Fiscal Cutoff

apps committee in actionState legislatures typically meet for a relatively short period of time each year and consequently are very deadline driven. Congress works on things until they are ready to be brought forward, but in most states (including Washington) the dates are relentless and serve to help the body focus on what is likely to get done this session and what is not.

Friday, Feb. 27 was our first fiscal cutoff – the date by which all bills that spend money have to pass out of a fiscal committee or they die. Like deaths in bad movies, sometimes dead bills come back to life and wander around like zombies, but most of the bills that didn’t pass out of the Appropriations committee are dead for real. The one big exception is bills that either raise money or cause a deep structural revision in how we fund things. These are Necessary to Implement the Budget, or NTIB. This is a coveted status as it means you are exempt from cutoff dates.

Over 200 bills were referred to Appropriations, and only 91 passed out before we adjourned at about 10 p.m. on Friday. This year, given our budget concerns, we were pretty brutal on spending proposals. Lots of interesting ideas either had “null and void” clauses, or had most of the spending ripped out before we passed the bill. (A “null and void” clause means that if the bill isn’t specifically funded in the budget, it’s as if the bill didn’t pass, and it never gets published in the law books. These allow us to continue to work on bills until we make funding decisions in the budget.)

Many bills this year proposed grant programs. These ranged from tens of thousands up to tens of millions. In almost all cases we removed these from the bills, as we can fund grant programs in the budget without putting them permanently into statute.

The budget this year is going to need to focus on a handful of priorities:

  1. Funding “basic education” so that we comply with the constitution as per the Supreme Court’s McCleary decision.
  2. Fixing our mental health system to respond to the emergency room boarding decision from last year and the upcoming “Trueblood” decision that will require us to take action more quickly on forensic cases where the suspect is waiting for an evaluation or treatment in a jail cell.

There are lots of other things we are going to need to do (like early learning, higher education, adequate rates for the facilities housing our low-income senior and disabled populations, etc.) but these two are the top of the list. Large requested increases in funding in other areas are going to be very difficult to do, and my committee avoided most spending increases. We did pass out a number of expensive mental health bills that are going to need to be more carefully organized. The bills come from two different committees and the ideas in them overlap. You will see more work on this in the next two weeks.

One big issue we addressed was the idea of creating a new medical school at Washington State University (HB 1559). The bill was quite contentious. The basic pitch from the proponents of the new medical school is that we need to create more doctors willing to serve in rural Washington. This is indisputably true – the question is how, and at what cost?

First, the biggest determinant of where doctors will actually practice is where their residency is located. Most residencies in Washington are currently west of the mountains, and there are not enough to support all the medical school graduates we have today, let alone new ones. To get new residents in Eastern Washington will require subsidies and complicated work to maximize federal reimbursement.

The next largest determinant of where a new doc will set up shop is the offer of loan repayment assistance. Our state has a program that helps new docs with loan repayment if they practice in a rural or otherwise underserved area. It has been suspended for the past four years of the recession, but I want to bring it back this year. It is not large enough to solve the problem and would need to be expanded, probably by at least twice as much.

We are currently training 40 first year and 20 second year medical school students through the University of Washington medical school in Spokane. This program costs about $5 million a year. Those students are part of a multi-state program set up by the late Sen. Warren Magnuson called the Washington, Wyoming, Alaska, Montana and Idaho Collaboration, or WWAMI. Unless we are going to shrink the UW program (which would be a mistake, as it is the top rated family practice medical school in the country) we need to continue to operate the Spokane UW operation, and shift the money back from WSU to the UW.

I tried to amend HB 1559 to require the state to fund the following items before WSU could create a new medical school:

  • $16 million for new residencies
  • $8 million for loan repayment assistance
  • $9.8 million to reimburse the UW for the Spokane-based program
  • Whatever it actually costs to run a WSU med school (as opposed to just capital and start-up costs)

I did not have the votes to sustain the amendment and withdrew it. However, we should be very, very clear that just setting up a medical school in Eastern Washington won’t magically convince new doctors to reside there. There is much discussion that needs to happen before a decision on a WSU medical facility is made, and I welcome your thoughts.

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