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House Appropriations Committee Approves Labor, Health and Human Services, and Education Spending Bill

On July 11th, the House Appropriations Committee marked up and approved its FY 2008 Labor, Health and Human Services, and Education (Labor HHS) spending bill. The funding bill includes $153.7 billion in discretionary funds, which represents a 6.2 percent increase from FY 2007 funding levels and $12 billion more than President Bush’s FY 2008 budget request. The Labor HHS spending bill was previously approved by the House Appropriations Labor HHS Subcommittee on June 7th. The Senate Appropriations Committee approved its Labor HHS funding bill on June 21st.

Under the House Appropriations Committee funding bill, the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment Block would receive a significant increase over last year’s spending level. In addition, the Committee-approved spending bill does not include cuts to SAMHSA’s Centers on Substance Prevention and Treatment that were proposed in the President’s FY 2008 budget.

Under the House Appropriations Committee spending bill, drug and alcohol education, prevention, treatment and research programming would receive the following amounts:

The Substance Abuse Prevention and Treatment (SAPT) Block Grant would receive $1.794 billion, a $35 million increase over FY 2007 funding levels. Under the Labor HHS spending bill approved by the Senate Appropriations Committee, the SAPT Block Grant would receive $1.7586 billion, funding level to last year and to the President’s FY 2008 budget request.

The Center for Substance Abuse Treatment (CSAT) would receive $399.3 million, a $328,000 increase over FY 2007 funding levels. The Senate Appropriations Committee recommended that CSAT receive $425.6 million, a $26.7 million increase over last year’s funding and $73.5 million over the President’s budget request. Under both the House and Senate Committee-approved funding bills, the Access to Recovery program would receive $100 million, level to last year’s funding.

The Center for Substance Abuse Prevention (CSAP) would receive $192.9 million, funding equal to FY 2007 levels. The Senate Appropriations Committee has recommended that CSAP receive $197.1 million, a $4.2 million increase over last year’s funding and $40.6 more than the President’s budget request.

Under both the House and the Senate Committee-approved bills, the Safe and Drug-Free Schools State Grants program would receive $300 million, $46.5 million less than FY 2007, and $200 million more than the President’s budget request.

The National Institute on Drug Abuse (NIDA) would receive $1.016 billion, a $14.9 million increase over FY 2007 spending. The Senate Appropriations Committee recommended that NIDA receive $1.0226 billion, a $23.6 million increase over last year’s funding and $22.6 million over the President’s budget request.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) would receive $443 million, a $6.6 million increase over FY 2007. The Senate Appropriations Committee recommended that NIAAA receive $445.7 million, a $9.7 million increase over FY 2007 and $8.7 million over the President’s budget request.

Both chambers of Congress are expected to remain in legislative session until Friday, August 3rd. It is unclear whether the full House and Senate will vote on the Labor HHS spending bills prior to the August recess or after Congress returns after Labor Day.

The status and text of the House and Senate Labor HHS spending bills can be found at: http://thomas.loc.gov/.

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House Appropriations Committee Approves Department of Justice Funding Bill

On July 12th, the full House Appropriations Committee reviewed and approved its FY 2008 Commerce, Justice and Science (CJS) funding bill. This funding bill includes a number of programs in the Department of Justice (DOJ) that serve people with drug and alcohol histories and people with criminal records. Under the Committee-approved bill, these programs would receive the following funding levels:

The Residential Substance Abuse Treatment (RSAT) program, which helps states and localities to develop and implement residential substance abuse treatment programs in state and local correctional and detention facilities, would receive $10 million, $2 million more than last year’s funding, and equal to the Senate Appropriations Committee’s request. The President had not requested any funding for the RSAT program in his FY 2008 budget.

The Drug Court program, which provides financial and technical assistance to state and local governments and courts to develop and implement treatment drug courts, would receive $40 million, an increase of $30 million over last year’s funding. The Senate Appropriations Committee recommended that the Drug Court program receive $25 million, a $15 million increase over last year’s funding amount. The President’s FY 2008 budget included a proposal to consolidate a number of DOJ programs into one program, including the Drug Court program and did not include a specific recommendation for its funding level.

