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News and Notes   |    
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.8.1035
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In recent years the Medicaid program has been called a "Pac Man," eating up state and federal budgets. Calls for reform have emphasized the "Medicaid crisis" and the necessity of Medicaid cuts. The threat of cuts has alarmed mental health care consumers and providers, because Medicaid is a major source of funding for mental health care.

However, public attitudes toward Medicaid are remarkably positive, and opposition to cuts is reasonably strong, according to a public opinion survey released by the Kaiser Family Foundation. "We expected Medicaid to be relatively unpopular with the public, much like welfare was. But we found that Medicaid ranks closer to popular programs like Medicare and Social Security in the public's mind," said Mollyann Brodie, Ph.D., vice-president and director of public opinion and media research for the foundation.

Almost two-thirds of Americans believe that their state's budget is either in crisis or has major problems, and about a third believe that Medicaid costs are a major reason for those budget problems. However, 52 percent say they "strongly" oppose and another 22 percent "somewhat" oppose cutting back on their state's Medicaid program to balance the budget. Just two in ten either "strongly" (5 percent) or "somewhat" (17 percent) support Medicaid cuts to help balance state budgets. Majorities of Democrats (65 percent strongly, 16 percent somewhat), independents (52 percent strongly, 23 percent somewhat), and Republicans (36 percent strongly, 29 percent somewhat) say they would oppose such cuts, the survey found.

Nearly three-quarters (74 percent) of adults say Medicaid is a "very important" government program, ranking it close to Social Security (88 percent) and Medicare (83 percent), equal to federal aid to public schools (74 percent), and above defense and military spending (57 percent). A majority of Americans (56 percent) report having some interaction with Medicaid, either having been enrolled themselves at some point (16 percent) or knowing a friend or family member who has received health coverage or long-term care assistance through the program (40 percent). In addition, 78 percent say they would be willing to enroll in Medicaid if they needed help with health care or long-term care. This view is consistent across different party identifications.

"This poll shows that Americans across the political spectrum value the role Medicaid plays in our health care system," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. "As with the rest of the health care system, much of the political debate surrounding Medicaid these days focuses on controlling costs, but proposals to cut funding for the program or scale back the coverage it offers do not appear to be popular with the public."

Although Americans seem reluctant to see state Medicaid funding cut, they are divided on the best way to grapple with their state's budget problems. Nearly a quarter (24 percent) say their state should cut funding for programs other than Medicaid, such as education, prison systems, and transportation; 21 percent say that their state should raise taxes, and the same number say that the state should cut Medicaid funding to address the budget problems. Twenty-three percent of respondents say that the budget problems should be addressed in some other way.

Half (50 percent) of the public feels the federal government should put more money into the Medicaid program to help states with budget problems, but 43 percent think the federal government cannot afford to do this given its own budget problems. When asked more generally about approaches to federal spending on Medicaid, 44 percent say they would retain current levels, 36 percent that they prefer to see an increase in spending, and 12 percent that federal Medicaid spending should be cut.

Despite concerns about Medicaid's financial problems, none of the proposals to address the program's problems that the public was asked about garnered support from a majority of respondents. For example, 44 percent say they favor reducing the number of people qualifying for the program. Other proposals were lowering payments by Medicaid for prescription drugs (42 percent), lowering payments to doctors and hospitals (41 percent), increasing copayments and deductibles that enrollees pay (41 percent), and eliminating the ability of middle-class elderly persons to transfer their assets to children in order to qualify for Medicaid (37 percent).

Although most Americans believe that Medicaid is an important program, and many have a basic understanding of this complex program, about half tend to be less familiar with the program's specific details. More than half (53 percent) do not know that Medicaid is the insurance program for many low-income families regardless of their age, and 62 percent do not understand its role for people with low incomes who need nursing home care. Nearly half the public (47 percent) does not know that Medicaid is funded by both the federal and state governments, and more than half (55 percent) don't realize that it covers more people than Medicare.

Although low-income children and their parents account for three-quarters of Medicaid's total enrollees, 54 percent of the public does not know that low-income families make up most of Medicaid's enrollees. Furthermore, although 70 percent of program spending is for the elderly and individuals with disabilities, 46 percent of the public do not know that most of program spending is for those groups.

