The budget process in Washington in a “normal” year is nothing short of mind-boggling. Yet it usually follows a certain pattern that we here in the Capitol call Regular Order: The President releases a budget outlining White House priorities, usually in early February; the House then passes a non-binding budget resolution outlining its priorities in the late spring, and the senate sometimes follows suit; the House and Senate Appropriations subcommittees then formulate 12 appropriations bills (each). After they pass through each chamber, a conference between the two chambers takes place to formulate a final recommendation, and the legislative and executive branches then entangle in a complex, twisted back-and-forth until a budget is produced and passed.
That’s the scenario if all cylinders are firing and the stars are aligned. As we enter the budget process for fiscal year 2014, such is clearly not the case. In reality, it hasn’t been the case for going on five years. Now, however, Washington is in the midst of three budget issues in one. First is the fiscal year 2014 (“FY ’14”) budget itself. Second is the ongoing sequestration and the budget cuts it rained upon us beginning in March. Third is the looming showdown over the increase required in the debt ceiling. Again.
Wait, there’s more. The FY 2013 budget was never completed in earnest. While some agencies received full appropriations bills, establishing new programs and new funding streams, the Department of Health and Human Services (HHS) – which houses SAMHSA, CDC and the NIH– received a continuing resolution instead. This means all programs continued at least year’s funding levels (with maybe a slight increase of less than 1%) and no new programs were created. Continuing resolutions are not rare in Washington, but they have been used with increasing regularity over the past decade.
Forget the “fiscal cliff.” This is a fiscal minefield. Our mission is to find a safe place in this minefield where funding for substance abuse treatment, prevention and recovery can grow. It’s about as close to a suicide mission as you can come in advocacy. Advocates are no longer playing offense, seeking new funding and new programs. It is time to play defense, protect what you have and hope that you can hold still long enough without taking a bad step.
Yet in this tempest is a beacon, and some signs from the administration that substance abuse can become a priority. Due to recent mass shootings, especially Newtown, policymakers have become aware that the treatment and prevention of substance abuse and mental health needs to be a national priority. In addition, because the debate on gun violence is so politically charged and volatile, many policymakers are casting their lot entirely with behavioral health on this issue. It has been thrust into the national spotlight, and advocates hope to take advantage.
In the administration’s FY 2014 budget request for SAMHSA, an initiative entitled “Now is the Time” is one of the boldest efforts to expand the behavioral health workforce in recent memory. A collaborative effort with HRSA, this program will set aside $50 million for the recruitment and training of new mental health and substance abuse professionals. Thirty-five million dollars will be used to train professionals to better address the needs of children and adolescents, as well as expand the workforce by close to 4,000 professionals. Ten million dollars will go to strengthening the SAMHSA Peer Professionals training program, as peer recovery workers are quickly gaining recognition as an integral part of the treatment system. Finally, $5 million has been set aside for the expansion of SAMHSA’s Minority Fellowship Program.
In addition to the workforce provisions, “Now is the Time” provides a considerable amount of funding for advancing behavioral health within communities, especially via youth programs. Forty million dollars is designated for state grants to help communities by improving referral systems, so students with mental health and substance abuse disorders can be referred to the services they need. Twenty-five million dollars is slated for the development of strategies to assist young people in the navigation of the behavioral health system.
Of course, this is far, far easier said than done. Keep in mind the minefield we are navigating. If Congress and the White House do not pass a budget in FY 2014 for HHS, and we end up with another continuing resolution, it is doubtful that funding for “Now is the Time” will be available. This is why we as advocates must keep an eye on the larger political picture, and work with others in the health care arena to ensure that HHS gets a complete budget.
Our strategy to protect programs, such as “Now is the Time”, must evolve to work in the current environment. Normally, a reliable strategy would be to support SAMHSA and its programs, and to ask Congress for as much support as possible on that front. Instead, the bigger picture is more deserving of our attention. Avoiding a continuing resolution is critical. As a result we should dedicate our time and resources towards passing the larger HHS bill as well, in an attempt to avoid a CR.
So cue Bette Davis. Fasten your seat belts. It’s going to be a bumpy night.