February 3, 2009
The Senate is expected to vote later this week in support of $10 billion for the National Institutes of Health (NIH) as part of the nearly $900 billion Economic Recovery and Stimulus Package (S 1), known as the American Recovery and Reinvestment Act of 2009. The full Senate debate begins today, including an amendment being pushed by Senator Arlen Specter (R-PA) to increase NIH funding.
Senator Specter's amendment would add $6.5 billion to the $3.5 billion for NIH currently included in the bill. Additional funds provided by the amendment would be distributed to the Institutes and Centers – including the National Institute of Mental Health (NIMH) proportional to their current funding level.
Click here to send a message to your Senators telling them to support the Specter Amendment to S 1, the American Recovery and Reinvestment Act of 2009 (S 1) to add $6.5 billion in funding for the National Institutes of Health (NIH), including mental illness research at the National Institute of Mental Health (NIMH). You can also call Senate offices at 202-224-3121
The current economic downturn is already having a devastating impact on state budgets and critical programs that meet the needs of people with mental illness and their families. Both children and adults living with serious mental illness rely heavily on public programs such as Medicaid and state and local mental health departments.
In response to the current economic crisis, President Obama is now pressing Congress to move forward and quickly pass the American Recovery and Reinvestment Act of 2009 (HR 1), an $825 billion two-year package of public investments and tax cuts to promote recovery and stimulate an American economy now in recession. The House passed HR 1 on January 28 by a vote of 244-188. The Senate took up its version of the legislation starting on February 2.
There are number of provisions in the American Recovery and Reinvestment Act that are of critical importance to children and adults living with mental illness and their families. NAMI urges that the final version of HR 1 include the following critical elements to protect the needs of the most vulnerable and promote investment that will spur economic growth.
Medicaid is the largest and most important investment in the nation’s public mental health system. NAMI strongly supports the enactmentof a significant and temporary increase to the federal share of Medicaid spending (FMAP) to counteract current shortfalls in revenues being experienced at the state level. Absent such an increase, it is certain that states will be forced to limit access to critical services funded as part of Medicaid such as Programs of Assertive Community Treatment (PACT) and coverage of medications critical to treating severe mental illness (including policies that ensure access to the broad array of available treatments).
NAMI strongly supports the $87 billion over the next two years for a temporary increase in FMAP funding that is included in this bill. Current projections for the remainder of FY 2009 and for 2010 and 2011 are that state budget shortfalls could reach $350 billion. A recent report from the Kaiser Foundation estimates continued Medicaid financing gaps for FY 2009. Projected forward, these financing gaps could exceed $97 billion, and reach as high as $118 billion. Congress must act. NAMI also supports provisions in HR 1 extending through October 1, 2009 the current moratoria on Medicaid regulations put forward during the Bush Administration, including those on rehabilitation and case management services.
People with serious mental illness and other disabilities are extremely vulnerable in the current economic downturn as states face continued pressure cut safety net programs. The American Recovery and Reinvestment Actincludes $4.2 billion to help 7.5 million extremely low-income people with disabilities and seniors eligible for SSI by providing an additional monthly SSI payment for 2009 equal to the average monthly federal payment. NAMI strongly supports this one-time payment that will serve as an immediate economic stimulus as half of all SSI recipients have no other form of income.
NAMI also supports the $500 million in this legislation to help the Social Security Administration (SSA) process the steep increase in disability (SSI and SSDI) claims and prevent the current backlog of claims from getting worse than it already is. The House bill also makes $40 million available to help SSI upgrade health information technology.
NAMI supports the $2 billion in this legislation for the National Institutes of Health (NIH), including the National Institute of Mental Health (NIMH). This investment in research has enormous potential to produce immediate and long term dividends that protect good jobs, stimulate local economies across the nation, provide data to help make health care reform evidence-based and expand the research that is the foundation for innovation and global competitiveness. NAMI also supports the $500 million for capital funding for the NIH that will ensure completion of the John Edward Porter Neuroscience Research Center on the NIH campus.
In addition, health care lags far behind other sectors on investment in information systems and technology because of the complexity of the delivery system and the unique needs of payers, patients and providers. NAMI supports the $20 billion included in HR 1 for Health Information Technology (IT) development. This investment will not only stimulate economic growth, but would also promote efficiency, improve health outcomes and dramatically reduce health costs for patients and taxpayers.
While NAMI supports many of the provision in the American Recovery and Reinvestment Act, we are extremely concerned about the specifics of the $1.1 billion proposal for Comparative Effectiveness Research (CER). This investment at the NIH and the Agency Health Care Research and Quality (AHRQ) is designed to spur studies to compare the effectiveness of different medical treatments funded by Medicare and Medicaid. While NAMI generally supports investment in research designed to improve health care quality and outcomes, the proposal in the House-passed version of HR 1 for "comparative effectiveness" lacks transparency and accountability poses extreme risk of promoting "cost effectiveness" studies that will be used to deny coverage for specific treatments.
NAMI therefore urges that this CER proposal be amended and patient protections added to ensure that studies are not used by the government and other payors to deny access to specific treatments and therapies for individual patients and their families – especially for complex conditions such as serious mental illness. Specifically NAMI recommends that the following be added to the legislation:
NAMI supports the changes made in the Senate version of the American Recovery and Reinvestment Act that will ensure CER is focused on “clinical” research and promotion of quality improvement, as opposed to only cost containment. Congress must ensure transparency, accountability and adequate input from patients.
HR 1 includes a critical investment in supportive housing for elderly and non-elderly people with disabilities, including people with serious mental illness -- $2.5 billion for retrofitting and upgrading supportive housing projects developed through the HUD 202 and 811 programs. These funds will be directed toward energy efficiency and "green" technologies to lower utility costs. Many of these older 202 and 811 properties currently people living with serious mental illness. NAMI strongly supports this investment in< supportive housing for people with disabilities. NAMI also support the $1.5 billion allocation in the House and Senate bills for the Emergency Shelter Grant (ESG) program to further homelessness prevention activities at the state and local level.