Breaking recent precedent, the House of Representatives, the Senate and President Barack Obama agreed to a legislative package extending payroll tax relief, unemployment benefits and Medicare physician payment rates more than a week before each was set to expire at the end of February. The House approved the final package by a 293-132 vote on Feb. 17, and the Senate followed suit with a 60-36 vote later that same afternoon.

The package will maintain Medicare’s physician payment rates at current levels through the end of this year, thus postponing what would have been a 27 percent payment cut. The 10-month postponement in the rate cut will cost $18 billion. The high cost of even this stopgap measure indicates why Congress has yet to permanently fix the payment rate problem; eliminating the “sustainable growth rate” formula completely would cost roughly $300 billion over 10 years. Despite lobbying by the American Counseling Association and our coalition partners, the package did not include Medicare coverage of counselors and marriage and family therapists.

Congress paid for the short-term payment rate fix for physicians by cutting billions of dollars in Medicare payments to clinical laboratories as well as “bad debt” payments to hospitals and skilled nursing facilities to cover losses when patients don’t pay their bills. Unfortunately, the package also cuts $5 billion in the Prevention and Public Health Fund established by the Affordable Care Act. The fund is an important investment in keeping Americans healthy and reducing health care costs over the long term. Only a handful of other Medicare provisions besides the physician payment rate were included in the package. It did not include a provision sought by currently covered mental health provider groups to maintain a 5 percent rate increase that had been in effect for outpatient psychotherapy services.

The Medicare physician payment rate issue is expected to be left on the “to do” list for a lame-duck Congress convening after the Nov. 6 elections. Consideration of the multibillion dollar “doc fix” will take place at the same time that other major issues with big fiscal impacts are considered, including the Jan. 1 expiration date for the Bush era tax cuts and $1.2 trillion in automatic spending reductions scheduled to kick in on that same date. This package will be our next target for attaching our provision, and we will be working with counselors through the coming months to make the best use of this opportunity.

President requests more money for VA, zero dollars for ESSCP

President Obama submitted his budget request for Fiscal Year 2013 spending to Congress on Feb. 13. He suggests increasing spending for the Department of Veterans Affairs (VA) by 10.5 percent compared with prior-year levels. A hefty $1.35 billion of VA spending would be directed toward ending homelessness among U.S. veterans, marking a 33 percent increase for these programs. The budget would provide $6.2 billion in funding for mental health treatment, $312 million more than the prior year. It also calls for $54 million in advance appropriations for FY 2014, set aside for the purpose of funding VA medical programs a year in advance in case of a government shutdown.

ACA continues to work with its partners to apply more pressure on the VA to hire additional counselors and marriage and family therapists. ACA staff is meeting with congressional offices to share concerns with federal lawmakers, and we are optimistic everyone will see that a large population of qualified counselors exists to help meet the needs of our nation’s veterans. For more information on issues relating to the VA and counselors, contact Art Terrazas of ACA at or 800.347.6647 ext. 242.

As in previous years, the president’s budget contains no money for the Elementary and Secondary School Counseling Program (ESSCP), which is the only currently existing Department of Education program that provides focused support for school counseling services. Instead, Obama proposes to consolidate ESSCP and other programs into a new, larger “Successful, Safe and Healthy Students” program, which would include student mental health and well-being programs as an allowed use of funds. However, this change and others put forward as part of the budget can take place only if the Elementary and Secondary Education Act is reauthorized, which few analysts expect to happen this year.

ACA encourages school counselors to contact their members of Congress to express support for the ESSCP program. States and localities continue to cut school counseling positions and programs to cope with shrinking budgets that have resulted from the lingering economic climate. School counseling services are vitally important for preparing students to learn and helping them to reach their academic and personal potential. Research shows that lower student-to-counselor ratios correlate to lower frequencies of school discipline problems. The most recent data from the National Center for Education Statistics indicate that the national average student-to-counselor ratio in elementary and secondary schools is greater than 459:1, nearly twice the ratio that ACA recommends. ESSCP is a cost-effective investment in our nation’s future.