Psychiatr News March 16, 2007
Volume 42, Number 6, page 6
© 2007 American Psychiatric Association
Mentally Ill Could Pay Price for Bush Budget Cuts
Rich Daly
A promise from Democrats to offset new federal spending with budget
reductions complicates the chance that Congress will restore many of the
health care cuts proposed by the Bush administration in next year's
budget.
Among a wide range of health care cuts President Bush has proposed in his
Fiscal 2008 budget, mental health advocates are most concerned about proposals
that would force states to drop hundreds of thousands of beneficiaries from
Medicaid.
The Bush administration's $2.9 trillion proposed budget, introduced in
February, includes a range of health care cuts that would reduce the
availability of a variety of services for people with mental illness including
drug addiction. The proposed cuts, which would impact Medicaid programs that
address mental illness, the State Children's Health Insurance Program (SCHIP),
suicide prevention, PTSD care, and juvenile-justice and housing grants, have
left little for mental health supporters to celebrate.
"Everyone across the board is pretty upset about what is proposed for
Medicaid," said Lizbet Boroughs, associate director of APA's Department
of Government Relations, about the administration's proposals that would cut
$25 billion from the amount by which the program was expected to grow over the
next five years. "That affects hospitalization, that affects
medications, that affects case management, and that affects the daily lives of
people with severe mental illness."
Medicaid has risen to the top of APA's federal budget concerns because the
federal-state partnership that provides health coverage for about 55 million
poor people is the largest source of funding for mental health services. In
2007 the program will cost the federal government more than $200 billion,
while states will spend about $150 billion. Most of the $24.7 billion in
federal spending cuts would come from shifting to the states expenses now paid
by the federal government.
The single largest Medicaid cut, $5.3 billion over five years, would come
from reducing the federal-funding match for states to 50 percent. Some states
rely on federal matches of up to 72 percent of patient costs to fund
administrative functions required by federal regulations.
Most Vulnerable Targeted
Reduced spending also would include a $3.6 billion reduction in Medicaid's
school-based transportation and administrative service functions and decrease
services for children. Other cuts would include revised coverage of
rehabilitation services to save $2.2 billion and elimination of reimbursements
for graduate medical education to save $1.8 billion.
Another cut would reduce the federal contribution toward the cost of
targeted case management for Medicaid recipients, including those with serious
mental disorders, to save $1.2 billion over five years.
"Rehabilitative services are the critical services that enable people
with mental illnesses to live in the community," said a statement from
the Bazelon Center for Mental Health Law, which was critical of the Bush
budget. "They include skills training, illness self-management, peer
services, intensive in-home services, therapeutic foster care services for
children, and other interventions that promote recovery."
Another key health care program that is facing large cuts, SCHIP, would
lose funding for hundreds of thousands of beneficiaries over the next five
years. Although SCHIP's mental health benefits are more limited than
Medicaid's, mental health advocates have made it a priority to fight cuts that
would limit eligibility to children from families with incomes at or below 200
percent of the federal poverty level.
Democrats and some Republicans plan to push for an additional $45 billion
for SCHIP over five years.
A third major area of focus for APA is additional funding for the
Department of Veterans Affairs (VA). APA opposed the Bush budget proposal for
higher health care copayments based on veterans' incomes and urged an
additional $500 million for mental health and substance abuse treatment each
fiscal year through 2012.
"There is increasing need both in the number of service members
returning from combat and in the severity of mental health diagnoses,"
Joseph T. English, M.D., a former APA president, told the House Veterans
Affairs Subcommittee on Health on February 14 (see
page 4).
Budget Includes Mental Health Cuts
The Substance Abuse and Mental Health Services Administration (SAMHSA) is
facing a $76 million cut in its Center for Mental Health Services (CMHS)
program that funds advances in mental health care and translates research into
practice at the community level. Programs proposed for cuts are the State
Incentive Grants for Transformation, which faces a $6.2 million reduction;
school-violence prevention, which would be cut by $17.4 million; and jail
diversion, reduced by $3 million. Two grant programs proposed for elimination
are seniors' mental health and technical-assistance centers that support
non-Medicaid patients.
The budget would freeze core CMHS programs at Fiscal 2007 levels. Among the
programs that would receive no inflationary increase are those for the mental
health block grants, children's mental health services, the protection and
advocacy program, and the PATH (Projects for Assistance in Transition From
Homelessness) program, which supports community-based outreach to people who
are homeless and have a severe mental illness.
The Bush budget also would cut suicide prevention programs by $3 million,
PTSD programs for youth by $1.5 million, and the Section 811 Supportive
Housing Program for people with disabilities by $113 million.
Other cuts that would affect youth with mental illness are an $86 million
reduction in juvenile-justice programs and elimination of the Office of
Juvenile Justice and Delinquency Prevention. Both are critical, said mental
health advocates, because estimates link 80 percent of youth in
juvenile-justice facilities with mental illness or substance abuse
disorders.
A number of factors complicate this year's budget picture. Democrats
control both chambers of Congress by narrow margins and have vowed to reverse
most of the president's proposed health care cuts. The situation gets
complicated, however, because of the House Democratic leaders' commitment to a
budget that is revenue neutral, known as PAYGO. Thus, any cuts that are
restored require that congressional budget staff cut something else.
Additionally, Congress uses the president's numbers as a starting point and
will have to justify cuts to priority programs in defense or other areas or
raise taxes to find the funds for health care programs.
"We certainly have a plan for lobbying to restore those cuts, which
we're hopeful but not overly optimistic about because of the PAYGO
environment," Boroughs said.
Information on the president's proposed budget is posted at
<www.whitehouse.gov/omb/budget/fy2008/>.
Budget analysis from the Center on Budget and Policy Priorities is posted at
<www.cbpp.org/>.
Related Article:
-
Though Drastic Change Needed, Congress to Take Small Steps
- Rich Daly
Psychiatr News 2007 42: 4-5.
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