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Human services in the Age of Austerity

Clients and welfare workers from the state’s human services system will discuss attacks on public services coming under the guise of austerity — including a privatization contract that an artbitrator recently ordered shut down — at a public meeting Monday.

The Alliance for Community Services is sponsoring the meeting on health care and human services at 6:30 p.m, Monday, July 8, at Teamster City, 300 S. Ashland.

Ralph Martire of the Center for Tax and Budget Accountability will discuss the state’s fiscal crisis.

“The reality is, we’re not broke,” said Fran Tobin of Northside Action For Justice, one of the initiators of the alliance.  “There’s lots of wealth in the state, but our regressive revenue system is failing to tap into it.”

Human service clients and welfare workers will tell stories of difficulties caused by a chronically understaffed system, said Steve Edwards, a retired union activist.

One source of problems is a new DHS pilot program — poised for expansion — that shifts from case-based to task-based organization of office work.  Under the program, caseworkers have been shifted to “teams” devoted to specific tasks.

“You have former caseworkers — who have college degrees in specific fields and a year of additional training — spending all day opening mail,” he said.  Everyone’s work goes into a single pile, with no one responsible for the ultimate disposition of particular cases.  It means clients no longer have a caseworker who they can call to address problems.

“They’ve blown up accountability,” Edwards said.  “It looks to me like sabotage.”

“Under the rhetoric of increasing efficiency, they’re clearly making things worse,” Tobin said.  “It’s insane.”

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Barriers to health care for people with disabilities

People with disabilities face an array of obstacles to getting health care, and budget cuts and market-oriented “reform” of Medicaid could be making things worse.

Results from a participatory research study of the health care experiences of Medicaid beneficiaries with disabilities will be presented at a town hall meeting Thursday afternoon, with health care consumers and providers commenting on their experiences and possible solutions.

The town hall takes place Thursday, June 27, at 1:30 p.m., at Access Living, 115 West Chicago Avenue.  The study was conducted by Access Living’s health policy team and UIC’s Department of Occupational Therapy.

Relatively simple problems, like access to clinics and exam tables for people who use wheelchairs, can lead to significant gaps in care, said Marilyn Martin, policy analyst at Access Living.

Many are examined in their wheelchairs instead of on exam tables, though that’s not considered an acceptable practice, she said.  As a result, pap smears and prostate exams are often not given to people in wheelchairs.

With mammogram units that aren’t accessible for mobility-impaired patients, many people go years without cancer-detection exams — and mortality rates for breast and cervical cancer are significantly higher for people with physical disabilities, Martin said.

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Stroger staff oppose pediatric cuts

County Hospital staff say administration proposals to limit pediatric admissions are “unnecessary and shortsighted” — and come at a cost of millions of dollars in revenues, potentially threatening the long-term viability of of the county’s entire health system.

Staff from Stroger Hospitals Neonatal Intensive Care Unit will speak at the Cook County Health and Hospital System board meeting Friday morning (April 26, 8 a.m., 1900 W. Polk) and will be available for the media shortly after the public comment portion of the meeting ends at 8:15.

They say that earlier this month, administrators told senior staff that patients should be turned away after 17 beds are full — the number was raised to 24 after an impromptu meeting with county health system chief Ram Raju last week, I’m told — due to “patient safety” concerns.

The unit has 54 beds and an average daily census of 29, and the safety issue is unfounded, staff say. Patient outcomes meet all standards, and the unit’s 1-to-3 or less nurse-to-patient ratio is in line with other hospitals — and much better than staffing levels in Stroger’s adult medicine and surgery wards, which far exceed staffing norms, according to a release from NICU advocates.

And in a health system desperate for revenue to fund care for the uninsured, the unit — all of whose patients are covered by Medicaid — generates betweeen $10 million and $14 million a year.

Advocates say they worry that the administration is “manufacturing a financial crisis” that could threaten the entire system county health system, which could provide a pretext for selling off the system.

Patients ‘disappeared’ in mental health closings

Last year’s closing of six of the city’s twelve mental health clinics – for a reported savings of just $3 million – was “characterized by poor planning, mismanagement, inaccurate information, and profound insensitivity to clients,” according to a new report from the Mental Health Movement and AFSCME Council 31.

