Bloomberg Businessweek
To Prevent Massacres Like Newtown's, Expand Medicaid
http://www.businessweek.com/articles/2012-12-19/to-prevent-massacres-like-newtowns-expand-medicaid
Itfs too soon to know what drove Adam Lanza to massacre 26 children and
adults at Sandy Hook Elementary School in Newtown, Conn. But early signs suggest
that serious mental illness played a role. If so, that—alongside another
arsenal—would be a thread connecting last weekfs atrocity with the recent mass
killings in Aurora, Colo.; Phoenix; and Blacksburg, Va.
Since Friday, a wave of outrage and a renewed
desire for gun-control laws have swept the country, including Washington,
D.C. gEnough is enough,h Senator Mark Warner, a Virginia Democrat with an gAh
rating from the National Rifle Association, said on Monday. gI think most of us
realize that there are ways to get to rational gun control.h
Limiting the availability of assault weapons is an obvious and necessary step
to reducing the future likelihood of mass shootings like the one in Connecticut.
But so is maintaining and improving mental health-care services, which have been
severely strained in recent years (and in some areas reduced) and are further
threatened by the fallout from a recent Supreme Court decision and the incipient
deal to avert the fiscal cliff.
The linchpin is Medicaid. Although mainly thought of as a safety-net program
for the poor, Medicaid provides about half of state mental health budgets.
gMedicaid is hands down the most important source of funding for public mental
health services,h says Ron Honberg, the director for policy and legal affairs at
the National Alliance on Mental Illness. But the recession and the
Republican-led effort to slash social spending have put enormous pressure on
those budgets.
Initially, Medicaid fared well during the recession for two reasons.
The 2009 federal stimulus directed billions of dollars to state programs to
prevent cuts, and Obamafs health-care law used Medicaid as a vehicle to expand
coverage, requiring states to enroll people earning up to 138 percent of the
poverty level.
But two things have happened since to turn that around. The stimulus funds
dried up. And the Supreme Courtfs decision on the health-care law, while
preserving the individual mandate to purchase coverage, struck
down the other mandate requiring states to expand their Medicaid programs.
Itfs now optional.
Without the stimulus to fill their Medicaid coffers, states were forced to
cut mental health services and restrict eligibility for care. No evidence has
emerged that Adam Lanza depended on Medicaid; his family appears to have been
financially stable. But care for the non-poor mentally ill—paid for through
state general funds—has been especially hard hit by the recession, because many
states are diverting general funds to preserve their Medicaid budgets and
qualify for federal matching funds.
That has left many severely disturbed people without any coverage. For
example, says Honberg, gIf youfre a non-Medicaid recipient in a state like
Arizona, youfre no longer eligible for public mental health services, even if
you have a diagnosis of schizophrenia. Thatfs a result of the recession and the
budget cuts that have come in its wake.h
Until last month, the biggest threat to Medicaid was Mitt Romneyfs budget,
which sought to cap and block-grant the program. That would have cut benefits by
about one-third within a decade, says Judith Solomon, vice president for health
policy at the Center for Budget and Policy Priorities, a Washington think tank.
Romney may be gone, but entitlement cuts are a major component of the ongoing
fiscal cliff negotiations. As of Tuesday, President Obama was offering to cut
$400 billion over a decade; House Speaker John Boehner was demanding $600
billion. gFurther cuts to Medicaid will have a profoundly negative impact on the
system,h Honberg warns. gIt is the safety net program for lots of
people with serious mental illnesses.h
In the wake of the Supreme Courtfs Obamacare decision, states have been left
to decide whether to expand Medicaid coverage as the health-care law envisioned.
So far, 15
states, including Connecticut, have indicated theyfll do so. Even absent the
mandate, the law offers powerful financial incentives to go along, with the
federal government paying the full cost of new Medicaid enrollees for the first
three years and 90 percent thereafter.
But many Republican governors who opposed the law have announced they will
not participate. Many more remain undecided.
Anyone moved to act by Adam Lanzafs massacre would probably have a greater
near-term impact by pushing states to expand Medicaid coverage rather than
lobbying for new gun laws. Newtown provides a vivid, heart-wrenching example of
how broader coverage might help prevent future tragedies. Even before the
shooting, Nevadafs Republican governor, Brian Sandoval, who opposed Obamafs
health law, cited mental health care as a reason why he decided to accept the
Medicaid funding.
And unlike new gun restrictions, which will be difficult to get through
Congress, Medicaid expansion has already passed into law and requires only
public pressure on politicians to have its maximum positive
effect.