GRAYLING, MI/LANSING, MI – Budget negotiations are continuing this week at the state Capitol with the October first deadline just nine days away. Many Democrats are angry that Democratic House Speaker Andy Dillon has agreed to try to match the Senate Republicans' target of at least $1.2 billion dollars in spending cuts. The prospect of big cuts and little or no talk of raising revenue is also troubling to college students, schools, local governments, and nursing homes that care for the sick and the elderly.
Nursing home administrator Marilyn Heard counts on Medicaid payments from the state to make sure she has the staff to care for patients 24/7.
"We're looking right now at a lot of money going out the window that we need to operate efficiently," Heard says.
Here at the Grayling Nursing and Rehabilitation Community in northern Michigan, Medicaid pays the bills for more than half of the 72 patients.
Heard says people here are paying attention to what's happening down at the state capitol in Lansing.
"There's family members that come here that are concerned about whether they're going to have to take their loved one home, and they don't know how they can care for them," she says.
More than two-thirds of Medicaid funding goes to pay staff. So Heard says cuts would likely force her to lay off workers. She says that would mean slower responses to requesfor assistance. A beep signaling that a patient is seeking help is a near-constant presence here.
"If have to go to the restroom, you have to go now...you don't want to wait, so that's a dignity issue," Heard says. "If we had to cut back, I'm guessing anything might be the activity program. Then you get boredom and you get depressed people."
And she says that's a real hardship on elderly people. Depression can make them sicker, and even affect their will to live.
"In our facility, we have 13 people who are 90-plus years old. We have four people over 100 years old," Heard says.
"How many nursing homes in this state will actually be forced to close? How many of our community mental health agencies will be forced to close?"
Representative Gary McDowell chairs the House budget subcommittee that deals with Medicaid and other health care spending. And McDowell says he's not happy with the spending targets he's been handed by the House Democratic leadership.
"What's the contingency plan for these people when they no longer have a bed in a nursing home --can no longer get these services to treat their mental illnesses, and get their prescriptions?" McDowell asks. "And I need to have more than just a jail or an emergency room. I need to have a better alternative than that before I will agree to these numbers."
"People are going to work through this and some of these budgets are going to be very difficult to get done."
Speaker Andy Dillon says he knows a lot of Democrats -- in the House, in the Senate, even Governor Granholm - are upset by his strategy for negotiating with Senate Republicans. But he says big cuts to Medicaid, to local governments, to schools, and to the Michigan Promise college scholarship are not part of his end game.
"I want to do as best we can on these budgets, and if we have some shortfalls, whether we can find dollars from some other budgets, or from reduction, getting discounts from our vendors, and, if need be, if we need to find some revenues then we'll look at that," Dillon says.
Republican Senate Majority Leader Mike Bishop says increasing taxes would be a very tough sell in his chamber, and he'd like to stick to a plan of strictly cutting spending and using federal stimulus money to backfill the rest of a $2.8 billion dollar budget hole.
"They may or may not send tax increases over," Bishop says. "That's the prerogative of the House leadership. If they want to do it that's certainly within their right."
The legislative leaders have agreed they'd like to get a finalized budget to Governor Granholm by Friday. Granholm has not said definitively that she'd veto Senate-sized spending cuts, but she has signaled it is very possible. The Legislature is also making plans to send her a temporary continuation budget if there's no deal before the October 1 deadline.
Marilyn Heard - the nursing home administrator - says she's wondering how she'll pay for a new $100,000 ceiling sprinkler system that's required by a new federal rule if the governor and the Legislature cut her budget.
"It's very difficult when everybody is telling you what you gotta do, but taking away the money," Heard laughs.
Heard says other nursing homes have it even worse, and some will probably close if there are budget cuts.