With the shadow of war hanging over the Congress, House and Senate leaders are pushing to complete action on the FY 2004 budget resolution, perhaps as early as the end of this week. As part of this effort, House leaders are continuing efforts to force as much as $92 billion in future cuts to Medicaid over the next decade.
These unprecedented cuts would have devastating consequences for children and adults with severe mental illnesses who depend on Medicaid for access to treatment and supportive services. While states have primary responsibility for setting eligibility and benefits for their Medicaid programs, Congress plays an important role in setting federal guidelines. In order to meet a specific target for federal savings under Medicaid, the House Energy & Commerce and Senate Finance Committees would be forced to pass legislation either cutting federal matching funds or limiting the ability of states to offer optional services to mandatory and optional populations. This could include severe limits placed on access to prescription drugs and supportive services such as psychiatric rehabilitation, case management, as well as early diagnosis and screening of children and adolescents.
Within the next few days, congressional leaders are expected to bring forward a House-Senate "Conference Report" on the FY 2004 budget resolution. Immediate efforts are needed to push members of Congress to reject the House-passed proposal for $92 billion in future cuts to Medicaid. NAMI advocates are strongly encouraged to contact members of the congressional delegation to urge them to contact House Speaker Dennis Hastert (R-IL), Senate Majority Leader Bill Frist (R-TN), House Budget Committee Chairman Jim Nussle (R-IA) and Senate Budget Chairman Don Nickles (R-OK) to express opposition to the House proposed cuts to Medicaid. Remind them that Medicaid has become the most important source of funding for public sector mental illness treatment and supportive services. Remind them also that cuts to Medicaid services for people with mental illnesses will lead to increased burdens on other systems such as criminal justice, which already disproportionately bear burdens caused by inadequate public mental health services and supports.
While it is important for all members of Congress hear from NAMI advocates on the need to remove cuts to Medicaid from the budget resolution, it is especially important for Senators to be pressed to reject the House Medicaid proposal. Advocates are therefore strongly encouraged to urge support for the Specter-Harkin amendment on discretionary health funding for FY 2004 (see below).
All House members can be reached by calling the Capitol Switchboard toll free at 1-800-839-5276 or at 202-224-3121 or online.
Under the 1974 Budget Act, Congress is required to pass an annual budget resolution that sets overall parameters for mandatory and discretionary spending over the next 10 years. While the budget resolution does not encompass actual spending or authorization legislation, it does contain binding instructions to House and Senate Committees to produce legislation to meet specific spending and budget savings goals.
On March 21, the House cleared its version of the FY 2004 budget resolution (H. Con. Res. 95) by a 215-212 margin. As noted above, it would require the House Energy & Commerce Committee to cut $92 billion over the next decade from projected federal spending on Medicaid. By contrast, the Senate version of the budget resolution (S. Con. Res. 23) does not contain these deep cuts to Medicaid. Thus, it is critically important that the House proposal be rejected in the final conference agreement.
Yesterday during consideration of the FY 2004 budget resolution, the Senate voted 96-1 in favor of an amendment offered by Senators Arlen Specter (R-PA) and Tom Harkin (D-IA) to increase funding for discretionary health research and services programs by $2.8 billion in FY 2004. These discretionary programs include funding for medical research at the National Institutes of Health (including the National Institute of Mental Health) and funding for health services programs (including the Substance Abuse and Mental Health Services Administration). These federal discretionary programs are subject to annual appropriations measures, in contrast to mandatory entitlement programs such as Medicaid, Medicare and SSI where Congress does not set annual spending levels, but can amend eligibility rules and covered services.
With passage of the Specter-Harkin Amendment, the Senate budget resolution now contains $4.3 billion more in overall discretionary health research and services funding for FY 2004 than the House budget resolution. The House and Senate Appropriations Committees (not the budget resolution) will be responsible for setting FY 2004 spending levels for programs such as NIMH and SAMHSA. However, inclusion of the higher spending limit for discretionary health programs in the Senate budget resolution is critically important (resulting in as much as $1.8 billion in additional funds being available to NIH research). NAMI advocates are therefore strongly encouraged to urge their members of Congress to support adoption of the Specter-Harkin amendment in the final House-Senate conference agreement on the FY 2004 budget resolution.