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Jesus wasn’t the only one who has ever had just a few loaves and fishes to feed a throng. This year, every director of a state agency in Missouri knows how it feels to try to do almost as much as ever with only fives loaves and two fishes. That was the message from the panelists at the Missouri Budget Forum last Friday, sponsored by the Nonprofit Services Center and moderated by Dr. James Kimmel. Ron Levy, head of the Department of Social Services, the largest department in the state, with a budget of $8 billion, showed a slide depicting the fact that until 2002, the state had not, in more than a quarter of a century, experienced a drop in revenue. ’02 and ’03 were bad years, but the drop in revenue in ’09 rivaled the drops of those two years put together.

Rep. Rachel Storch, D-St. Louis, serves on the House Budget Committee. She smiled ruefully that there’s a difference between playing the hand you’re dealt and fretting that the economic structure is a house of cards. Perhaps Storch would feel more upbeat if Missouri were like Oregon, which is one of nine states to raise taxes on the wealthy this year. Right. When hell freezes over. Meantime, some revenue enhancement ideas being seriously considered are: levying an internet sales tax and raising cigarette taxes. One of the Carolinas is about to do the latter, and when it does, Missouri will have the lowest cigarette tax in the country.

The funding issue that will drive the budget this year, Storch says, is that the public school foundation formula is going to require an additional $87 million. Nixon has found $18 million of that. Where the other $59 million will come from, nobody knows.

And looking beyond this year, when we at least have stimulus funds to cushion the blow, the picture is bleak. We could be facing a one billion dollar shortfall in FY 2011.

Even with the stimulus funds, Margaret Donnelly, Director of Health and Senior Services, pointed out that she had to pare 130 jobs–despite the fact, for example, that senior abuse and neglect hotline calls were up 9 percent last year. And those calls have to be answered. She had high praise for Governor Nixon in this tough economic environment:

“I had the opportunity in the transition of the two months last year before he took office–because I had served in (inaudible) and budget–I worked on the transition team with him on the budget. He really understands all of this. And, as I said, he’s been very respectful of the mission of the department and what we need to do. He’s just not faced with any good choices.”

Despite the tough economic times, Donnelly could point with pride to several achievements.

Ron Levy, describing the activity at the Department of Social Services, said they have been preparing plans for implementing federal health care, if and when Congress ever passes it. They have also been planning how to create electronic health records. And finally, it is crucial for his department, which administers Medicaid, to better manage health care delivery–as a means of paring costs as the Medicaid rolls burgeon. In January of last year, there were 820,000 people on the list. Now there are 880,000. By the end of this year, he expects to see 900,000, and by the end of next year, 950,000 to a million. Even as we look at a possible one billion dollar shortfall in the state budget in 2011, the growth of Medicaid rolls is inexorable.

It’s enough to remind me of Dr. James Kimmel’s jest about health care costs.

We’re going to need a dark sense of humor to weather the next few years.