Election 2010: Implications for Federal Addiction and Mental Health Policy

by Rebecca Farley on November 4, 2010

By Chuck Ingoglia, Vice President, Public Policy

I am sure that most of us have had our fill of pundits offering opinions about why the elections went the way that they did, and what this means about the mood of the American people.  You will not find any of that in this short piece.  Instead, I will focus on what might the election mean for our community in terms of policy and funding.

I must begin this process with the acknowledgement that I do not own a crystal ball, and my ability to predict the future is cloudy at best.  Therefore, I will confine myself to areas that have greater certainty than others…

Discretionary Spending Will Not Grow

Government agencies have already submitted Federal Fiscal Year 2012 budget figures to the Office of Management and Budget.  Earlier this year, the President issued guidance to all federal agencies requested that each non security agency submit a budget request five percent below the discretionary total provided for that agency for FY 2012 than in the FY 2011 Budget.

It is safe to assume that discretionary programs in the Department of Health and Human Services, Justice, and Education will likely remain level or shrink.

The Increase in Federal Medicaid Payments will not be Extended

In light of revenue shortfalls in almost all of the States, the federal government provided a temporary increase in the Federal share of Medicaid spending that was scheduled to end on December 31, 2010 and was extended until June 30, 2011, albeit at a reduced rate.  The combination of concern over federal spending, combined with changes in Congressional composition would suggest that chances of extending this federal support to states is unlikely to be extended again.

It will be Difficult to Repeal Healthcare Reform

The political realities of repealing a law make this scenario very unlikely, principally because of President Obama’s veto power. Another complication is that some parts of health care reform already in effect are pretty popular. Among them are provisions forcing insurers to cover children with pre-existing conditions and allowing parents to keep kids up to age 26 on their policies.  That’s why congressional veterans predict that any potential rollbacks would be more piecemeal rather than a full-scale discard.

While we will likely see many proposals related to changing the healthcare reform law, most concerning to the addiction and mental health community will be efforts to scale back, or delay the Medicaid expansion scheduled for 2014.  We have already discussed that federal discretionary funding will not be growing, and that additional federal Medicaid assistance is unlikely.  The consequences of these actions is to put further pressure on STATE and COUNTY appropriations, further eroding addiction and mental health funding, especially for indigent populations.

There will also be efforts to take money away from funded programs, and the new Prevention and Wellness Fund is already seen as the prime target to steal from.

The National Council will continue to provide you with timely updates as the 112th Congress unfolds.  Your continued advocacy will be essential as we move forward.

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{ 1 comment… read it below or add one }

Ilene Flannery Wells November 8, 2010 at 6:18 am

We will never have true parity until the Medicaid Institutes for Mental Diseases (IMD) Exclusion is repealed. This law was enacted during a time period when everyone thought that the new medications will bring everyone would benefit from living within the community, utilizing the community mental health system. Not only does this one-size-fits-all approach not work for everyone, it has had disaterous results.

Due to the Medicaid IMD Exclusion, people with mentall illness are, in effect, completely denied access to long-term care. This is federally sanctioned discrimination. If someone with diabetes, Alzheimer’s or Parkinson’s disease was denied access to long-term care, this country would be in an uproar, but for some reason, it seems acceptable to allow very sick individuals to go without treatment, live on the streets, or wind up in jail or prison where they get inadequate care, at best.

Hundreds of thousands of individuals with severe mental illness are homeless, incarcerated or dying 25 years sooner than “normal” people. We are now treating more people in prison than in the community. Others are going completely untreated. This is a national disgrace.

HR 619, introduced by Edie Bernice Johnson (TX-30) would repeal this archaic, discrimintory law. With the new Congress, it will need to be re-introduced. I urge everyone to call their members of Congress and ask them to support this bill which would bring us closer to true parity.

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