The Mentally Ill Offender Act, which grants resources to states and local areas to foster collaborations within the criminal and juvenile justice system for nonviolent adults or juveniles who have a mental illness or co-occurring mental illness and substance abuse disorder and face criminal charges that are the product of the person's illness, would receive $10 million, a $5 million increase from last year’s funding, and an amount equal to the Senate Appropriations Committee recommendation. This program was one of the programs that the President proposed be combined with other DOJ programs in his FY 2008 budget.

The Enforcing Underage Drinking Laws (EUDL) Program, which helps States to develop comprehensive and coordinated initiatives to enforce State laws that prohibit underage drinking, would receive $25 million, an amount level to last year’s funding and equal to the Senate Appropriations Committee request. This program was slated for elimination in the President’s FY 2008 budget.

The Byrne Justice Assistance Grant (JAG) program, which funds programs providing a number of different prevention, education, community corrections and drug treatment services, would receive $600 million, an $80 million increase. The Senate Appropriations Committee recommended that this program receive $660 million, a $140 million increase over last year’s funding. The JAG program was one of the programs that the President proposed be combined with other DOJ programs in his FY 2008 budget.

The FY 2008 funding process is expected to continue moving forward prior to the August Congressional recess; it is unclear, however, whether the full House and Senate will review the DOJ funding bills during the month of July or when Congress returns in September. Additional information about the FY 2008 funding process for programs in the Department of Justice can be found at: http://thomas.loc.gov/.

House Subcommittee Holds Hearing on Mental Health and Addiction Parity Legislation; Full Committee Votes for Passage

Subcommittee Hearing

On July 10th, the House Education and Labor Subcommittee on Health, Employment, Labor and Pensions held a hearing to discuss H.R.1424, the "Paul Wellstone Mental Health and Addiction Equity Act." The hearing was lead by Subcommittee Chairman Robert Andrews (D-NJ) and Ranking Member John Kline (R-MN). Witnesses providing testimony included: Congressmen Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), chief sponsors of the legislation; former First Lady Rosalyn Carter, chairwoman of the Carter Center's Mental Health Task Force; David Wellstone, son of former Senator Paul Wellstone (D-MN); Sean Dilweg, Wisconsin insurance commissioner; Amy Smith, a woman who suffered from untreated mental illness due to lack of insurance coverage; Steve Melek, actuary for Milliman & Robertson; Neil Trautwein, employee benefits policy counsel for the National Retail Federation; and Jon Breyfogle, from the Groom Law Group.

In his opening statement, Chairman Andrews underscored the importance of passing parity legislation by asserting that of the 44 million Americans who suffer from a mental health disorder, only one-third of these individuals receive treatment. Of those individuals not receiving treatment, Chairman Andrews stated that over eighty percent were precluded because of cost. Ranking Member Kline agreed with Chairman Andrews that there must be parity, but expressed three major concerns with H.R. 1424. Congressman Kline claimed that H.R. 1424 contained an employer mandate which he objected to; in addition, Congressman Kline expressed his concern that H.R. 1424 wouldn’t preempt state laws, which, he argued would subject employers to multiple laws, and also expressed his opposition to the broad definition of illnesses in the DSM-IV, that Congressman Kline claimed, would make medical management difficult.

In their testimony to the Subcommittee, Congressmen Kennedy and Ramstad discussed their own experiences with addiction and mental illness, and urged the Subcommittee to act quickly to allow millions of Americans to benefit from the same treatments. Congressman Kennedy stressed the fact that treatment would increase productivity by allowing those suffering from lack of treatment to become contributing members of society. He argued that Congress needs to recognize that addiction and mental illness are not the result of a moral failing but are treatable diseases. At its core, Congressman Kennedy argued, parity is a civil rights issue and if Congress does not move now, more people will lose their lives to these diseases. In his testimony, Congressman Ramstad echoed Congressman Kennedy's call for action by citing the 270,000 people denied mental health treatment last year, the 150,000 people who died of addiction, and the 34,000 people who committed suicide. Congressman Ramstad stressed that the cost to society of not passing parity legislation cannot be measured in dollars and cents, but in lost lives. Both Congressmen expressed that expanding access to mental health and addiction treatment services would only result in a nominal price increase to insurance companies and employers.

