Last week in the House Ways & Means Committee we held an emotional hearing about the serious ramifications of proposed budget cuts on small, critical care hospitals in primarily rural areas. From Sunnyside to Willapa, Dayton to Othello, the impact could be devastating given that Medicaid reimbursements could fall by half. The lost state dollars trigger losses in federal matching dollars as well putting many of these facilities in serious financial hardship.

Twenty nine Republican House members and three Democrats recently signed a letter to the Governor making the case why House Bill 2130 should be defeated. The bill, an essential piece of the state budget work in the Special Session, would eliminate Medicaid cost-based reimbursement to the state’s Critical Access Hospitals, a move that would severly impact rural communities. It would potentially reduce reimbursement from Olympia by more than $50 million but those cuts also trigger losses in federal matching dollars so the net hit is doubled.

The impassioned letter was signed by representatives of rural communities statewide. The somber anxiety on the faces of CEOs of these small hospitals was deeply moving. The fear that some these communities could lose their small hospitals is palpable.

Critical Access Hospitals have fewer than 25 inpatient beds, provide 24 hour emergency services, serve rural areas and are long distances from the next closest hospital. There are 38 such of these hospitals representing 40 percent of the total hospitals in the state and serving two-thirds of the area of the state, according to the letter.

And yet.

Once again–like levy equalization and other programs designed to mitigate the effects of rural and property-poor communities– the issue serves as a powerfully symbolic representation of the philosophical inconsistency of those who generically claim government spending is out of control while at the same time seeking funding for local priority projects.

While these legislators argue strenuously, valiantly and understandably against these cuts, some of them have also signed an anti-tax pledge to resist any and all new revenues under any circumstances regardless of the public value of public services. Many of them have made fierce political arguments that government spending is out of control in Olympia and dramatic even radical cuts must be made. Many of these signatory legislators make the case that health care costs for Medicaid–a central driver of the increasing costs in state government–are ‘out of control.’

And so we are faced, once again, with the philosophical inconsistency by which at the rhetorical political level government spending is eviscerated as irresponsible while at the tangible level it is seen as extremely valuable for the economic, social and educational survival of rural communities.

Critical Access Hospitals play a vital role in access to affordable health care. I strongly support them and hope we can find a source of revenue to continue such reimbursements. Ironically, the largest provider of Medicaid services in the state is Harborview, a Seattle-based regional treasure that many of these same legislators have no compunction to cut.

I have argued publicly for a courageously honest public conversation about how tax dollars flow, who pays and who benefit, and what type of state we wish to be. I do this not to arrogantly throw elbows against subsidies for rural communities but to challenge the anti-government, anti-tax, anti-public service rhetoric of those who pretend that such philosophical inconsistency is sustainable.

I do this to attempt to genuinely educate the public about the true cost of asking for disproportionately higher public spending in education, health care, transportation, capital budgets and so much more all the while sending legislators to Olympia who prioritize anti-tax pledges to Washington, D.C.-based anti-government organizations.

If, as some argue, we have a massive state budget deficit because spending from Olympia is out of control, we have that deficit in large because we can no longer sustain an unbalanced status quo by which only 6 primarily urban counties are ‘net contributor’ of taxes while 33 primarily rural are ‘net recipient’ counties.

Our rural communities are part of the soul of our state’s glorious history and residents deserve the same quality education and health care that urban communities receive. I am not troubled by the massively unbalanced subsidy of tax dollars from state government to rural areas, I am troubled by the disingenuous political arguments of those who pretend those subsidies don’t exist and prioritize anti-tax pledges above all else.

We are so much more than what we’ve become.

Your partner in service,

Reuven.