Audit raises questions about Prop 63 spending

by Brian Leubitz

So-called “ballot box budgeting” comes in waves. California voters tend to draw back from spending money in bad economic times, and will fund more programs in the heydays. 2004’s Prop 63 hit as we were clearly on the upswing after the 2001 recession. The real estate bubble was rapidly building, making everybody feel wealthy. And Prop 63 went for an undeniably good cause, protecting some of the most ignored in California, people with mental health issues.

As both president and governor, Ronald Reagan went about slashing money for social services, especially mental health. The results are written everyday on the streets of Los Angeles, San Francisco, and many other cities across the state and nation. Mental health institutions closed down, and the homeless population went up. California spent about $5 billion before the measure, but could certainly use the additional resources.

But after the measure went into place a number of things happened. As you can tell from the date, we are talking peak of the real estate bubble. Once the bubble burst, mental health spending got slashed from that $5b high. Although Prop 63 wasn’t intended to serve as backfill for cut dollars, it ended up serving those purposes.

Recently, the state auditor released a report on Prop 63 spending, which criticized the state for a lack of spending oversight on those funds. But the news that was getting all the headlines, perhaps because the auditor highlighted them because they sound juicy, were some of the more effective programs. Programs like yoga and gardening were shown to have good outcomes for the mentally ill and to have both therapeutic and preventative value.

On KQED’s Forum today, some of the original authors of that measure debated how the money has been spent. Much of the debate is a little technical, depending on how you define prevention and early treatment, etc. There can be questions of effectiveness, and clearly the state needs to do a better job of consolidating outcome data. But, the question of whether we need to make more substantive changes is still out there.

All that being said, mental health services are still underfunded, as most social services are in this state. But we can always do more to ensure that our dollars work as effectively as possible.

(Thanks for the update. – promoted by Brian Leubitz)

The California State Plan on Aging estimates the population of seniors, over 85 years of age, will increase 172% over the next 20 years.  The most recent draft of the plan finds that “California’s older adult population will increase by 90 percent as members of the Baby Boomer cohort reach 60.” The Plan outlines the major areas of concern for seniors in the next four years.

EDIT By BRIAN: See the flip for more on the Plan on Aging.

The first goal of this plan is to make it easier for older Californians and their caregivers to access local information about services and programs available in their communities. One step to achieving this goal is currently underway. CalCareNetwork is being developed to provide a single searchable web site of information about home, community based and institutional long-term services.

To “enable older Californians, adults with disabilities and their caregivers to be active and supported in their homes and communities” is another stated goal of the state plan. Transportation issues are a major barrier to independence in many communities. Of note in the report is the acknowledgement that transportation planners have not worked with members of human services agencies to integrate the needs of seniors and those with disabilities.  California now has representatives from the Department of Transportation on the California Olmstead Advisory Committee to address transportation concerns from both the individual need and infrastructure perspectives. The Department of Motor Vehicles is developing a Three-Tiered Driver Assessment program. The goal is to keep drivers safely on the road for as long as possible, however this assessment could lead to more adults relying on alternative transportation.

One of the most dramatic changes to the health of seniors has been in the last century is the shift in the causes of death from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. Californians may live many years with diseases that need to be managed to maintain health. Californians have increased their use of preventive health screenings however significant racial health disparities persist in the treatment of chronic health concerns.  Alzheimer’s disease and other forms of dementia continue to be a substantial concern for individuals and their families. The third goal of the state plan is to promote the health of seniors through increased participation in health  initiatives and expanding  the availability of programs for family caregivers.  Additionally the promotion of early intervention and treatment for mental health issues is a stated goal.

The final goal is to protect the rights of older Californians through the Long-Term Care Ombudsman Program and Health Insurance Advocacy and Counseling Program (HICAP).  Updates to these programs and tools to improve communication and recognize fraud are part of the state plan.

The State Plan on Aging is clear in its anticipated funding from the state, noting: “The Department considers increases in State funding unlikely even though the population of older adults and adults with disabilities will continue to increase.” Interestingly over three pages of the State Plan draft is dedicated to the “opportunities for volunteerism and civic engagement.” This is due to the fact that many services are provided within the Aging Network through volunteers. The California Department of Aging (CDA) notes it is difficult to recruit and retain volunteers. The CDA will work to encourage increased volunteerism among older adults for their peers and those with disabilities.

It is difficult to know how anyone program will be affected when the state budget is finalized. The concerns highlighted by this report necessitate planning for the increased needs of a rapidly growing population of seniors. Current fiscal concerns are leading to reduction in services as the leading edge of the baby boomers enters the period of greatest need to age well within their communities.

While the recruitment of volunteers is beneficial for these social programs it will not be a sufficient substitute for the dollars needed for transportation, care, and health concerns of the 14.6 million seniors expected to populate California in the coming decades.  

In 1998 California voters approved Proposition 10, taxing tobacco sales to pay for educational and health care programs for children under age 5 whose families are otherwise unable to afford those services (the First Five program). And in 2004 voters approved Proposition 63, levying a 1% surcharge on incomes over $1 million to finally reverse decades of deliberate underfunding of mental health services. These programs have been VERY successful and both programs have stable long-term funding.

