In the words of the famous holiday song, “the weather outside is frightful” – and particularly so as we look at the funding climate for healthcare services in the years ahead. What do proposed spending cuts in 2013 and beyond mean for behavioral health? Join Linda Rosenberg and Chuck Ingoglia of the National Council as they discuss Medicaid, the current political environment, and the future of funding for the mental health and addictions safety net.
Chuck Ingoglia, Vice President, Public Policy: Let’s start by talking about what we have achieved this year in terms of protecting Medicaid and behavioral health funding.
Linda Rosenberg, President & CEO: You know it’s funny, in a way, Chuck. I think that what we may have achieved is something that didn’t happen, which was the Supercommittee didn’t come to a decision. Maybe that was a win in some ways for people with serious mental illnesses and addictions and the organizations that serve them – that their coming to a deal would have been more dangerous than their not coming to a deal.
Chuck: Absolutely, Linda. I think we can take Congress not reaching a conclusion as a victory. Many people mobilized within the disability community, within the provider community, and within our membership to send the message to the Supercommittee that Medicaid is too important right now to cut, and I do think that was a victory.
Linda: But Chuck, do you think that we just delayed the inevitable? Healthcare will remain a banner issue both through the elections and afterward, when Congress gets back to looking at healthcare and Medicaid. What strategy do we need to articulate then?
Chuck: I agree, these issues are not going to go away and we’re going to have to continue to be vigilant. In terms of strategy, I think most importantly, how can people understand what Medicaid is and who benefits from it? Part of the problem is that people don’t really understand what the program is or who benefits from it. Not just the fact that people with disabilities benefit from Medicaid, but lots of older adults in nursing homes and lots of middle class families also rely on Medicaid.
Linda: You know, I agree with that, and I always wonder why we’re not able to articulate that more clearly. For many families, my own family included, with my very elderly mother –
Chuck: Mine too.
Linda: Right, for our parents, it becomes a lifeline for them because Medicare does not pay for that kind of long term care.
Chuck: The good thing was, in our most recent experience during the Supercommittee, that AARP and other seniors’ groups really stepped up to protect Medicaid because they see that connection. And they’re probably the best voice to help make that connection to the average person.
Linda: We know that for people with serious mental illness, years ago, they were the responsibility of the state, and it was state general fund money that supported services. Now, over the last 20 years there has been a steady movement towards Medicaid to support services for people with behavioral health disorders. And so any cuts to Medicaid are cuts to the fundamental services and lifeline for those people.
Chuck: Also, SAMHSA money remains vitally important for substance use disorder treatment and prevention, as well as for innovative programs in both substance abuse and mental health treatment. The failure of the Supercommittee now triggers drastic across-the-board spending cuts within the federal government, $1.2 trillion. If those cuts were apportioned equally in the department of health and human services, that would be over a 7% cut to SAMHSA. But we know they won’t be apportioned equally. There will be some programs that will be held harmless, like the National Institutes of Health and like programs at the Health Resources and Services Administration. So the potential for cuts to SAMHSA is even higher.
Linda: So what you’re saying Chuck, is that we have an immediate crisis, and we have a crisis a few months down the road. The immediate crisis is the potential cuts to SAMSHA in terms of grant programs and the block grant funding that supports both services for people who have no insurance as well as innovations in treatment and practice. But additionally, SAMHSA is a strong voice within the federal government for this group of people with substance use disorders and mental illnesses, often chronic illnesses – and the more that voice is weakened, the easier it is for federal programs to disregard those people. So we have a fight for a number of reasons right now to make it clear to Congress and the Administration about how important SAMHSA is and how we need to protect their funding.
Chuck: Absolutely. The other thing I think about, as we see how much state and county money has been slashed for these programs, that every federal dollar available that can support treatment becomes more critical than ever.
Linda: We’re becoming more like the rest of healthcare, when you think about it. There is very little county and state money that goes into other diseases. It is insurance money, whether it’s federal insurance money like Medicare and Medicaid or commercial insurance, that pays for treatment of other diseases. We always wanted to be part of healthcare, and now we have one of the unintended consequences of being part of healthcare – which is that we won’t have as much state and local support in the years to come.
Chuck: I think that’s true, and all the more reason why the projected Medicaid expansion under healthcare reform is so critically important. But until that happens, we’ve got to hold on to as many treatment dollars as possible.
Linda: Our members have done a really amazing job, in their states, at holding on to state funding – probably at success rates that have even surprised some of them! They’ve been very smart at organizing and making their voices heard in partnership with consumers and families. What we try to do at the National Council is to duplicate those efforts at the national level, working with our network of state and local associations. Our members have tried to really step up to the plate and have rallied when we ask them to at the national level. That’s pretty exciting, and I think it’s been a great accomplishment of our member organizations.
Chuck: I agree. I think the level of member engagement continues to increase and show dividends. The number of people that contact their Members of Congress continues to grow. It continues to show a direct benefit. And this is going to continue to be important into the future as the decisions confronting Congress become more and more complicated.