President Bush Unveils Budget Plan, Proposal Includes Major Increases For Medical Research
As is being widely reported in the press, the White House yesterday released the outline of the President's budget plan for FY 2002. Yesterday's release followed the President's address to Congress and the nation making the case for his tax cut proposals. Overall, President Bush is planning to increase federal discretionary spending by 4 percent above inflation. However, this will not translate into a proposed increase for every federal program and agency. Instead, many federal programs will actually see proposed cuts in order to accommodate larger increases for top White House priorities such as education, medical research and defense.
President Bush's budget proposal release does not contain funding requests for specific federal programs. Rather, it is an attempt by the President set forth major priorities and build public support for the broad outlines of his economic plan. Thus, specific funding requests for key federal programs of concern to NAMI are not in this document. It is expected that these specific spending recommendations will be issued in late April, just before the House and Senate Appropriations Committees begin work on FY 2002 bills - a process that must be completed before next federal fiscal year begins on October 1, 2001.
Copies of the White House budget blueprint can be viewed at: http://www.gpo.gov/usbudget/index.html
One of the major health care proposals outlined by the President both in his speech and the budget plan is a $2.8 billion increase for medical research at the National Institutes of Health (NIH) - bringing total NIH spending up to $23.1 billion for FY 2002. This increase would keep the agency on track to finish the job of doubling federal spending on medical research by 2003. NAMI has enthusiastically endorsed this goal as critical to increasing federal investment in scientific research on severe mental illness. The White House budget outline does not include specific recommendations for each NIH institute - including the National Institute of Mental Health (NIMH). However, Bush Administration officials have made clear that all institutes at NIH will receive roughly the same proposed percentage increase (approximately 13.7%). In the case of NIMH, this would mean that the President will be proposing as much as a $151 million increase for FY 2002 - raising the NIMH budget from $1.107 billion to $1.258 billion. As is in the past, NAMI will be vigorously supporting these increases and urging that the increase for NIMH be directed to research on serious brain disorders such as schizophrenia, bipolar disorder, major depression and severe anxiety disorders.
While yesterday's budget outline made specific reference to the President's push for doubling the NIH budget, very few details were included with respect to mental illness service programs at the Center for Mental Health Services (CMHS). In fact, the only reference in the Bush budget blueprint to SAMHSA (CMHS's parent agency) was a proposal to increase federal funding for drug treatment programs by $111 million to close the gap between demand for treatment and the number of available treatment slots. At the same time, a preliminary list of expected agency and program cuts did not make reference to any CMHS programs.
More importantly, the budget outline includes specific reference to a forthcoming Bush Administration proposal to increase flexibility for the states in administering federal block grant programs addressing public health needs. This proposal is expected to include both the Mental Health and Substance Abuse Block Grant programs ($420 million and $1.6 billion, respectively) and grant states new authority to transfer funds to better target emerging public health needs at the state and local level. This proposal is very similar to one endorsed by NAMI last year to allow states to blend funds from the Mental Health and Substance Abuse Block Grants to finance integrated treatment for persons with co-occurring mental illness and addictive disorders. This proposal was rejected by Congress after intense lobbying by state substance abuse treatment agencies. NAMI is encouraged by this proposal from the President as an important step forward in helping states cope with the large, and growing, public health burden associated with co-occurring disorders.
Yesterday's budget outline contains additional details on the President "New Freedom Initiative" for people with disabilities. As detailed in an E-News message on February 1 (http://www.nami.org/update/20010202.html), the White House has put forward a series of initiatives to assist people with disabilities - including people with severe mental illnesses - in achieving greater independence through employment, housing and community supports. Among the key provisions in the "New Freedom Initiative" are endorsements of full implementation of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and state compliance with the Supreme Court's decision in L.C. v. Olmstead (community integration for people with disabilities under the ADA). In addition, the "New Freedom Initiative," as well as the budget outline, include President Bush's proposal for a national commission on improving the nation's mental illness treatment delivery system. The President is also proposing a $20 million increase for the Office of Disability Employment at the Department of Labor, nearly doubling funding.
The President's budget outline also includes additional details on Administration proposals to reform Medicare. Specifically, President Bush is proposing to set aside $156 billion in FY 2002, with additional funds over the next 10 years, to reform the program consistent with a plan put forward in 1999 by Senators Bill Frist (R-TN) and John Breaux (D-LA) and Representative Bill Thomas (R-CA). This proposal would require Medicare beneficiaries to choose among competing health plans, with a requirement that these plans offer an outpatient prescription drug benefit. In addition, the President's budget outline includes an interim and immediate program of block grants to the states (known as "Immediate Helping Hand") to provide financial assistance to low-income Medicare beneficiaries to purchase outpatient prescriptions or "drug only" policies. NAMI is waiting for details on both of these proposals to ensure that non-elderly people with severe disabilities eligible for Medicare (SSDI beneficiaries) can fully participate in these programs and that they do not rely on restrictive drug formularies that block access newer medications.
As is the case with CMHS, the budget outline released yesterday provides few details for the Department of Housing and Urban Development (HUD). Overall, the Bush Administration is projecting a $1.9 billion increase for HUD in FY 2002, up to $30.4 billion. Most of this increase would go toward renewing existing agency obligations for Section 8 rental vouchers and expiring rent subsidy contracts. In addition, the Administration will ask for an additional 34,000 tenant-based "incremental" vouchers - with an as yet unspecified amount to be directed to non-elderly people with disabilities. No details were included in yesterday's budget blueprint for other programs at HUD serving people with severe mental illnesses such as Section 811 and homeless assistance (including Shelter Plus Care and SHP supportive housing). As with the HHS programs noted above, further details on the Bush Administration's FY 2002 budget requests are expected by late April.