Last week the House and Senate voted on two very different budgets. It would be most unusual if they did not differ in some ways. This year, however, there is a more than $600 million difference. If, as usual, each body votes against the other’s budget, we will begin discussing each line of the budget in which we are in conflict.

The biggest issues surround health care. The Senate looked and listened closely to the biggest concerns around the state. I wrote last week that the Senate budget focused on those most in need of help, as well as how to reduce the cost of health insurance that is destroying opportunities for small businesses and their families. The House looked at the opportunity to get federal “free” money. With that Washington money, they included two stipulations. The first is that if one is capable, they must work or attend school. As an example, one could enroll in community college, take a few classes or reduce their hours at work to gain access to free health care. The second stipulation is that if the federal money is reduced, the state could likewise cut off services to those they have added to the rolls of Medicaid. Clearly, easier believed than done.

With the new “Obamacare” money, the House scattered funds around state services, with only part of them going to serve the most in need among our citizens. They promised raises to teachers, sheriff’s deputies and state employees, all very much needed for their services to Virginia. Yet they only increased care by the minimum possible for those who are severely handicapped. The Senate proposed funding more than three times more on those most in need.

Others offered no new assistance. Consider the plight of home health care service. Their employees were frozen with no pay increase, but the companies that serve these folks were saddled with more expensive requirements to operate with no increased funding. This will put out of business some that serve this critical need for many fragile seniors. Some of their employees will decide that it is to their advantage to reduce their hours in order to receive free health care as well as other government support. Without the employees needed, the families of these clients will be left without the option to remain in their homes but rather be forced into nursing homes which will also drive up the federal and state share of Medicaid spending.

Every state that has expanded has seen Medicaid usage rise by more than 30 percent more than expected. Therefore, even if the 10 percent continues to be the state portion, the bottom line will be at least 30 percent higher than budgeted. This is one reason that Kentucky is experiencing budget problems.

Until we get a grip on Medicaid waste, we will simply aid those who misuse it. One example under the current system can best be understood by this: an over-the-counter medication that could be obtained for about $5 at the drugstore can be received for free with a prescription from a doctor. Under Medicaid requirements, one pays nothing to see the doctor and get that prescription. However, as a taxpayer, you will pay more than $100 for that visit to the doctor.

We must find a better way to help folks in real need if we are to avoid financial quicksand.

Frank Ruff represents Charlotte in the state Senate. His email address is Sen.Ruff@ verizon.net.