LAST WEEK, you couldn’t pick up a newspaper without seeing at least one article lamenting the plight of yet another critical, lifesaving program that did not survive the Beacon Hill chopping block. On January 30, Governor Mitt Romney implemented $343 million in emergency spending cuts — cuts that have hit health- and human-services programs particularly hard — to help cover an estimated $650 million shortfall this fiscal year. But while many eyes remain focused on the current budget, advocates and recipients of government-funded health and human services are turning their attention to the budget woes that lie ahead.

That was obvious at a packed, chaotic hearing on the fiscal year (FY) 2004 budget held by Romney administrators at the State House last Thursday, February 6. By 9:30 a.m., just 30 minutes into the daylong event, more than 300 advocates and aid recipients had poured into the Gardner Auditorium to voice their concerns about the harm wreaked upon health and human services since the fiscal crisis surfaced in 2001. The crowd was diverse, a mix of the state’s most vulnerable populations: teen mothers, the blind and deaf, the mentally ill and mentally retarded, and residents suffering from HIV/AIDS.

For seven hours, they addressed high-level officials of the Executive Office of Health and Human Services (EOHHS), which oversees the 15 departments that care for the state’s neediest citizens. One elderly man invoked the governor’s "share the pain" rhetoric on the latest round of budget cuts. "But why is it that most of the pain was felt by the most vulnerable among us?" he demanded. Minutes later, a middle-aged man, who wore dark, square-framed sunglasses and used a white cane to navigate, wondered how the Commonwealth "always seems to find the money" to cover cost overruns for the Big Dig. "Why is it," he asked, "the state cannot find the money needed to keep these human-services agencies operating?"

Such questions, of course, were rhetorical. The budget numbers speak for themselves. To date, health and human services have absorbed $1 billion of the $2 billion cut made thus far to balance the state’s $23 billion budget. But advocates wanted to make one thing clear: these programs can’t take any more reductions and still deliver services.

Outside the Gardner Auditorium, awaiting her chance to testify before the EOHHS officials, Marcia Hams, a deputy director for the Boston-based advocacy group Health Care For All, summed up the sentiment best: "Since taking office, Romney has been aggressive in his actions against health and human services. Advocates are here to say to the administration, ‘Enough is enough.’"

LAST WEEK’S EOHHS hearing attracted an unusually large turnout for an administrative event. It brought out policy wonks and lobbyists, many of whom are following the governor’s budget more closely than in previous years. During the last three Republican administrations, legislative leaders dominated the budget-writing process; nobody took the governor’s budget, known as "House 1," very seriously. State House observers used to quip that what former governors Paul Cellucci and Jane Swift proposed, the legislature disposed. This time, though, Romney has put people on alert. The first budget for any new governor receives scrutiny, yet this governor also boasts something that his predecessors did not: a mandate. As Michael Widmer, of the Boston-based Massachusetts Taxpayers Foundation (MTF), explains, "Voters have said, ‘Fix state government.’ But the reality is that one can reorganize government, and it doesn’t begin to address" a projected FY ’04 budget deficit that may approach $3 billion.

Aside from the usual suspects, the EOHHS hearing brought out scores of Massachusetts residents who are newcomers to Beacon Hill. Most of them turned out to say that, contrary to what Romney and his top aides might have you believe, they are hurting from the barrage of spending reductions to social services. Attendees included people like 46-year-old Diane Kucher of Bedford, who suffers from chronic diabetes. Kucher is one of the 50,000 residents statewide slated to lose health insurance on April 1 because of cuts to Medicaid (also known as MassHealth), the joint state-federal health-care program for the poor. Though the move was instituted by the Swift administration, Romney has done nothing to reverse the restrictions in service. Indeed, in his attempts to balance the budget, he hammered away at the Medicaid program further by slashing an additional $75 million. Kucher’s medications cost approximately $240 a month — a price that she can’t afford now that her unemployment benefits have dried up. "I don’t know how I’m going to survive," she says.

That so many people like Kucher showed up at the State House last week was, no doubt, a victory for human-services advocates. Given the turnout, no one can deny that recipients care about what’s happened to the programs on which they depend. Yet for all the pain and misery on display, the EOHHS hearing amounted to something of a dog-and-pony show. Testimony isn’t likely to sway the Romney administration from putting forward a FY ’04 budget that relies on spending reductions and consolidations. The budget process is in full swing. Administrators have submitted their funding requests for next fiscal year. And Romney’s budget chief, Eric Kriss, has handed down an as-yet-unreleased target figure for the EOHHS budget. While testimony may influence EOHHS secretary Ronald Preston in deciding which programs to spare and which to slash, it isn’t likely to affect the big picture. As Steve Collins, who directs the Massachusetts Human Services Coalition (MHSC), says, "I doubt officials will go to Romney and say, ‘We’ve heard about all these terrible needs, and we need more money.’" Put another way, officials will find a way to live within the bottom line.

