Psychiatr News March 17, 2006
Volume 41, Number 6, page 6
© 2006 American Psychiatric Association
President Wants Budget Savings To Come From Health Programs
Rich Daly
President Bush's proposed Fiscal 2007 budget would cut a variety of
mental health programs, but election-year politics may help preserve many of
those programs.
Mental health programs would face a variety of cuts in President Bush's
proposed $2.77 trillion Fiscal 2007 budget, released last month. The proposed
budget would cut nondefense discretionary spending for the second straight
year and save about $15 billion by eliminating or significantly reducing 141
programs.
Large savings of $65.2 billion over five years would stem from cuts in the
growth of entitlement spending, including $35.9 billion in Medicare cuts over
five years and $12 billion from Medicaid over 10 years.
The cuts may prove difficult to sustain in an election year, especially
since Congress only recently cleared last year's hotly contested $39 billion
savings package, which was the first since 1997 to slice Medicare, Medicaid,
and several other entitlement programs (Psychiatric News, March 3).
Republican leaders of Congress said the $11 billion in savings from Medicare
and Medicaid in last year's package was not easy, and it may be too soon to
seek more cuts.
"We remain hopeful in the fact that this midcycle election year will
offer some protection to some health care programs because no one in an
election year wants to be accused of recommending federal funding cuts that
would hurt people who are poor or with disabilities," said Lizbet
Boroughs, deputy director of APA's Department of Government Relations
(DGR).
The proposed budget seeks $698 billion for the Department of Health and
Human Services (HHS), up from $677 billion in Fiscal 2006. Net Medicare costs
are expected to reach $387 billion in Fiscal 2007, but discretionary spending
would drop 4 percent, to $72.6 billion.
The Bush budget aims to slow the growth of Medicare through increased cost
sharing for high-income seniors and reduced payments for some providers,
including home health care agencies and hospitals. Much of that savings would
be eaten up by the president's $29 billion proposal to expand the use of
tax-free health savings accounts.
Medicaid Savings Sought
Medicaid funding would also be cut through changes to the formulas for drug
reimbursement and by increasing rebates from drug manufacturers.
Funding for the National Institutes of Health (NIH) for Fiscal 2007 would
be held to the Fiscal 2006 level, or $28.6 billion. Mental health advocates
consider this a reduction, when an expected 3.5 percent rise in biomedical
costs this year is considered.
"It gives us pause that we are backing away from what was for many
years a national will to increase our investment in biomedical and severe
illness research," said Andrew Sperling, director of legislative
advocacy at the National Alliance on Mental Illness (NAMI). "It is
unfortunate that we have to back away from that now."
The Substance Abuse and Mental Health Services Administration (SAMHSA)
would be cut by $70 million, largely by changes to the State Mental Health
Block Grant and State Substance Abuse Treatment Block Grant. The change would
mandate that states receiving the grants establish a voucher system to
reimburse the cost of health services provided by faith-based programs, a
favored Bush administration initiative. The net effect is a cut in the block
grants because this change would fund the vouchers through funds that were
previously available for a range of projects under the block grant, said
Boroughs.
Minority Training Would Be Cut
Other HHS proposed cuts include a $155 million reduction in the Health
Professions Training Program, which targets minority and underserved
populations.
"This is one of the few programs in the federal government that looks
to train people to serve populations that historically have a very hard time
accessing services," Boroughs said. "It's a shame because that
fellowship training program has been proven to work."
Payments to children's hospitals for graduate medical education would be
cut by $198 million.
The budget includes $169 million to accelerate progress in health
information technology. The funding aims to promote nationwide
interoperability of health information technology systems through
industry-wide standardization.
The Department of Housing and Urban Development would see its Section 811
housing for people with disabilities cut in half, from $237 million in Fiscal
2006.
Department of Veterans Affairs (VA) funding would swell by 6 percent to
$35.7 billion, although the increase is linked to new health care fees that
Congress previously rejected. Without the new fees the discretionary total
would rise 3 percent above Fiscal 2006, and funding for medical care would
increase 8 percent. That would reverse the trend over the past two years in
which VA funding proposals did not keep up with inflation.
The demand for VA services among veterans has grown, and the cost of
long-term care has risen, which contributed to two consecutive budget
shortfalls that totaled nearly $3 billion.
"These are record increases because of the increased demand on the
system," Sperling said about the veterans funding increases, which had
been sought by NAMI.
Nearly $800 million of the VA increase would be paid for from a proposed
new $250 enrollment fee and boosting drug co-payments from $8 to $15 per
prescription for higher-income, less-disabled veterans.
APA officials told legislators in testimony for the Fiscal 2007 budget that
it is concerned that some budget assumptions, such as the reliance on the
collection of user fees and copays from veterans, might be overly ambitious if
counted on to fund the entire budget increase. APA is concerned about the
impact on the estimated 200,000 veterans it will affect including those who
rely on the VA to pay for psychiatric medications.
Spending on VA medical care would see an 11 percent increase to $27.5
billion, if the fee proposals are rejected.
The president's budget proposals are posted at
<www.whitehouse.gov/omb/budget/fy2007/>.
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