With the 2010 midterm elec- tions behind us, there are liter- ally hundreds of questions surrounding Washington. While anyone who says they
have all the answers is lying, we can make educated guesses in some cases. For now, let‘s focus on the questions that impact the CAADAC membership. I‘m sure you‘ve all been asking yourselves, will the election re- sults impact funding for prevention and treat- ment services and research? Will it impact health care reform and its provisions pertain- ing to substance abuse treatment? Will it impact federal drug policy?
Most of the answers can be found in fiscal policy. The Republicans, now in the majority, ran on a platform of smaller government and spending cuts. While a large percentage of their candidates would not specify exactly what programs should be cut, this still does not bode well for health programs. The ap- propriations bill that funds the Department of Health and Human Services- and in turn NIDA, SAMHSA, and HRSA- is the largest non- military domestic spending bill to come out of congress each year. It is produced by the Appropriations subcommittee on Labor, HHS, and Education, or ―Labor/H‖ for short. Being one of the largest spending bills, it naturally has a huge bulls-eye on it. There have been discussions and rumors that the House leader- ship would like to see domestic spending re- duced to FY 2008 levels, or at the very least FY 2010 levels. Regardless, it is highly unlikely that the House of Representatives will approve any increases for SAMHSA or NIH. Of course, the Senate remains in Democrat hands. So passing any budget can be diffi- cult, and a government shut down this time next year is a possibility. This could have a severe impact on those who depend on Medi- care to cover the cost of their treatment, and countless other social services.
As far as health care reform is concerned, it is almost a sure thing that the entirety of the bill will not be repealed. With the Democrats in the Senate and the White House, there is no way that such legislation will pass. However, this does not mean that changes will not be forthcoming. What it comes down to is how certain provisions of the Affordable Care Act are being funded. Those parts that require appropriations over the next two years face trouble in the House. Even before the elec- tion, Republicans attempted to chip away at certain provisions via the Johnanns amend- ment, which would have taken billions of dol- lars out of the Public Health and Prevention fund created by the act. The amendment was defeated, and $40 million allocated to SAM- HSA for the integration of substance abuse treatment into primary care was preserved. CAADAC and CFAAP both signed letters to Senate leaders, urging them to defeat the amendment.
According to the National Council of Commu- nity Behavioral Health, we will likely see many proposals related to changing the healthcare reform law, and most concerning to the addiction and mental health community will be efforts to scale back, or delay the Medicaid expansion scheduled for 2014. We have already discussed that federal discre- tionary funding will not be growing, and that additional federal Medicaid assistance is unlikely. The consequences of these actions is to put further pressure on state and county appropriations, further eroding addiction and mental health funding for indigent popula- tions.
Of particular concern to the research commu- nity, and those whom support NIDA and NIAAA, is the election of Pat Toomey of Penn- sylvania to the Senate. Mr. Toomey has a history of challenging NIH grants that he considers to be controversial, and has at- tempted to de-fund specific grants in the past. While most of these grants were fo- cused on human sexual behavior, many are connected to the prevention and treatment of HIV. As soldiers in the trenches in the fight against substance abuse, CAADAC members know first-hand how intertwined substance abuse and HIV are, as drug and alcohol abuse can lead to reckless sexual behavior and the transmission of HIV and other STDs.
As supporters of evidence based practices and the translation of science to service, we cannot afford to stand by idly if the grant-making decisions of NIDA or NIAAA are attacked.
With NIDA and NIAAA in the NIH forefront due to the possibility of a new institute being cre- ated, it is very possible that many of their grants can come under scrutiny. Also, if a new institute is created in place of two, Congress may see this as an opportunity to cut research funding in order to appear fiscally responsible. CAADAC supports the creation of a new insti- tute, but only on the condition that research funding does not suffer as a result.
At NIH, Director Francis Collins has already spoken his mind. The reduction in funding pro- posed by Speaker-to-be John Boehner would be “very devastating” and would demoralize scientists, whose odds of winning a research grant from the agency could drop to about 10 percent, he told the Washington Post.
No one should think that our situation is hope- less, that it‘s all gloom and doom. It‘s not as if funding for the programs we support will be cut off tomorrow. Yet our work is cut out for us. Your advocate in DC will be calling on you often to make your voice heard, so that we can protect those policies most important to our field and the consumers we serve. Be on the lookout for increased Capwiz alerts, and be sure to respond to them when asked! (Or we‘ll sic Warren on you!)
So fasten your seatbelts. It‘s going to be a bumpy ride!
Regards,
Andrew