Only in the twisted logic of the May 19 special election could that be seen as a bad thing.

Propositions 1D and 1E on the May 19 ballot are raids on the Prop 10 and Prop 63 programs, respectively. As the LA Times explained in their article on the propositions today:

The early childhood and mental health programs became prime targets for budget negotiators working to solve the state’s $42-billion deficit. They were sporting a budget surplus of about $2.5 billion each at a time when health and welfare programs funded the old-fashioned way — through the state’s general fund appropriations — were being stripped.

Backers say those surpluses were a fiscal mirage, because the money had been committed to future programs or was being saved for tough times.

Let’s be clear here – because Props 10 and 63 were a successful method of creating important programs and paying for them, they are now seen as viable targets for attack. The LA Times goes further and uses this as an occasion to criticize ballot box budgeting:

But the measures, Propositions 1D and 1E, also represent ballot-box budgeting coming back to haunt the California electorate.

Though they often complain that statehouse lawmakers spend like drunken sailors, the state’s voters have in recent decades repeatedly performed in much the same manner. Time and again they have approved propositions that critics say have combined to straitjacket the state’s budgetary process.

“The voters have been as responsible for this budget mess as anyone else,” said Larry Gerston, a San Jose State political science professor. “Election after election they have authorized money for this or that. And it ties the hands of the Legislature at budget time.”

I don’t buy this. True, I tend to reject the “ballot box budgeting is bad” argument generally speaking, but in particular it’s not appropriate for this situation. Especially when voters are being asked to do more ballot box budgeting. Voters haven’t “tied the legislature’s hands” by things like Prop 10 or Prop 63. What they’ve done is say “we like social programs, we like taxing people to pay for them, and since you have proved unwilling or unable to do it, we’ll do it instead.”

To criticize ballot box budgeting without explaining why it happens – because Prop 13 gutted the state’s ability to pay for core services and created the conservative veto through the 2/3 rule – is to miss the point almost entirely.

And it enables things like Props 1D and 1E, which seem designed to punish voters for having successfully funded important programs.

One-time program raids are not a solution to the budget mess anyway. Nothing the LA Times has included in this article does anything other than convince me a NO vote on Props 1D and 1E is the right move for our state.

The No on 1D/E Campaign, which recently merged, have released an internal poll (PDF) from Tulchin Research.  The data is consistent with a previous PPIC poll. Prop 1D (First 5) is slightly ahead 48-42, and Prop 1E (Mental health) is down 44-46. More spin details from the No campaign:

   *  A solid majority of voters describe the measures as “deceptive” (56%).

   * Nearly half of the voters are concerned they will “cut funding for children and the mentally ill” (45%).

   * There are nearly twice as many voters who strongly oppose Props 1D & 1E.

   * The voters most likely to cast a ballot are more likely to vote NO than less likely voters.

   * “Definite” voters reject Proposition 1E (42% Yes – 48% NO).

   * “Definite” voters split their opinion on Proposition 1D (46% Yes – 45% NO).

   * Nearly 1 in 5 voters (18%) believe that Props 1D & 1E hurt programs and services, particularly for children and the mentally ill.

   * 16% of voters describe the initiatives as “deceptive” or “dishonest.”

Either way, being below 50% at this point is just a really bad position. It is possible to make up some grouund with a ton of money, but the yes campaign will be swimming upstream from the general drift towards no.  In a low-turnout special election, that drift is likely to be more visible.

All I’m saying is that if I were on the “Budget Reform Now” campaign, I’d be getting pretty nervous right now.

The New York Times continues its coverage on shantytowns today, highlighting a Bushville in Fresno that has suddenly popped up.  First of all, given that Los Angeles County has 70,000 homeless people and that number has remained durable for quite some time, I welcome the national media to the issue about the homeless but don’t necessarily think that because this new class puts up tents (they do the same on LA’s Skid Row, BTW) that somehow it’s novel.  The recession clearly has exacerbated this problem and brought it to new areas in the state and the country, but that doesn’t mean homelessness didn’t exist before.

Second, our Governor is either America’s stupidest person or he thinks you are:

Gov. Arnold Schwarzenegger said Wednesday that he has teamed up with Sacramento Mayor Kevin Johnson to help the homeless and has lobbied the president to speed the flow of federal dollars to address the problem […]

U.S. Rep. Doris Matsui, D-Sacramento, in February announced that the city and county of Sacramento each are in line to receive $2.4 million in stimulus money to prevent homelessness.

The money will be managed by the city-county Sacramento Housing and Redevelopment Agency.

In addition, Proposition 63, the ballot measure voters approved in 2004 to provide mental health funding, will provide “a lot of help” for some of those living on the streets, the governor said.

That would be Prop. 63, the fund which the Governor and the legislature are trying to RAID through Prop. 1E, to the tune of $230 million a year diverted to other purposes.  You can debate the pluses and minuses of that, but promising Prop. 63 funds to fight homelessness at the same time as running a campaign to take Prop. 63 funds away is either cruel or clueless.

You decide.