President Donald Trump is calling for a focus on mental health and school safety in response to shootings like the one that took 17 lives in Florida, but his budget would cut funding in both areas.
Trump's latest budget would slash the major source of public funds for mental health treatment, the Medicaid program serving more than 70 million low-income and disabled people. The budget also calls for a 36 percent cut to an Education Department grant program that supports safer schools, reducing it by $25 million from the current level of $67.5 million.
However, some smaller mental health programs would get an increase.
The budget was issued Monday, before the horrific mass shooting at a South Florida high school. Spending priorities often change in response to events that galvanize national attention. In this case, advocates and policy experts said the budget numbers call into question how much value the administration places on mental health.
"Whatever small increases they are asking for is more than offset by the changes they would make to Medicaid," says Andrew Sperling, legislative advocacy director for the National Alliance on Mental Illness.
The budget resurrects a GOP Medicaid plan that failed in Congress last year, which calls for turning the program over to the states and limiting future federal payments. That would mean a cut of about $1.4 trillion over 10 years from projected spending. States would face hard choices over competing priorities like mental health or addiction treatment, nursing home costs or prenatal care for low-income women.
"The only area where I see the budget providing an increase is on the opioid addiction side," says Diane Rowland, a Medicaid expert with the nonpartisan Kaiser Family Foundation. "Not all people who have mental health challenges are going to be substance abusers."
On school safety, the administration wants to slash funding for national school safety initiatives by nearly $25 million in 2019, down from this year's projected funding of $67.5 million.
The administration wants school districts to use these funds on opioid addiction and prevention programs, but Education Department spokeswoman Liz Hill that schools can also spend the money on violence prevention and safety.
"The department is committed to providing resources, direct support and technical assistance to schools who have suffered unthinkable tragedy," Hill says.
The department also has more than $5 million in special emergency response grants that schools can use in the aftermath of shootings and other tragedies. Hill did not address why a cut to the grant program was needed in the first place.
Education Secretary Betsy DeVos on Thursday called on Congress to start a serious national conversation on tackling mental health issues in the aftermath of the deadly Florida high school shooting.
"One of these shootings is one too many and we have got to have an honest conversation and Congress has to lead on this, it's their job," she told conservative host Hugh Hewitt.
A senior Democratic lawmaker involved with health care as well as budget issues said leadership is supposed to come from the White House.
"If the president was serious about stopping the scourge of gun violence...he would work with Congress on common sense gun safety measures, rather than pointing to mental health services and school safety as the only solutions just days after introducing a budget that slashes those very investments," Sen. Patty Murray, D-Wash., said in a statement.
The future of Medicaid under Trump and a GOP Congress is one of Murray's central concerns. The program's role in mental health care was underscored by a Kaiser Foundation study that found the program accounted for 25 percent of what the nation spent in 2014, or more than $46 billion. Medicaid was only slightly behind private payments for mental health care, which accounted for 28 percent.
The administration says states will be able to run Medicaid more efficiently, without sacrificing the health and well-being of their residents. Getting Trump's Medicaid overhaul through Congress would be a tall order, since key Republican governors opposed it last year, and there doesn't seem to have been much effort to get them on board now.
Also, in the mental health area, the administration is highlighting a $15 million budget request for "assertive community treatment," a new approach that seeks to keep people with serious mental health problems from being cycled through jails and emergency rooms. However, Sperling said that program had been already authorized by Congress and focuses on people with a long history of serious illness.
In budget documents, the Trump administration noted that an estimated 43 million American adults met the medical standard for having a mental, behavioral or emotional disorder that substantially interfered with or limited major life activities. Of those, 10 million people had a serious mental illness.