Former First Lady Rosalyn Carter discussed her work with the Carter Center's Mental Health Task Force for the last thirty-five years. Mrs. Carter expressed her opinion that the lack of parity is a fundamentally stigmatizing inequity that is unconscionable and morally unacceptable. The lack of insurance coverage for mental health and addiction, Mrs. Carter argued, sends the message to people suffering from those diseases that they are unworthy of care. Mrs. Carter stated that all diseases in the DSM-IV are potentially devastating and deserving of care. Mrs. Carter concluded her testimony by stating that when this legislation passes, the nation will be stronger as the benefits of parity are enormous.

Mr. David Wellstone opened his testimony by saying that nothing represents his father's efforts in the Senate better than parity legislation. Mr. Wellstone stated that he believed the two most important parts of H.R. 1424 are the basis in scientific knowledge by using the DSM-IV as the basis for coverage, and the protection of stringent state parity laws. Mr. Wellstone further stressed the overall low cost of parity and the benefits of lowering stigma and discrimination against those with mental illness and addiction.

Ms. Amy Smith spoke as a person with mental illness who did not have access to treatment for forty-five years. After suffering and living with essential treatment services for many years, Ms. Smith spoke about her experiences in the community mental health system, having received treatment for her mental illness. Ms. Smith spoke about how, after receiving treatment, she has full custody of her son and is the Vice President of the Mental Health Association of Colorado.

Mr. Neil Trautwein from the National Retail Organization spoke in opposition of H.R. 1424, stating that his organization prefers the Senate version of the bill. Mr. Trautwein expressed that the National Retail Organization opposes H.R.1424 because, he argued, it fails to protect medical management, and contains provisions that allow the states to enact even more extensive provisions and those that mandate out-of-network-coverage. Mr. Trautwein acknowledged the cost increase would be negligible, but urged the Subcommittee to adopt provisions from S. 558 to address the concerns of small business owners.

Mr. Steve Melek testified briefly on Milliman, Inc.'s findings regarding an actuarial analysis on the impact of insurance parity. According to the findings, the cost of a typical HMP and PPO group benefit plan would increase by 0.6% or less per capita, and insured out-of-pocket costs would decrease by 18%. Mr. Melek expressed that he and Milliman, Inc. do not endorse legislation.

Mr. Sean Dilweg, the Insurance Commissioner from Wisconsin, spoke in support of H.R. 1424, especially speaking in favor of the legislation’s lack of state law preemption provisions. Mr. Dilweg expressed concern regarding the preemption language in S. 558, stating that it would be problematic for Wisconsin, and the 46 states requiring some level of mental health coverage.

Full Committee Action

On Wednesday, July 18th, the House Education and Labor Committee voted to approve H.R. 1424 by a vote of 33 to 9, with all Democrats and several Republicans voting in favor of the bill. During the Committee review of H.R. 1424 Representative Kline (R-MN) offered an amendment that would have substituted the current version of H.R 1424 with a version that more closely resembled Senate bill S.558, however the amendment was not approved.

H.R. 1424 was introduced on March 9th, has 268 bi-partisan co-sponsors and has been referred to the House Education and Labor, Energy and Commerce, and Ways and Means Committees for review. The Senate version of the bill, S. 558, has been approved by the Senate Health, Education, Labor and Pensions (HELP) Committee and is awaiting review by the full Senate. Full text and status of H.R. 1424 can be found at: http://thomas.loc.gov/. Full witness testimony and Member statements from the House Health, Employment, Labor, and Pensions Subcommittee hearing can be found at: http://edworkforce.house.gov/hearings/help071007.shtml.

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Two Pieces of Legislation Aimed at Improving Access to Veterans’ Health Services Introduced in Congress; Bills Contain Provisions for Mental Health and Addiction Treatment Services

Recently in Congress, two pieces of legislation were introduced that seek to improve health care services for veterans; both bills include provisions aimed at improving access to mental health and/or addiction treatment services.

On June 22nd, Senators Olympia Snowe (R-ME) and Blanche Lincoln (D-AR) introduced S. 1682, the "Servicemembers' Healthcare Benefits and Rehabilitation Enhancement Act of 2007." S. 1682 seeks to better assess the mental health of members both before and after deployment, to improve the management of medical care for members of the Armed Services, and to increase efficiency of the disability evaluation system.

