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Semi-solid ground

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The setting: The legislative office building in Raleigh last week, where state House members are debating an alternative to Gov. Jim Hunt's proposed $13 billion budget. Outside the chunky edifice, the air is filmy and hot. Inside the packed committee room, the atmosphere is cool--until the talk turns to cuts in spending on the state's Medicaid health-care program for the poor.

The characters: The leads are state Rep. David Redwine (D-Brunswick), co-chair of the House appropriations committee; members Lanier Cansler (D-Buncombe) and Theresa Esposito (R-Forsyth); and Dick Perusi, head of the state Division of Medical Assistance. Extras include numerous advocates for health care, environmental and education groups who have come to see whether their programs will fare any better in the legislature's spending plan than they did in the governor's budget. (Business lobbyists are present as well, but they don't seem as worried, since the vast majority of proposed spending reductions come from programs aimed at low-income citizens.)

As the scene opens, committee members have just received late-breaking word from state budget officials that the Medicaid program could be short by as much as $20 million next year because of unanticipated costs. Despite this information, House budget negotiators are backing the governor's spending cuts. From one side of the room, Cansler raises his hand to be heard.

Cansler: "These Medicaid reductions are a concern to me. We've been trying to raise the reimbursement rates for dentists [who serve Medicaid patients] and do some other things in mental health. The problem is, we are going to run short of state funds by at least $20 million. Why aren't we making any effort to deal with that in this budget?"

Redwine: "If they [state budget officials] say they can cover it, I'd say we're on semi-solid ground."

Cansler (persisting): "What we've managed to do over the last few years is reduce Medicaid by $200 million. The flexibility in the program is gone. We're putting ourselves on track for a major budget problem and there's nowhere else in this budget we can go to get the money [for increased Medicaid needs]."

Esposito (to Redwine): "Did you just say we could look elsewhere in this budget for these funds?"

Redwine (politely): "No. But we'd be glad to listen to any ideas on that. We encourage bright ideas and thinking outside the box."

Esposito (turning to Perusi): "Are you saying you feel comfortable that your department will have the money to meet its next payments?"

Perusi: "We may be looking at a budget deficit. ... It could range from $8 million to $20 million."

Esposito: "I want you to say that to me again, loud and clear."

(Perusi repeats himself.)

Esposito: "I think we just made our case."

Redwine (not so politely): "I didn't know we were in court."

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