Fundamental changes are being considered to Medicaid, which is the key component of the nation’s health care safety net. Members of Congress and President Obama have begun working toward an agreement to raise the nation’s debt limit, but time is running out before the limit is reached and the federal government begins defaulting on its financial obligations. Republicans in the House of Representatives are demanding deep longterm spending cuts as a precondition for approving a debt limit increase.

The budget proposal the House approved for Fiscal Year 2012 (H.Con. Res. 34) would end Medicare as it is known today. When individuals reach eligibility, they would be given a voucher with which to buy their own insurance in the private health care market. The size of the voucher would not keep pace with health care cost inflation, and beneficiaries’ out-of-pocket costs would almost double. This fundamental change in the Medicare program has become one of the more well-known — and unpopular — aspects of the Housepassed budget proposal, but similar changes are being discussed for the Medicaid program.

Medicaid was established at the same time as Medicare, in 1965. While Medicare covers 39 million people age 65 and older, plus another 8 million adults with permanent disabilities, Medicaid covers roughly 30 million children, 14 million low-income parents and adults, and another 14 million older adults and individuals with disabilities who need assistance covering their Medicare out-ofpocket costs.

The House budget resolution (aka the “Ryan Budget,” named for its author and House Budget Committee Chair Paul Ryan of Wisconsin) would cut Medicaid spending by $750 billion over 10 years and turn it into a block grant program. Beginning in 2013, states would receive a fixed contribution from the federal government, based on population growth and the consumer price index, to operate their Medicaid programs. According to the Congressional Budget Office, Medicaid would be cut in half by 2030 under this proposal.

In part because of its drastic effect on the viability of the Medicaid program, the Senate rejected the House-passed budget by a 57-40 vote on May 25. Nevertheless, policymakers are still attempting to make deep cuts in spending, and if defense and Medicare spending are kept off the chopping block, Medicaid may be at risk. Another proposal that threatens Medicaid is the idea of capping federal spending at a certain percentage of gross domestic product. Sen. Jay Rockefeller (D-W.Va.), a leading champion for Medicaid, considers this proposal as dangerous as turning Medicaid into a block grant because the spending cap would not take into account trends such as the aging of the population or health care cost increases.

Medicaid is the largest source of funding for mental health services, but because mental health and substance abuse services are classified as “optional,” states likely would be forced to cut these services under any significant reductions in federal support.

House education panel votes to end counseling program

Two bills demonstrate the diverging views of education reform among House members. On May 25, the House Committee on Education and the Workforce approved H.R. 1891, the Setting New Priorities in Education Spending Act, by a party-line vote of 23- 16. The goal of the legislation is “to repeal ineffective or unnecessary education programs in order to restore the focus of Federal programs on quality elementary and secondary education programs for disadvantaged students.” Sadly, among roughly 40 programs labeled “ineffective or unnecessary,” the legislation would get rid of the Elementary and Secondary School Counseling Program (ESSCP), the High School Graduation Initiative and the Arts in Education program. Rather than simply not funding the programs, H.R. 1891 would erase them from federal statute.

During consideration of the bill, Rep. Dave Loebsack (D-Iowa) offered an amendment to maintain school counseling services by expanding access to qualified school counselors and other qualified providers, supporting collaborative efforts between schoolbased service systems and mental health services systems, and supporting drug abuse and violence prevention programs. Unfortunately, Loebsack’s amendment was defeated by a party-line vote of 23-16.

The same day that H.R. 1891 was approved by committee, Loebsack introduced the Reducing Barriers to Learning Act of 2011 (H.R. 1995), which would establish an Office of Specialized Instructional Support within the U.S. Department of Education. The legislation would also authorize a competitive matching grant program for states to use in establishing and expanding specialized instructional support programs and services to address barriers to learning as well as to hire and support school counselors and other specialized instructional support personnel. The American Counseling Association applauds Loebsack for his work in championing school counseling services.

Counselors are encouraged to ask their representatives to cosponsor both H.R. 1995 and H.R. 667 (the Put School Counselors Where They’re Needed Act), while opposing H.R. 1891 and its elimination of ESSCP. School counseling services are often first on the chopping block when state and local governments run into budget problems. Congress’ work on reauthorizing federal education programs has just begun, and with grassroots support, we can maintain funding for school counseling services