S. 1682 would require the Secretary of Defense to assess the mental health of each member of the Armed Forces who is deployed to a combat theater or who is expected to be deployed. First, the bill would require mental health screening of each member at least once during the 120 days before deployment. Another screening would be required within the 60-day period following the return from deployment. A final screening would occur during the pre-discharge physical of a member. The mental health assessment would test the neurocognitive functioning of each member and would also include a comprehensive screening for traumatic brain injury.

In addition, S. 1682 seeks to improve the management of medical care for members of the Armed Services by requiring that both a Medical Care Manager and a Caseworker be assigned to each recovering service member. S. 1682 would also require the Department of Defense to look at all disabilities, injuries, illnesses, and diseases a member incurred or aggravated while on active duty in order to determine an overall level of disability.

In addition, the legislation would require the Department of Defense medical centers adopt the use of electronic medical records, preferably similar to those used by Veterans' Affairs.

On June 27th, Congressman Michael Michaud (D-ME) introduced H.R. 2874, legislation seeking to amend title 38 of the United States Code to provide better health care to veterans. The "Veterans' Health Care Improvement Act," which has 17 Democratic co-sponsors, would require improvements in readjustment and mental health services for veterans returning from Afghanistan and Iraq.

If approved, H.R. 2874 would require the Secretary of Veterans' Affairs (VA) to establish a program to provide peer outreach services, readjustment, and mental health services to veterans from Iraq and Afghanistan. The Secretary could contract with clinicians of community mental health centers and other entities to provide counseling only after civilian clinicians received training to recognize the unique experience of veterans returning from Iraq and Afghanistan. Additionally, community health centers would be trained regarding best practices and technologies. Support would be given to immediate family members through the dissemination of educational materials regarding mental health issues, including the signs and symptoms of post-traumatic stress disorder. Individual counseling and mental health services would be provided for up to three years for family members of veterans, with the time period beginning when the member first sought treatment.

In order to assist returning veterans at risk of not seeking mental health services, the Secretary would be required to establish and implement a pilot program to provide confidential readjustment counseling and mental health services at centers other than VA department facilities. The Secretary would compile a list of mental health care providers for veterans as well as a non-currency form of payment that would provide three visits to mental health providers outside of the VA. The non-currency payment would allow veterans to avoid out-of-pocket costs offered by the VA, but also receive confidential care. Following the establishment of such a program, the Secretary would by required to submit a report on the program's effectiveness and supply recommendations. A separate report regarding VA services as a whole would also be required.

H.R. 2874 would also authorize a supportive services financial assistance program for very low-income veteran families residing in permanent housing; the legislation defines supportive services as including diagnosis, treatment and counseling for mental health and substance abuse disorders and for post-traumatic stress disorder.

Following its introduction, S. 1682 was referred to the Armed Service Committee, where it awaits review. On July 11th, the House Veterans' Affairs Subcommittee on Health approved H.R. 2874 by voice vote; the full House Veterans’ Affairs Committee is next slated to review the legislation. Full text and status of both bills can be found at: http://thomas.loc.gov/.

Representative Bobby Scott Convenes Summit on Violent Crime-Prevention and Solutions

On June 21st and 22nd Representative Bobby Scott (D-VA), Chairman of the House Judiciary Subcommittee on Crime, Terrorism and Homeland Security convened a forum to discuss the reality of crime today in the United States and the possible solutions to address the issue. The event featured several panels that spoke on a range of issues of relevance to the addiction prevention and treatment field. One panel, entitled “Juvenile Justice Reform and Early Intervention and Prevention” discussed strategies for addressing issues of court involved youth and improving the juvenile justice system. Amongst the many speakers were Dr. Robert Hahn, who highlighted suggestions from a Guide to Community Preventive Services Division of Health Communications; Jeffrey Butts, a research fellow at the Chapin Hall Center for Children; Jason Zeidenberg, Director of the Justice Policy Institute; Alfred Blumstein, professor at the H. John Heinz III School of Public Policy; and Nancy Gannon Hornberger, Executive Director of the Coalition for Juvenile Justice. A subsequent panel entitled, “Beyond Lengthy Incarceration: Effective Punishment and Reentry into the Community”, discussed new alternatives to dealing with court involved individuals and included a particular emphasis on what has not worked in the criminal justice system to reduce recidivism. The featured speakers for this panel were, Gene Guerrero, a Senior Policy Analyst with the Open Society Policy Center; Dr. Timothy P. Condon, the Deputy Director of the National Institute on Drug Abuse (NIDA); Roberta Meyers-Peeples, Co-director of the Legal Action Center’s National H.I.R.E. Network; Julie Stewart, President of Families Against Mandatory Minimums (FAMM); Andy Block, Founder and Legal Director of the JustChildren Program; and Alexa Eggleston, the Director of National Policy at the Legal Action Center.

