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