Major federal mental health program funding would remain generally flat under the budget for Fiscal 2010 proposed by President Obama in May. But mental health advocates hope that Congress will boost funding before voting on the budget.

The record $3.6 trillion budget proposal includes small increases for some mental health programs, although few increases would be sufficient to keep up with inflation.

The generally flat funding for mental health programs was expected by many mental health advocates due to the numerous new financial obligations undertaken by the federal government in recent months as the nation struggles through the recession.

"It could have been worse," said Lizbet Boroughs, associate director for APA's Department of Government Relations.

Among the Obama budget requests is $828 billion for the Department of Health and Human Services (HHS), of which only $78.3 billion is nonentitlement, or discretionary, spending. The discretionary amount is a slight reduction from $78.5 billion that HHS received in Fiscal 2009.

The HHS funding was boosted through the stimulus law (the American Recovery and Reinvestment Act of 2009; PL 111-5), which provided an extra $22.4 billion in discretionary funds for Fiscal 2009 and Fiscal 2010. FIG1

Obama's budget would provide a 1.85 percent increase for the National Institutes of Health (NIH), which would bring its budget to $30.8 billion in Fiscal 2010. This includes a nearly 2 percent increase for the National Institute of Mental Health, bringing its total to $1.47 billion; a 1 percent increase for the National Institute on Drug Abuse, to $1.04 billion; and a 1 percent increase for the National Institute on Alcohol Abuse and Alcoholism, to $455 million.

Those amounts differ greatly from those requested by the Mental Health Liaison Group (MHLG), an advocacy coalition that includes APA. The MHLG is seeking a nearly 7 percent increase for each of the three institutes, beyond the $1 billion total boost the three recently got through the stimulus law. The institute's budgets are in stark contrast to the administration's highly publicized plan to double federal spending on cancer research by 2017 and the 5 percent increase, or $6 billion, in such spending the president is seeking in his 2010 budget.

"It's great that the administration wants to address cancer, but it's frustrating that the president wants to take it out on the other institutes," said Andrew Sperling, J.D., director of legislative affairs for the National Alliance on Mental Illness.

The generally flat NIH spending proposal follows the approach of many previous administrations, which knew that NIH was likely to receive large increases through the congressional budget process regardless of what the administration proposed, according to Sperling.

In a change from the Bush era, during which the administration routinely proposed budget cuts for the Substance Abuse and Mental Health Services Administration (SAMHSA), programs administered by its Center for Mental Health Services (CMHS) would receive an increase of nearly 2 percent in the Obama budget. However, that amount is substantially less than the $152 million boost requested by the MHLG for CMHS.

Among the CMHS programs that would receive funding increases are the Systems of Care Program for children ($17 million increase) and Projects for Assistance in Transition From Homelessness, known as PATH ($8.4 million increase). Many other CMHS programs would receive funding at current levels while some would face cuts, including a 2 percent proposed reduction for the Programs of Regional and National Significance (PRNS). The MHLG has requested a nearly 16 percent increase in PRNS funding, including grants to co-locate primary care in community mental health centers and support youth violence prevention.

Other major programs at SAMHSA would remain flat or face decreased funding under the Obama budget. Block grants through the Center for Substance Abuse Treatment (CSAT) would receive no funding boost; the MHLG has requested an 8 percent increase to $1.9 billion. The CSAT programs of regional and national significance, including funding for the use of evidence-based practices, would get a $46 million boost, which is short of the $75 million increase sought by the MHLG.

Another SAMHSA agency, the Center for Substance Abuse Prevention, would lose 1 percent of its current funding, to $198 million. That proposed reduction comes despite the pledge by Gil Kerlikowske, Obama's new drug czar, to focus on reducing demand for illicit drugs.

Some federal health programs would fare better. The Food and Drug Administration (FDA), which did not receive stimulus money, would get a $367 million increase in its Fiscal 2010 budget under Obama's plan. His plan also proposes that Congress encourage the FDA to begin approving generic competitors to complex biotech drugs and that it authorize the agency to assess fees specifically for the approval of generic drugs. The plan factors in for $141 million in new user fees for the FDA, which when added to increases in existing fees would provide the agency a $511 million increase over Fiscal 2009.

Medicare spending would total $452 billion in Fiscal 2010, up 6 percent from Fiscal 2009. Medicaid spending would rise to $290 billion, a 10 percent increase. As part of the stimulus law, Congress increased the federal government's share of Medicaid costs in Fiscal 2009, Fiscal 2010, and part of Fiscal 2011.

The president plans to avert a scheduled cut in Medicare payments to physicians and would instead hold their reimbursements at the 2009 level, at a cost of $11.7 billion. The increases in nondiscretionary programs like Medicare and Medicaid were notable departures from the administration's effort to keep overall health spending static.

Another notable exception to keeping the health-related budgets flat is the proposal for the Indian Health Service, which is slated to receive a 13 percent boost. However, most of that funding is earmarked for rebuilding deteriorating facilities instead of increasing the care provided.

The budget proposal leaves unanswered many questions about various high-cost areas of health care. For instance, the Obama budget claims that it would save Medicaid $664 million over 10 years, but the administration's document does not explain how that will be achieved. Also left unexplained is $300 billion in savings that the administration said will be squeezed from other federal health programs to finance an expansion of coverage for the uninsured. The administration also has claimed that the move toward adoption of health information technology will result in large savings but has largely left unexplained the mechanics of how those savings will be achieved.

Further information on Obama's Fiscal 2010 proposed budget is posted at<www.whitehouse.gov/omb/budget/>.▪