A number of panelists cited the link between drug use and addiction and crime. In addition, panelists cited the high percentage of incarcerated people who are addicted to alcohol or other drugs or who have a mental illness and noted that incarceration has not been successful in resolving drug addiction. Alexa Eggleston of the Legal Action Center, citing SAMHSA data, noted that nearly 20 million Americans are in need of drug and alcohol addiction treatment services. Dr. Timothy Condon of NIDA testified that instead of increased incarceration, studies show that drug addiction treatment can cut drug abuse in half, reduce criminal activity up to 80 percent and reduce arrests up to 64 percent. In addition, Dr. Condon stressed NIDA’s finding that in order to resolve our nation’s drug addiction problem and consequently in order to reduce crime, policymakers must acknowledge that drug addiction is a brain disease that affects behavior and that recovery from drug addiction requires effective treatment, followed by management of the problem over time. Dr. Condon also spoke about how the criminal justice system must begin tailoring services to fit the needs of the individual so that that individual can find a path to recovery.

A number of panelists testified about drug laws and mandatory minimums. Julie Stewart of FAMM testified that one solution to the cyclical problem of increased incarceration and thus increased violence would be a repeal of the mandatory minimum laws, which remove a judge’s power in sentencing, and which were re-instated in the 1980s as a part of the government’s war on drugs. In his testimony, Alfred Blumstein further argued that during the mid 1980s and the rise of the crack-cocaine epidemic the criminal justice system attempted to address concern about violence and desire for justice by establishing the 1986 Anti-Drug Abuse Laws. Mr. Blumstein stated that the increased incarceration which followed was futile in preventing the spread of addiction and related crime and instead led to higher rates of violence. Mr. Blumstein also highlighted that the 1986 Anti-Drug Abuse Laws created a disparity ratio of 5:1 between crack and cocaine, resulting in a clear racial dynamic, wherein crack offenders, who were primarily African-American, as opposed to cocaine offenders, primarily white and Hispanic, were incarcerated at much higher rates. In her testimony, Roberta Meyers-Peeples of the National HIRE Network also discussed the relationship between race and the criminal justice system, also pointing out that incarceration follows with the clear racial disparities faced in education, the workforce and political representation. Ms. Meyers-Peeples advocated for the development of community re-integration programs which would allow individuals to break the cycle and become contributing citizens.

In statements, several panelists discussed concern with a failing criminal justice policy, evident in the 500 percent increase in the prison population since the 1980s, which has not led to a significant reduction in violent and drug related crime. Jason Zeidenberg of the Justice Policy Institute highlighted that despite an overall decrease in crime in the past ten to fifteen years, based on FBI Uniform Crime Reports, nationwide, violent crime rose 2.3 percent between 2004 and 2005, and that the trend appeared to continue in 2006, as violent crime rose 3.7 percent between the first six months of 2005 and the same time period in 2006. Gene Guerrero of OSI pointed out that despite the unparalleled incarceration rates in our nation, the rate is expected to continue to increase; by the year 2011 it is estimated that one in every 178 persons will be imprisoned.

Moreover, panelists discussed juvenile justice and the focus on gangs and violence. Panelists cited a recent Justice Policy Institute report that found that increased imprisonment could negatively impact youth who may otherwise age out of delinquent behavior, and aggravate public safety goals. The report also highlighted that the increase in gang violence might have a correlation with the failing education system in communities where the violence is widespread and that the President’s proposed budget cuts of 25 percent for juvenile justice programs could lead to the closing of the Office of Juvenile Justice and Delinquency Prevention (OJJDP), which works to reduce youth crime and make communities safer. In her testimony, Nancy Hornberger spoke of the many problems facing the juvenile criminal justice system, arguing that many of the youth who go through the system often suffer from untreated mental and behavioral health issues. Moreover, Ms. Hornberger testified that that transfer of nearly 250,000 juveniles to adult systems means that many of them will not benefit from programs and treatment designed for incarcerated youth in juvenile programs. In his statement, Andy Block agreed with Ms. Hornberger, criticizing the federal laws approved in the 1980s that gave prosecutors discretion to determine where youth should be incarcerated, rather than allowing judges to assess the situation and make a decision based upon the circumstances of the crime. Mr. Block argued that this shift has caused for a lack of transparency within the juvenile criminal justice system and has led to increasingly uneven results.

