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Assessing the Impact of the 2010 Mid-Term Elections on People Living with Mental Illness and Their Families

By Andrew Sperling, NAMI Director of Legislative Advocacy

Capitol building

The dust is beginning to settle on the results of this year’s mid-term elections and the full picture of the changes coming in 2011 is starting to take focus. A few certainties are emerging about what could be in store for NAMI’s federal legislative agenda in the new Congress that will convene in January—with a new Republican majority in the House and much narrower majority in the Senate. With so many new members of Congress—85 new House members and 15 new Senators—there will be important opportunities to educate them about mental illness and NAMI’s agenda to promote research and recovery.

It Will Be Difficult to Repeal Health Care Reform

The new majority comes to Congress with a strong commitment repeal the health care reform law passed earlier this year—and short of that, roll back major provisions. The political realities of repealing a law make this scenario very unlikely, principally because of the Senate’s opposition to repeal and President Obama's veto power. Another complication is that some parts of health care reform that are already in effect are 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 health care reform law, most concerning for NAMI will be efforts to scale back, or delay, the Medicaid expansion scheduled for 2014. We are also certain to see efforts in the House to stop funding for individual provisions or legislatively block enforcement of particular rules and regulations.  

As many NAMI groups have experienced in recent years at the state level, a successful outcome is often being able to avoid deep cuts to critical programs serving people living with mental illness and their families.

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 FY 2012 in February—with exceptions made for priorities such as homeland security, defense and veterans. The new House Republican majority is likely to go even further and seek to cut domestic discretionary programs back to FY 2008 levels. This could mean significant reductions for key NAMI priorities.

  • Mental illness research at the National Institute of Mental Health (NIMH) could see a proposed reduction as high as 7 percent—from $1.541 billion, down to $1.405 billion.
  • Affordable housing programs would be hit even harder. For example, the McKinney-Vento homeless program would see a reduction of more than $400 million (down from nearly $2 billion, to less than $1.6 billion), with insufficient funding to renew existing units of permanent supportive housing in place through programs such as Shelter Plus Care.

As many NAMI groups have experienced in recent years at the state level, a successful outcome is often being able to avoid deep cuts to critical programs serving people living with mental illness and their families.  

New Focus on Entitlement Spending

On or about Dec. 1, the President’s deficit reduction commission, led by former Sen. Alan Simpson and former White House chief of staff Erskine Bowles, will be releasing its report. The draft that began circulating two weeks ago included a volatile mix of changes to entitlement programs such as Medicare, Medicaid and Social Security as well as strict limits on discretionary spending and cuts to defense and reforms to the tax code. While none of these recommendations may garner the required support of 14 of the 18 panel members, the commission’s report is certain to spark debate in the new Congress about how to address long-term structural deficits at the federal level, what must be done to bring them under control and what protections must be put in place for vulnerable populations. 

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 that was scheduled to end on Dec. 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. 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.

To stay up-to-date on the latest in health care reform, visit www.nami.org/healthcare.

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