|Sita Diehl, Director of State Policy and Advocacy|
Conserving Scarce Resources, Looking To More Prosperous Times
Despite improvements in the economy, last year was tough for state governments and next year will be even tougher for state budgets. In 2011, state budgets nationwide closed with $100 billion in shortfalls. In 2012 states are projecting a total deficit of $140 billion with enhanced federal Medicaid funds expiring June 30, 2011. Unemployment is part of the issue. For every one percent increase in the unemployment rate state revenues fall over three percent, just as more people enroll in Medicaid or join the ranks of the uninsured.
Governors will make key decisions over the next few months about how to conserve scarce resources while simultaneously preparing for the promise of more prosperous times. Some governors will examine what government should be doing versus the private sector and will be looking for ways to become more efficient so they may invest scarce dollars in direct care. Contracting with nonprofit organizations and businesses is one method for states to shift toward non-governmental jobs to deliver efficient, effective care.
Unfortunately, many mental health systems are already at the point of collapse, due in part to steep budget cuts over the past two years without a corresponding investment in community services. As mentioned earlier, on average, state mental health care systems get only a “D” grade in part because of a lack of adequate investment in community services. And this grade was in 2009—predating some of the worst fallout from the economic crisis. Reducing state government investment even further may precipitate a complete mental health care system failure.
Health Care Reform: Roots on the Democrat and Republican Sides of the Fence
Some governors will move forward to implement the ACA, planning for state insurance exchanges and expansion of Medicaid to cover uninsured residents with incomes at or below 133 percent of the poverty level. Despite widespread distrust of the law as a whole, the ACA has roots on both the Democrat and Republican sides of the fence. Republican principles of reduced government and personal responsibility are embodied in private insurance exchanges and small business coverage. Democratic values of a just and equitable society are represented in insurance industry reforms and coverage of the uninsured through Medicaid expansion. Mental health parity, incorporated throughout the law, has long standing bipartisan support.
|What else can mental health advocates do to help save mental health? |
Mental Health Advocates Must Stand Firm in 2011
Mental health advocates must urge governors to preserve mental health benefits in Medicaid and encourage the development of a plan for 2014 when, as insurance exchanges begin, people with mental illness will be able to join the workforce without losing health care coverage.
In states across the country, this is a time of economic retrenchment, but it is also a time to plan for a more prosperous future. The smart choice is to invest in supporting mental health systems that deliver the right care at the right time and in the right place so children and adults living with mental illness can succeed and contribute to their family, workplace, school and community.
Sita Diehl, M.A., M.S.S.W., is NAMI's director of State Policy and Advocacy. She served as executive director of NAMI Tennessee from 2004 to 2010. She has developed a range of mental health curricula for individuals living with mental illness, families, mental health care providers and criminal justice personnel. Her research experience includes a two state comparison of the effect of public managed behavioral health care on women and children, a multi-site study of consumer-operated services and a longitudinal study of mental health services in Tennessee county jails.