That meant a rocky transition for many clients, while the Chicago Department of Public Health seems to have lost track of as many as two thousand clients whose transition it had pledged to monitor.

According to the report, “Abandoning the Most Vulnerable,” the city listed 5,337 clients in October 2011 when the clinic closings were announced, but its report on the transition this July gave the total as 2,798.

Asked about this, the city told researchers that a March review found only 3,282 “active” cases.  The difference includes clients who weren’t currently seeing a therapist but expected to be able to if necessary – and in any case, between March and July, nearly 500 clients “disappeared” entirely, according to the report.

One problem was that therapists who were being transferred from closing clinics weren’t informed of their new assignments until the very last minute, making it impossible to keep their clients in the loop, said Jo Patton of AFSCME.

The failure to monitor all the city’s clients “represents a signficant lapse at the top echelons” of CDPH, while “the attempt to cover up that failure by simply revising the total number of clients raises serious ethical concerns,” the report charges.

No comprehensive effort

“There was not a comprehensive effort to reach each client and provide them with the information they needed to continue to receive services,” according to the report.

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Warning on Social Security, Medicare cuts

Seniors, people with disabilities, and the poor shouldn’t be pushed over a “fiscal cliff” manufactured by politicians.

That’s the message of a coalition of senior, disability, community and labor organizations that is hosting an accountability sessions with local members of Congress, Tuesday, October 30, 4 p.m., at the Chicago Temple, 77 W. Washington.

Representatives Danny Davis and Jan Schakowsky have confirmed their attendance, and others are expected, said Gary Arnold of Access Living.

Sponsors of the event include Access Living, Illinois Alliance of Retired Americans, IIRON, Jane Addams Senior Caucus, Jobs With Justice, and the Lakeview Action Coalition.

They’ll ask legislators to oppose cuts to Social Security, Medicare, and Medicaid in any resolution of the impasse over the debt ceiling to be considered in Congress after the November 6 election.

Neither Democratic nor Republican proposals – nor automatic cuts set to go into effect if no deal is reached – are good options, said Tom Wilson of Access Living.

Democrats would reach deficit reduction goals with a mix of heavy budget cuts and increased taxes on the wealthy; Republicans have proposed only spending cuts.  A “sequestration” plan if no deal is reached would involve 8 percent across-the-board cuts in domestic and military spending.

“Any of the solutions they’re talking about would drive us right back into recession, throw a lot of people out of work, and send the economy into a downward spiral,” said Wilson.

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Sheriff Dart to speak on impact of clinic closings

Sheriff Tom Dart’s warning last year that closing the city’s mental health clinics would add to the burden of the Cook County Jail is coming true, according to the Mental Health Movement.

Joined by mental health professionals and consumers, Dart will discuss the impact of the clinic closings on the jail — including people who could avoid incarceration if they had access to mental health services — at a forum on Wednesday, September 5, at 6:30 p.m. at Episcopal Church Nuestra Senora, 2610 N. Francisco.

Dart will be joined by Crystal Colon of Iraq Veterans Against the War and psychologist Rebecca Paz-Ford of Lurie Children’s Hospital and Northwestern University.  According to MHM, psychiatric hospitalizations doubled in April, after half of the city’s clinics were closed.

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In Springfield, no solutions

Sad to say, nothing they’re doing or talking about in the General Assembly will have a significant impact on the state’s chronic budget crisis.

Not draconian Medicaid cuts, not possible pension cuts or casino expansions.  The legislature is barking up the wrong trees, and doing it over and over.

That’s because the state doesn’t have a spending problem.  In real terms, Illinois has been steadily cutting spending on education, human services, health care, and public safety for the past decade.  Medicaid is not the problem: general revenue funds going to Medicaid are down over the past five years.

According to Ron Baiman of the Center for Tax and Budget Accountability, Illinois is one of the nation’s wealthier states, looking at the state’s gross domestic product per capita.  But it has been one of the nation’s lowest-spending states, looking at state spending as a percentage of GDP.

So the problem isn’t overspending, and cutting doesn’t get us closer to a solution. The problem is a regressive tax system that doesn’t tax where the money is.

