What Happens Next in Washington DC?

Right now it is hard to think about anything beyond the president’s unbelievably offensive statements made on Tuesday in response to the Charlottesville protests and Neo-Nazi terrorist attack that killed one woman and injured many. The statements were broadly condemned by both Republican and Democrat congressional leaders. But what impact will this have on policy?

On the directly related issues, and on its own, the Trump administration continues on its new war on drugs strategy and attacks on immigrants and affirmative action. But none of these issues have been presented for congressional action.

Congress is in recess until after Labor Day. Very few Congressional Republicans have held town hall meetings. Those that have encountered overwhelming objections to their health care proposals which failed to pass the Senate last month.

When Congress returns the main focus will apparently be on tax reform, but we know there will be efforts to cut Medicaid as part of that subject because those cuts can be scored as budget savings which makes it politically easier to lower taxes as Republican leaders will want to do.

Most of our concerns will be back on the table and we will have to resume our advocacy, focusing mainly on the 14 California Republican House members.  While all voted for the house “repeal and replace” bill in May that does not mean they will vote for Medicaid cuts when it is not part of a repeal of the Affordable Care Act – which was a campaign pledge for nearly all  Republican members of congress.

As before, something very bad could emerge from the House which might not have the votes needed in the Senate.

Even before these recent inflammatory statements there was growing discomfort between the president and many senate republicans which should reduce the White House’s ability to exert pressure on individual Senators. However it is unclear whether this will have any impact on what happens.

There is also the bipartisan effort to stabilize the health exchange markets and the uncertainty about where the White House stands on that concept – as well as what it may do on its own to stabilize or destabilize the health exchanges which are dependent upon federal subsidies.

In any event, our work is not done and we cannot assume that there is no longer a threat of losing significant federal support for behavioral health.

Strong Economy Boosts Revenues

 It is only August, so we have a long way to go in this fiscal year. But with the stock market hitting new all-time highs and Silicon Valley and real estate price increases leading the way we should have another strong year for state and county revenues – especially Mental Health Services Act funding which tends to rise almost perfectly in sync with the stock market.

It is the time of the year for state agencies to start developing budget proposals for 2018-19 and there should be a budget surplus that agencies can propose to expend.

It also means counties should be getting more revenue than was assumed when they adopted their budgets. But that may not matter until they do their 2018-19 budgets.

We have expressed concerns many times about the budget assumptions and limitations that county budget departments have imposed upon behavioral health departments who seem to have no say in how those calculations are made.

We will continue with our efforts to get state officials to provide better guidance and longer term revenue forecasts as we continue to hear of counties setting EPSDT spending caps and MHSA budgets that don’t account for all of the revenues that could be made available.

AB 1250 (Jones –Sawyer) destroys behavioral health system

AB 1250 is the bill that seems to make it impossible for counties to contract out for nearly all services including behavioral health despite the fact that 70% of services are currently done by private providers.

It is pending in the Senate Appropriations Committee, which will vote on September 1.  If it is approved there, both houses of legislature must approve it by September 15th to get it to the governor.

There has never been a bill this devastating to our system as it would put most community agencies out of business outside of Santa Clara County and all cities including San Francisco and Berkeley which are exempted for political reasons.

Everyone who cares about behavioral health as well as other health and human services should be alarmed about this bill and contacting their legislators.

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