The survey was conducted by telephone by Princeton Survey Research Associates between April 1 and May 1, 2005, among a nationally representative random sample of 1,201 respondents 18 years of age and older. Results were weighted to be representative of the U.S. population. The margin of error is plus or minus 3 percentage points for total respondents. Near the beginning of the survey, but after basic knowledge questions were asked, all respondents were read a definition of Medicaid: "Medicaid is a government program for low-income people whose costs are shared by both the federal government and state government. It provides health insurance and long term care assistance to eligible children and their parents, elderly, and people with disabilities." The survey findings are available on the Kaiser foundation Web site at www.kff.org.

New AJP editor named: Robert Freedman, M.D., chair of psychiatry at the University of Colorado Health Sciences Center in Denver and superintendent of Colorado Psychiatric Hospital, has been named editor designate of the American Journal of Psychiatry (AJP). Dr. Freedman's primary research interests include physiology of the central nervous system and pharmacology and its application to clinical psychiatry. He serves on the editorial boards of the New England Journal of Medicine, Schizophrenia Research, Neuropsychopharmacology, Biological Psychiatry, and Experimental Neurology. Dr. Freedman will become editor on January 1, 2006, replacing Nancy Andreasen, M.D., who has been editor for 13 years, the maximum term that an APA editor may serve.

Depression widespread among heart attack patients: One in five patients hospitalized for a heart attack suffers from major depression, and these patients may be more likely than other heart attack patients to be rehospitalized for a cardiac problem within a year and three times as likely to die from a future attack or other heart problem, according to a new report by the Agency for Healthcare Research and Quality (AHRQ). Approximately 765,000 Americans were discharged after treatment for heart attacks in 2002. The AHRQ scientific evidence review on which the report is based suggests that 60 to 70 percent of individuals who become depressed when hospitalized for heart attack continue to suffer from depression for one to four months or more after discharge. Some studies show that depression can continue to affect mental and physical health for as long as five years. The American Academy of Family Physicians, which requested the evidence review, plans to use the report to develop evidence-based clinical practice guidelines. The reviewers found strong evidence that both counseling and certain antidepressants are effective treatments for these patients but no evidence that either therapy reduces the likelihood of suffering future cardiac events or the odds of dying from them. Evidence Report on Post-Myocardial Infarction Depression is available on AHRQ's Web site at www.ahrq.gov.

Web-based performance measure and management tool: SAMHSA has announced the online availability of National Outcome Measures (NOMS), a data resource to help state substance abuse and mental health managers facilitate evidence-based decision making to improve services. "This new Web-based tool is the very beginning of a data reporting system that ultimately will provide a comprehensive state-by-state picture of mental health and substance abuse service system results," said SAMHSA Administrator Charles Curie. Using maps and charts, the tool will present prevalence data for mental and substance use disorders and information about treatment, prevention, and funding. In collaboration with states, SAMHSA has identified National Outcome Measures in ten domains, such as symptoms, functioning, abstinence from substance use, resilience and recovery, and quality of services. SAMHSA will support states' efforts to report data with infrastructure and technical assistance through a new State Outcomes Measurement and Management System (SOMMS), an umbrella activity in SAMHSA to implement NOMs. The goal is to achieve full state reporting on all NOMs by the end of fiscal year 2007. NOMS is available at www.nationaloutcomemeasures.samhsa.gov.

Materials for Recovery Month in September: September marks the 16th annual observance of National Alcohol and Drug Addiction Recovery Month. The Substance Abuse and Mental Health Services Administration (SAMHSA) has released materials for use in the observance. This year's theme is "Join the Voices for Recovery: Healing Lives, Families, and Communities," which celebrates the positive impact of treating alcohol and drug use disorders in communities. Materials include a planning kit, TV and radio public service announcements, and other Web-based and print materials. The materials were developed by more than 75 organizations and coalitions within and outside the alcohol and drug addiction treatment field. The kit has already been distributed to 75,000 individuals and organizations throughout the country. In 2004 more than 400 events were held in local communities. The public service announcements, produced in both English and Spanish, aim to dispel negative characterizations about individuals who have achieved sobriety and are in recovery. The materials and other information are available at www.recoverymonth.gov/2005.

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