|Andrew Sperling, Director of Legislative Advocacy|
While the political pundits and partisan spinmeisters are still busy on television and on-line analyzing the 2010 election results, a few certainties are starting to emerge regarding how the repercussions this may play out in 2011 and beyond for people living with mental illness and their families. While the impact is far from certain, we can predict with some precision what the shift of partisan control in Congress will mean–both in terms of the Republicans taking over the House and the Democratic majority in the Senate being significantly reduced.
A few things we anticipate include:
Discretionary Spending Will Remain Flat in 2011 and 2012
At minimum, the Obama Administration is expected to come forward with a flat budget proposal for fiscal year 2012 in February–with exceptions made for defense and veterans. The new House Republican majority is likely to go even further and seek to cut domestic discretionary programs back to fiscal year 2008 levels. This could mean as much as a 7 percent reduction for mental illness research at the National Institute of Mental Health–from $1.541 billion, down to $1.405 billion–ASSUMING the President relents and accepts cuts of this level to domestic spending.
The Increase in Federal Medicaid Payments (FMAP) 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. which was scheduled to end on December 31, 2010 and extended until June 30, 2011, albeit at a reduced rate. The combination of concern over federal spending with the changes in Congress would suggest that chances of extending this federal support to states is unlikely to be extended again. Not a single House Republican voted for the higher FMAP last summer, so there is little expectation that the new majority would be supportive of extending higher FMAP any further in 2011.
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 you hear so many pundits asserting 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 for NAMI and people with mental illness will be efforts to scale back or delay the Medicaid expansion scheduled for 2014. As noted above, federal discretionary funding will not be growing and additional federal Medicaid assistance is unlikely. The consequences of these actions will put further pressure on state and county budgets, further eroding resources for publicly funded mental health services which are critical for many people who live with mental illness.
A more thorough analysis of what the election results might mean for people with mental illness will be published in the November edition of the NAMI e-Advocate. To subscribe, sign up for this monthly e-newsletter.