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Published: Tuesday, 4/5/2011

Invisible victims

As details emerge about Gov. John Kasich's proposed state budget, it becomes increasingly clear that the governor seeks to resolve the state's fiscal problems by transferring many of them to local governments. That strategy would affect most directly the most vulnerable — and least powerful — Ohioans.

To close a projected $7.7 billion budget gap, Governor Kasich proposes cutting state funding to local governments by more than $500 million over two years. State aid to schools would fall by $1.3 billion over the same period.
Such deep cuts could force local governments to raise taxes and school districts to seek more local funding at a time when most taxpayers already feel stretched to the limit.

But even these cuts could have less effect on the health of local communities in Lucas County than the governor's proposed reductions to state service providers such as Children Services, the Department of Mental Health, the Ohio Department of Job and Family Services, and Medicaid.

A new report by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation ranks Lucas County 72nd among Ohio's 88 counties in health outcomes. There was some good news: The county scored well in clinical care.

The percentage of its residents who lack health insurance, at 12 percent, is two points lower than the statewide average. Lucas County has one primary-care provider for every 627 residents, compared with one for every 859 across the state.

But county residents rank poorly in health behaviors such as sexually transmitted infections and teenage births. At the same time, the Lucas County Health Department says it needs a 5 percent increase in funding from member communities to do its job, which includes providing prenatal care to women without insurance.

The department says it needs the increase because next year, the state will reduce to 35 percent the amount the department can spend on salary and benefits in its grant programs. Current labor contracts commit the department to 41 percent, so the difference must be made up locally.

Against this backdrop, Mr. Kasich wants to divert more prison inmates to treatment and counseling programs — a worthwhile goal, but one local governments would have to pay for. He wants to cut funding for Children Services, the Department of Mental Health, and Adult Protective Services.

Job and Family Services, in addition to losing state funding, would lose $160 million in federal money that has gone to child care and help for needy families. Medicaid would be cut by $1.4 billion over two years, including $478 million in reduced payments to hospitals.

Proposals to slash these services feed on public perceptions that government programs have padded budgets, rampant waste, top-heavy administrations with inflated salaries, and workers with cushy wage-and-benefit deals. That is often not the case. Local service agencies have trimmed spending to the bone in recent years, even as they struggled to meet increased demand.

The need for such services won't go away just because the state reduces the share it is willing to pay. To the contrary, the need will grow as low-level criminals are referred locally, unemployment benefits run out, and families that depend on the services look elsewhere for food, health care, and help with mortgage, rent, and utility payments.

The burden of meeting these needs will fall on local governments and charitable organizations, including nonprofit hospitals. They will be forced to ask local residents for higher taxes, increased hospital fees, and more generous charitable giving.

The Ohioans who will endure Mr. Kasich's proposed cuts — elderly, poor, and mentally ill people, and children — are often faceless, voiceless, and politically impotent. The governor may feel he can ignore them, but local communities cannot.



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