at the end without having to decide anything. Here's a miniscule sampling of the decisions they will have to make:
Kevin is a young insurance salesman who is confined to a wheelchair. His mind is quick, his body uncooperative. He needs assistance for things like taking a drink or arranging his arms. He spoke about a program that allows him to hire an attendant. Keeping the job filled is difficult, he said, because few people are willing to work 24-hour days for $6,000 a year, but at least the program exists.
Claire is 80 years old and lives alone in an apartment. She's not well, but is able to stay in the community because of a program that provides some personal and practical assistance, like help dressing and cooking. The money that pays for the program is very small compared to the cost if she were in a nursing home, which is exactly where she'd be within 90 days if the help were not available.
Ann has 13-year-old twin daughters who are handicapped. One requires constant care. Thus far, Ann and her husband have managed to keep the girls at home, but it is becoming more difficult. This couple is one of many that need programs like brief respite help to keep their children out of intermediate care facilities - which would cost the state a lot more and is considered a worse quality-of-life option.
Sara Sinclair, chairman of th Health Facilities Committee, said that the long-term care facility where she works is losing $5 a day caring for Medicaid patients, who make up 60 percent of the center's population. Unless reimbursement rates are raised, the survival of long-term care in Utah is in jeopardy.
The list goes on and on and on, a statistical portrait of flesh-and-blood people.
Public assistance recipients haven't had a grant increase in four years, despite inflation, and the grant doesn't even approach poverty level. The homeless and very poor desperately need dental care. Welfare recipients need more day care slots if they are ever to become self-sufficient.
Staff in the Office of Community Operations is so overworked that workers can't get ahead of the caseload and as a result people are having to wait too long for life-sustaining help. Waiting lists are unwieldy, there's a need for more youth treatment slots and the Emergency Work Program should be available year-round.
The tragedy is that every proposal is worthwhile and every person affected by the panel's final decision is important.