Full testimony of the Crime Summit’s panelists can be found at: http://judiciary.house.gov/committeestructure.aspx?committee=6.

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House Subcommittee Holds Hearing on the Workforce Investment Act; Subcommittee Members Discuss Improving Job Training for People with Barriers, Including Those with Criminal Records

On June 28th, the House Education and Labor Subcommittee on Higher Education, Lifelong Learning, and Competitiveness held a hearing entitled, “Workforce Investment Act: Recommendations to Improve the Effectiveness of Job Training." Subcommittee Chairman Ruben Hinojosa (D-TX) led the hearing, which focused on reauthorization of the Workforce Investment Act and recommendations on how to improve the effectiveness of job training. Individuals providing witness testimony to the Subcommittee included: Dr. Sigurd Nilsen, the director of the Education, Workforce and Income Security Issues Government Accountability Office; Dr. Rachel Gragg, the Federal Policy Director of The Workforce Alliance; Ms. Evelyn Ganzglass, the director of the Workforce Development Center for Law and Social Policy; Dr. Sandra Baxter, the director of the National Institute for Literacy; Mr. Wes Jurey, the President and CEO of the Arlington Texas Chamber of Commerce; Mr. Bruce Ferguson, Jr., the President and CEO of Worksource. Subcommittee members participating in the hearing included Congressmen John Yarmuth (D-KY) and Bobby Scott (D-VA).

In his opening statement to the Subcommittee, Chairman Hinojosa spoke about the importance of WIA maintaining a focus on those with barriers who were most in need of the job training services provided. Specifically, Chairman Hinojosa spoke about the need for WIA services to provide support for English language learners, adults with disabilities, migrant and seasonal farm workers, adults with low levels of education and low levels of literacy and others seeking additional help in reaching their workplace goals. In his comments to the Subcommittee Congressman Scott also spoke about the need to ensure that WIA services are accessible to people with barriers to employment. Congressman Scott discussed the need to increase capacity for workforce programs, highlighting training and education as necessary services. In addition, Congressman Scott pointed out that a large number of individuals needing job search and training activities are previously incarcerated people. Questioning whether WIA’s programs were designed to deal with the barriers that formerly incarcerated people face, Congressman Scott advocated for improvements to be made to ensure that WIA’s services address the employment needs of people with criminal records.

Dr. Sigurd Nilsen testified that the Workforce Investment Act (WIA) was designed to address workforce labor concerns, particularly in areas of low work concentrations. In her report, Dr. Nilsen explained that WIA was enacted in 1998 and was divided into programs focusing on three groups of workers: adult, youth, and dislocated workers. Further, Dr. Nilsen discussed WIA’s three-tiered program services structure; the types of services are offered in order of the needs of the individual, Dr. Nilsen explained, and in order for individuals to obtain more intensive services, they must demonstrate their inability to find work through the previous methods. In addition, some of the witnesses discussed that performance measurement reporting requirements in the WIA system could be acting as an incentive for providers to work with the “easiest to serve” potential workers and to discourage service for individuals with barriers to employment.

A number of the panelists noted that proper education and training were essential tools which many of the jobseekers lacked. In her testimony to the Subcommittee, Dr. Sandra Baxter spoke about the need for improved education programs for adults and young adults, signaling that more than 55 percent of adults had basic or below basic quantitative literacy skills, as well as, 43 percent of adults who had basic or below basic prose literacy skills. Moreover, the witnesses noted that, as jobseekers are often lacking in basic skills which might enable them to get a better and stable job, many of the employers were in fact hesitant to hire workers if they did not feel as though their business/organization would profit from the work in the end.

Full witness testimony and member statements can be found at: http://edworkforce.house.gov/.

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