The Labor, Health and Human Services, and Education appropriations bill that was passed by the appropriations subcommittee in the U.S. House of Representatives last week and that is scheduled to be marked up in the full U.S. House appropriations committee this week provides more funding for Medicaid, substance abuse prevention and treatment, and primary health care and community health centers that should provide health care to homeless people and other low-income people, but the bill surprisingly decreases funding for mental health and for cross-cutting activities that supplement mental health, substance abuse treatment, and substance abuse prevention activities.

Overall, the House Labor, HHS, and Education appropriations bill provides a total of $73.2 billion for the Department of Health and Human Services, an increase of $2.6 billion above the fiscal year (FY) 2016 level and $3.5 billion above the President’s budget request.  In particular, it provides $4.2 billion in funding for the Substance Abuse and Mental Health Administration, an increase of $431 million above the FY2016 enacted level and $480 million above the President’s budget request, provides $6.1 billion for the Health Resources and Services Administration, a decrease of $218 million below the FY2016 enacted level and an increase of $168 million above the President’s budget request, and provides $3 billion for the Centers for Medicare and Medicaid Services, a decrease of $576 million below the FY2016 enacted level and $1 billion below the President’s budget request.

For primary health care and community health centers, the House bill provides $1.491 billion, which is an increase of $300,000 compared to the FY2016 enacted level and $149 million more than the budget request.  The House bill does not contain the additional $150 million in mandatory funding that the Administration requested for FY2017.  This additional funding could be used to provide additional health care to patients at community health centers who may not otherwise have access to preventive care, diagnosis, or treatment for conditions such as HIV/AIDS, cancer, chronic liver disease, cardiovascular disease, diabetes, asthma, and chronic lung disease as our health care report released earlier this year illustrated.

For mental health, the House bill provides $1.26 billion for mental health and $21.0 million for related technical assistance and evaluation, which is a total of $7 million less than the FY2016 enacted level and $1 million less than the budget request.  With HUD data showing that more than 100,000 homeless persons were experiencing a serious mental illness, including at least 44,000 living without shelter on the streets and at least 59,000 residing in emergency shelters or transitional housing on a given night in 2015, the House should include at least this $7 million in funding for mental health programs.

The House bill provides significant new funding for substance abuse prevention and treatment for opioid abuse, including heroin abuse, but less funding for substance abuse treatment in general.  The House bill provides $500 million in new funding specifically for the prevention and treatment of opioid abuse, including heroin abuse, and related health conditions.  Yet, the Houses bill provides $2.108 billion under the substance abuse treatment heading, which is $6 million less than the FY2016 enacted level and $31 million less than the budget request.  It is unclear for which related health conditions the $500 million in new funding can be used, but these funding levels may result in reduced funding to treat non-opioid drug abuse.  With more than 100,000 homeless persons experiencing chronic substance abuse, including at least 43,000 living without shelter on the streets and at least 60,000 residing in emergency shelters or transitional housing on a given night in 2015 and many other Americans dealing with and dying from non-opioid substances, the House should provide sufficient funding for non-opioid drug abuse as well.

For health surveillance and program support for mental health, substance abuse treatment, and substance abuse prevention, the House bill provides $131.4 million for program support and $31.4 million for national surveys, which is $43.4 million less for program support than the FY2016 enacted level.  For the reasons given above concerning mental health and substance abuse, the House should include this $43.4 million in funding in the Labor, HHS, and Education appropriations bill to prevent and treat mental health and substance abuse.

For grants to states for Medicaid, the House bill provides $387.2 billion, which is an increase of $28.1 billion compared to the FY2016 enacted level and the same level as in the budget request.  The House bill does not provide the funding requested for states that choose to expand Medicaid and receive three full years of federal support as previously-expanding states have received.  With millions of Americans and hundreds of thousands of homeless Americans without health insurance, the House should provide the estimated $430 million in FY2017 so that more Americans may be able to receive health care for which they cannot otherwise receive in newly-
expanding states.

In summary, to save the lives of many Americans and prevent and end homelessness for many Americans, the House appropriations committee should provide at least $150 million in additional funding for community health centers, $7 million in additional funding for mental health treatment, $6 million in additional funding for substance abuse treatment, $43.4 million in additional funding for program support for mental health, substance abuse treatment, and substance abuse prevention, and provide $430 million to ensure three full years of federal support for newly-expanding Medicaid states when it considers the Labor, Health, and Education appropriations bill.