March 05, 2003 -- Oregon cuts off meds to poor mentally ill

While Oregon cuts off meds to the mentally ill, Washington DC debates
forcing anti-psychotic meds on a prisoner so he can be mentally
competent to face execution.


New York Times, March 5, 2003

A Prescription Plan Hailed as a Model Is a Budget Casualty

By TIMOTHY EGAN

PORTLAND, Ore., March 3 - In a state that says it is already so short
of public money it does not have enough to keep all the schools open
and prosecute many criminals, Oregon took another drastic step this
week to cover budget shortfalls: it cut off medications to thousands
of schizophrenics, manic-depressives, drug addicts and others who are
poor and have no health care.

A decade ago, Oregon was widely hailed as a pioneer in providing
health insurance, including prescription drug coverage, not only to
the poor but also to people who make just enough money that they do
not qualify for most federal Medicaid programs.

Now, in a reversal that has stripped a once ambitious program to its
core, Oregon has pared back the insurance, and removed prescription
drug coverage for things like mental illness and drug addiction. Most
of the cuts went into effect March 1, but others started Feb. 1, just
days after Oregonians voted in a referendum against a tax increase to
balance their budget.

And while state officials are looking for some way to restore some of
the health program, they admit that they will not be able to offer
anything like the expansive benefits of the past.

So throughout Oregon this week, about 100,000 poor people are suddenly
scrambling for the basic medications that allow them to function.

For Dave Cesario, 45, who is H.I.V. positive, diabetic and on
methadone to stave off addiction to heroin, it meant going cold turkey
Saturday.

"I'm just numb; I don't know what to do," said Mr. Cesario, who lives
with his disabled wife and 12-year-old son. "My only hope is that the
drug companies will have mercy and I'll be able to get some free
samples."

For Karen Hansen, 50, who has prescriptions for everything from
anxiety disorder to high blood pressure, the cutoff means taking only
the few drugs that will keep her alive. She lives on $689 a month in
Social Security disability payments, and her monthly prescription
bill, without assistance, is $615.

"I don't buy the newspaper, I eat hot dogs that they give out free and
get other meals from the food bank," Ms. Hansen said. "But that only
saves about $200."

The step is the latest response to a budget crisis that led state
officials to make nearly $600 million in cuts in the last two years,
and will require another $2 billion in reductions, according to
projections, in the new budget cycle that begins this June.

Hit by a harsh recession after a series of tax-cutting measures pared
the budget to the bone, Oregon, which has no statewide sales tax, now
lacks enough money for health care, schools, prisons and criminal
prosecution.

Portland schools had planned to cut nearly five weeks off the school
calendar this year. But teachers agreed on Monday to work two weeks
without pay, and that offer - together with a plan for a temporary
business tax - looks as if it will now save the school year. But the
state has announced plans to close a number of schools.

Prisons have let out some criminals early. And starting today,
prosecutions of people arrested for theft and drug crimes are being
delayed because there is not enough money for prosecution or legal
defense. Officials say those arrested are being released and may be
tried later, in the summer, if the legislature can come up with new
funds.

The latest round of cuts came after Oregonians considered a referendum
in January on whether to raise taxes temporarily. The measure was
narrowly defeated, after opponents of the tax increase said the state
could find ways to cut without major consequences.

Unable to raise taxes, and having cut financing for police,
prosecutors and schools, state officials turned to the Oregon Health
Plan. They ordered the board that governs the plan to decide how and
where to cut. It chose to revert to more basic coverage, stop paying
for many prescription drugs and charge higher premiums and
co-payments.

Dr. Patricia Kullberg, medical director of the health department of
Multnomah County, which covers Portland, said she just did something
she had never done in 21 years as a family physician: she advised a
patient which medications he could stop taking and suffer the least.
The patient lost his prescription drug benefit for arthritis,
depression, high cholesterol and hypertension.

"I feel like I'm living in some foreign country where suffering is
routine," she said. "It's scary. What we're doing is condemning people
to the long-term consequences of their diseases."

The hardest hit, say state officials, are the mentally ill. Jim
Underwood, a mental health specialist with Cascadia Behavioral
Healthcare in Portland, said his patient Robert Seaman, 47, a paranoid
schizophrenic, was likely to become delusional again without his
medications.

Mr. Seaman had trouble responding to questions in an interview.
"Without his meds, he has trouble with getting food, shopping, all the
basic survival things," Mr. Underwood said.

The legislature is working this week on a temporary patch. The
proposal would take video poker and cigarette tax money and drain a
reserve fund to make up an immediate shortfall of $250 million. If
this passes, and it appears it will, it would restore medications for
only about two months.

Mary Ellen Glynn, a spokeswoman for Gov. Ted Kulongoski, a Democrat,
said the next two-year budget could be even worse, because voters
refuse to raise taxes. "We're in real double-bind," she said.

Advocates for the mentally ill put the issue more starkly.

David Eisen, clinical director for Central City Concern, a private
nonprofit agency that provides care for drug addicts and the mentally
ill, said people whose basic medical needs were met by prescription
drugs costing the state about $90 a month per person, were now going
to start showing up in hospital emergency rooms, or jail, where they
will cost the state far more.

"The people who made this decision thought they could save a few
million dollars," Mr. Eisen said. "But the crime rate will rise,
emergency rooms will be flooded with people, and in the end, the state
is going to pay five to eight times more than they would have saved."

In most states, the federal Medicaid program covers the basic medical
needs of the poor. Oregon was given a waiver to shape its own program
because it promised to provide near-universal coverage for the poor,
something only a handful of states have tried to do. In good times,
the plan worked, and it was widely praised as a resourceful use of
limited public funds for health care.

One measure of its success was that Oregon has one of the lowest
percentages of mentally ill people in institutions. Prescriptions and
mental health clinics have allowed people to work, or live in
community settings, without presenting a danger to themselves or
others, state health officials say.

Critics of the plan, however, said it was allowed to grow too fast,
and even though Oregon rationed out services - drawing up a list of
what would be covered and what would not - it still proved too
generous. State Representative Jackie Winters, a Republican, said that
over the last 20 years, social services in the state have quadrupled,
far in excess of population growth.

"We expanded beyond the basics, and now we realize you can't cover
everything you want," Ms. Winters said.

Now a number of legislative committees are studying ways to redo the
Oregon Health Plan. Even if state revenues become less anemic, the
plan is unlikely ever to be as ambitious or far-reaching as it was,
supporters and opponents say.

And for now, the cutbacks mean that most people who were given
coverage have lost their prescription drugs. Some are now wandering
the streets or screaming in public squares.

About one-fourth of the 400,000 people covered by the Oregon Health
Plan lost prescription coverage in two rounds of cuts over the last
month and half.

Tony Tescara, 66, who lives on $630 in Social Security, relies on
heart medication from the state. When he heard we was cut off - after
his pharmacists refused to fill a prescription - he says he panicked.

"It was a big shock," Mr. Tescara said. "I took extra nitro pills,
just worrying about this medical thing. I called my caseworker and
said, `What am I supposed to do now?' She said call the doctor and ask
for samples."

Mr. Tescara said he was ashamed to beg for medicine. "I feel like I'm
a lowlife looking for handouts," he said. "I'm not. It's the first
time in my life I have to ask for help."

State officials say relying on free samples, which thousands of
Oregonians are doing this week to get their medications, will help
only the luckiest.