For advocates, the way Romney handled the FY ’03 shortfall signals what he could do in FY ’04. He wiped out teen-parenting programs for poor mothers who’re more vulnerable to the ills of child abuse, teen pregnancy, and illiteracy than their middle-class counterparts are. And he eliminated employment services for welfare recipients who must find decent-paying jobs as required by welfare reform. (In an unusual move, Romney had cut funding for psychiatric day treatment for mentally ill patients who, as a result, would have had no one to monitor their precarious conditions, and then restored funding. Over the weekend, Preston admitted that eliminating the day-treatment program had been "a mistake," and reinstated it for FY ’03, which ends June 30.) Allison Staton, of Health Care For All, says that Romney’s moves "show that he doesn’t get the fundamental purpose of these programs" for poor, vulnerable, and disabled families. She adds, "He has a different attitude than his predecessors. It appears his administration is looking at health and human services as if it were a big business."

Indeed. Romney has pledged to "fix" state government. And theories abound about the anticipated EOHHS overhaul. Last December, Charles Baker, who’s advising the governor on health matters, put forward a proposal that would consolidate the 15 agencies making up the EOHHS into seven new divisions organized by administrative function, as opposed to clientele. Another proposal, put forward by Romney during the 2002 gubernatorial campaign, would merge the 15 agencies into three super-size bureaus that would focus on health care, family and child-welfare services, and disabilities. At the February 6 hearing, Preston hinted that the administration would reorganize EOHHS as part of its House 1 proposal, although he offered few details. In any event, advocates fear that the word "consolidation" will become code for "elimination of services." Even fiscal watchdogs believe that the EOHHS reorganization cannot produce real results. According to Widmer, it’s not "realistic" for Romney to claim huge savings from restructuring. "The state has already cut deeply into services," he says, "so administrative efficiencies will be few and far between."

Taken together, all these factors spell disaster for health and human services. Geoff Wilkinson, who heads the Massachusetts Public Health Association (MPHA) in Jamaica Plain, has had high-level meetings with Preston and other EOHHS officials, all of whom have warned him and his colleagues to prepare for a big blow. "The message was clear to prepare for fiscal 2004 cuts that will make the 9C cuts [cuts to health and human services] seem gentle," Wilkinson says. In a moment of disarming candor, he adds, "I don’t think many human-services advocates are prepared for what the Romney administration is about to announce. I fear it’ll be an intolerable amount of pain."

IN MANY WAYS, the EOHHS hearing marks the first skirmish in what’s sure to be a lengthy battle over the FY ’04 budget. The next milestone comes on February 26, when the Romney administration will release its House 1 proposal. Even if it delivers a budget that guts health and human services, the fight won’t end there. It’s doubtful that legislators will rubber stamp the governor’s plan — indeed, if the debate over the current budget is any indication, lawmakers could toss it out altogether. Last week, House members ignored most of the controversial cost-cutting measures Romney had asked them to approve to close the FY ’03 deficit by $143 million. Instead, they tapped $150 million in reserve funds to cover the shortfall. The Senate, which begins considering the Romney measures this week, is also expected to reject those measures that limit Medicaid.

Some State House observers believe that the legislature will hold the line on deep reductions in health and human services. Advocates note that one of the more powerful constituencies on Beacon Hill — senior citizens — is suffering from the latest hits to Medicaid. Not only that, but Romney struck a blow to seniors when he eliminated $10 million from Prescription Advantage, a prescription-drug program for the elderly and disabled. Certainly, some lawmakers will lead the charge to protect health and human services. State Representative Kay Khan (D-Newton), who sits on the legislative committee for human services and who testified at the EOHHS hearing, plans to push her House colleagues to consider the implications of further cuts. "Legislators have to think about priorities," she says. "Are there other things we could cut that won’t be as devastating to vulnerable populations? I think so." Khan, for instance, suggests postponing major road and construction projects, as well as finding cost-saving measures in other sectors of the budget, such as corrections.

Still, it’s hard to say whether the legislature will broach the revenue issue — and thus avoid more painful cuts to social services. Right now, the administration and the legislative leadership seem to be vying over who will relent first. Romney looks to be holding out for lawmakers to make a move (see "Finneran: Is He Off His Game?", page one). Then, naturally, he could blame any attempt to pass new revenues on tax-and-spend Democrats. But lawmakers aren’t necessarily going to act unless they feel it’s politically safe — and the narrow defeat of the 2002 ballot question that would have eliminated the income tax suggests otherwise. "In some ways, it comes down to who will jump first," Khan observes. "My sense is we’re in for some troublesome times."

Kristen Lombardi can be reached at klombardi[a]phx.com