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Medical Matters
Ken Wilson

Federal budget cuts
threaten individual freedoms

While advancing freedom has become a top foreign policy goal, here at home millions of Americans face the loss of the most basic freedoms under budget cuts proposed by President Bush. The most devastating of those cuts would slash $60 billion from the Medicaid program, a federal-state health-care program that serves, among others, those who have low incomes and experience mental illness. Untreated mental illness robs many people of the most basic aspects of freedom, freedom to participate fully in the community. Yet the administration's proposal would rip apart the Medicaid safety net that now provides needed mental health treatment to millions who have no other sources of care, and expose them to cuts in services or outright denials of care. For many with mental illness, such a policy choice could result in job loss, school failure, family breakup, homelessness and even suicide.

In addition to cutting federal Medicaid funding, the president's budget calls for fundamentally changing the Medicaid program. Rather than meeting the needs of all beneficiaries, Medicaid -- under the budget proposal -- would retreat from its commitment to some of these people, many of whom have disabilities, high medical costs, and incomes at or below the poverty level. Administration spokesmen indicate that likely targets will be needy individuals they dismiss as mere "optional beneficiaries," as though they have the option not to have a chronic illness or disability.

These proposals would place many who have mental illnesses at profound risk. A Medicaid cut is tantamount to a cut in mental health services, because Medicaid is the single largest source of financing for mental health care. Medicaid provides more than half of state and local spending on mental health services, covering critical services including hospital care, outpatient treatment, psychosocial rehabilitation and prescription drug coverage.

Cuts to Medicaid are not new. But too often, mental health services are among the first to be slashed. Such cuts have reduced crucial benefits, increased out-of-pocket costs for the poor and near poor, and restricted access to desperately needed medications.

In urging Congress to savage the Medicaid program, Bush is retreating from a key goal in his State of the Union address, to provide "families greater access to good coverage and more control over their health decisions." Plainly, the president's Medicaid policies would have just the opposite effect. New federal policies that make it more difficult for those with mental illness to get needed care and hold employment surely do not advance the "ownership society" and individual liberties this administration seeks to foster.

In addition to being extremely cruel and unfair to individuals with mental illness and other disabilities, Medicaid cuts are fiscally irresponsible. Limiting Medicaid services would not reduce costs, but simply transfer them to already overburdened hospital emergency rooms, homeless shelters or even jails. Clearly, our communities will bear the costs the federal government seeks to shirk.

President Bush was right when he said the choices we make today will determine the type of society we leave for our children and grandchildren. What kind of society is it that would turn its back on people who need care for a mental illness? Surely that is not the legacy we want to give future generations, or the vision of freedom we want to uphold.

Ken Wilson is executive director of the Mental Health Association in Hawaii in Honolulu. The MHA, an affiliate of National Mental Health Association, is a nonprofit organization addressing all aspects of mental health and mental illness.

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