Regressive

Illinois has one of the most regressive tax structures in the nation.  As noted here last year, the bottom 20 percent of households pays twice as much of their income in state and local taxes as the top 20 percent does.

Even the flat income tax is regressive, since it imports all the federal tax code’s loopholes; of the current nominal rate of 5 percent, households earning over $1 million a year pay an effective tax rate of just 2.1 percent – the same as households earning over $10,000.  The squeeze is on the middle.

And especially with the surge of income inequality in recent decades, that means the state asks more and more from people who are doing less and less well, and fails to capture the gains of economic growth, which are increasingly found at the top.

It can’t go on forever.  At some point Illinois leaders are going to realize there’s no alternative to a progressive income tax.  The constitution, which mandates a flat tax, will have to be amended.

All our neighboring states have progressive systems – and that’s the reason their budget problems are so much less than ours.  If we took Iowa’s income tax rates and applied them to Illinois’s tax base, we’d raise $6 billion more a year – and 54 percent of taxpayers would get a tax cut averaging 24 percent, according to CTBA.  If we took Wisconsin’s we’d raise $3.6 billion more a year and cut taxes for more than half our residents.

Tax cut

The Illinois constitutional amendment will have a straightforward appeal: nearly all taxpayers’ rates will go down.

CTBA has fashioned a proposal for a progressive tax system for Illinois that raises an additional $2.4 billion yearly (even after allowing for increased tax avoidance by wealthy taxpayers) and reduces the tax rate for 94 percent of taxpayers.

Everyone earning under $150,000 would get a tax cut.  Starting to sound good?

It’s not even very tough on the wealthy; CTBA figures the effective tax rate (after deductions, credits and offsets) would top out at 6.3 percent for those earning over a half million a year.

There’s other money the legislature is leaving on the table, as it cuts public services to the bone.  A restructuring of the corporate income tax in 2001 – an unsuccessful attempt to encourage job growth — means most Illinois corporations pay no income taxes.

And an antiquated sales tax which applies to goods but not services – so if you buy a lawnmower and gas to mow your own lawn, you pay a sales tax, but if you hire a lawn service you don’t – costs the state between $500 million and $1 billion a year.

Corporate welfare

Then there’s corporate welfare – an area in which Illinois is a leader.  The Responsible Budget Coalition identified six corporate tax loopholes which don’t make economic sense — and where Illinois departs from federal policies and practices in other states — costing Illinois nearly $700 million a year.

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Mental health closures causing hospitalizations

With four more mental health centers slated for closing Monday, clinic users and supporters will seek a “pardon” from President Obama tomorrow – and highlight psychiatric hospitalizations that have resulted from the closure of two clinics earlier this month.

The Mental Health Movement will march on Obama’s campaign headquarters, 130 E. Randolph, at 11 a.m., Monday, April 30, to ask for “presidential pardon” for the condemned clinics – and for the clinic users they say will die as a result of the closures.

At 5:15 p.m. on Monday, therapists from the city clinics joined by health advocate Quentin Young will hold a press conference outside the mayor’s office in City Hall to discuss the impact of the closures.

One immediate outcome has been a surge of psychiatric hospitalizations for clients of two clinics closed earlier this month.  MHM knows of 18 such hospitalizations, said organizer Matt Ginsburg-Jaeckle.

One client – who was hospitalized after attempting suicide when she lost her long-time therapist – has been released and is telling her story for a video that MHM will be releasing, Ginsburg-Jaeckle said.

The cost of such hospitalizations (averaging $13,000 each) will eat up any taxpayers savings from clinic closings, according to an MHM report issued earlier this year.

Other issues highlighted in the report include the firing of all bilingual therapists at a time when immigrant communities increasingly need mental health services; the closure of four clinics in South Side communities that have a critical shortage of mental health services; and the diminished capacity of nonprofit providers that are supposed to take up the slack.

MHM members and supporters have been occupying the lot across from the Woodlawn Mental Health Center, 63rd and Woodlawn, since 23 were arrested at a sit-in at the clinic on April 12.  The Woodlawn center is slated for closure Monday.



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