(12-27-16) This is the conclusion of Connecticut Democrat Senator Chris Murphy’s behind-the-scenes account of how major mental health reform got signed into law during President Obama’s lame duck session. Yesterday’s account ended with Democrats and Republicans in a deadlock because of Sen. John Cornyn’s introduction of language into the Senate version of the mental health reform bill that involved restoring the right to buy guns to individuals with mental illnesses.
Getting Mental Heath Reforms Signed Into Law: Sen. Chris Murphy’s First Hand Account
In March, Chairman Alexander schedules the bill for the mark-up, even with the language over the insurance reform section unsettled. As the eve of the meeting arrives, we still haven’t gotten a compromise. Alexander’s language is too soft for me, and my language is too tough for Alexander. As the night wears on, the Senators go home and our staff – from my office, Alexander’s, Murray’s, and Cassidy’s – engage in shuttle diplomacy between Senators to try to find common ground. At 10 p.m., I get a call from my lead staff on the bill, Joe Dunn. He tells me that Alexander has a new and final offer. If we reject it, the bill will be dead. Joe reads the language to me word for word as I sit on the foot of our bed in our bedroom, and as I listen, I realize we have finally found the sweet spot. Alexander has bent just enough to make sure the language still holds the insurance companies’ feet to the fire. The mark-up goes forward, and with support from both Alexander and Murray, the bill passes the committee unanimously. For a committee that has such a diverse membership (Bernie Sanders on the left to Rand Paul on the right) this is a big step and it couldn’t have happened without the hard work and leadership of Senators Alexander and Murray.
Meanwhile, in the House, Tim Murphy understands that he needs Democrats to support his bill if he wants it to move forward, and Democrats realize that compromise is possible. They begin to work toward a new bill that softens the edges on some of the most controversial sections, like the court ordered outpatient treatment section and the section giving parents the right to get information about their adult children’s care. In July, the House approves, in a huge bipartisan vote, a slimmed down version of Murphy’s original bill. The focus now clearly shifts to us in the Senate.
“I just can’t do that.”
In the Senate, the Cornyn bill is now proving to be a major roadblock. Every few weeks, I seek him out on the Senate floor and try to pitch him on a compromise. At one point, I bring him a copy of his bill, with the sections I objected to highlighted, just to give him a visual representation of how much of his bill I actually like compared to the small section on guns that I can’t live with. My filibuster, which happens in June, doesn’t help matters much. Though I never mix the issue of mental health and guns during my 15-hour marathon speech, the attention that it gets certainly doesn’t warm Republicans to me.
But we keep talking. In July, Cornyn makes a new offer, dropping most – but not all – of the language on guns. He brings his offer to me and Cassidy in a huddle between the three of us on the Senate floor during a vote. I look at Cassidy and he knows what I’m going to say.
“I just can’t do that, John,” I say. “I know you’re making this offer in good faith, but if we mix gun policy with mental health policy, even in a small way, the whole bill will blow up. I’ll lose support from Democrats and anti-gun violence advocates if there is anything in here that can be seen as weakening the background checks system.”
I feel bad, because Cornyn does legitimately care about fixing our broken mental health system, and he made a big concession in dropping most of his language related to guns. I walk back to office feeling totally discouraged, thinking that this might be the end for the entire mental health bill.
A Second Breakthrough
We spend the rest of summer ginning up the mental health advocacy groups to help us build cosponsors of the bill. Our hope is that if we can display broad bipartisan strength then maybe Cornyn will come back to the table. He’s the second ranking Republican – without him we can’t get the bill through the Senate. Our work pays off. By the fall, we’ve grown our “1 for 1” cosponsor list to 14 Republicans and 14 Democrats.
Then, a breakthrough. In September, as everyone is distracted by the presidential campaign, Cornyn comes back to us with a creative solution. The core of his concern has to do with a process at the VA, where veterans who are found to be mentally incompetent to manage their own finances have a “fiduciary” appointed on their behalf. The main consequence of this process is that their VA benefits are managed by someone else, but they also end up losing the right to buy a gun. What he is really worried about, he says, is that there are veterans who truly aren’t mentally incompetent who have been badly served by the process and have had their rights taken away unjustly. Of course, I would be concerned if that was happening too. His team suggests that we codify an existing VA procedure to make sure that every veteran has access to medical and legal representation if they are going through a mental competency review process. This sounds very reasonable, and a creative way to get at Cornyn’s concern without having to amend any gun laws.
Now, time is running out – Congress has recessed for the October campaign and our only hope is to get mental health reform on the very short list of bills that will be debated in the “lame duck” legislative session, the time between the election and the swearing in of the new Congress. Luckily, Tim Murphy has gotten House Speaker Paul Ryan jazzed about our bill, and Ryan is now proposing to add it to a bill called the 21st Century Cures Act, a major update of drug approval laws that is a priority for both caucuses.
That means we’ve got to finalize Cornyn’s compromise language as quickly as possible, but the Veterans Administration is taking a very long time giving us technical feedback. Mark Barden, whose son was killed in Sandy Hook and who has been a major backer of the bill, heads over to the White House to try to convince them to intervene. It’s hard to say no to Mark, because of who he is and because of the cause he represents, and I’m so glad to have him on our team.
Our bill gets attached to the Cures Act, along with $1 billion in funding for treating the nation’s heroin epidemic and close to $5 billion for biomedical research, including $1.8 billion for Vice President Biden’s Cancer Moonshot initiative. It’s an enormous package, and after passage in the House by a wide margin, it’s heading to the Senate. But there’s one more – very big – trouble spot.
Roadblocks in the Senate
Elizabeth Warren and I are close pals. We came into the Senate together in 2013, we care about the same things, and we tend to both be on the same side of pushing our Democratic caucus to fight a little harder and louder for our progressive beliefs. Thus, I’m worried when I get a call from her on Saturday night as I’m in the car with my wife and kids, telling me that she is going to oppose the new, consolidated Cures Act (which now has my mental health bill attached) because she believes the drug approval reforms are way too generous to the drug industry. She walks me through her concerns, and she has a case. One provision seems particularly egregious – it would exempt from the current disclosure laws the fees that drug companies give to doctors for trips. That’s a really bad idea, and I’m starting to worry about whether the big bill can get to the finish line. In the Senate, you need 60 votes for anything to pass, and that means we need Democratic support.
As we all head back to Washington for the lame duck session in December, once again the Mental Health Reform Act is on a knife’s edge. Clearly, this drug industry disclosure provision has to come out of the bill. And miraculously, it does, because of Senator Patty Murray’s dogged negotiating skills. Off the Senate floor on Tuesday morning, I huddle with Senator Murray as she waits for a call from the House Republican leaders about the bill. She ducks into a phone booth (yes, there are still mid-century original phone booths off the Senate floor) to take the call, and she emerges to announce that, thanks in part to Elizabeth’s pressure, she was able to secure the agreement to take this section out of the bill.
Conveniently, this happens just as the Senate Democrats are convening for our first party caucus lunch of the month. Inside our lunch room, (which was at one time Senate Majority Leader Lyndon Johnson’s Capitol office) I get up and passionately argue for the bill, explaining to my colleagues the difference the Mental Health Reform Act would make. It helps that I can explain that one of the most harmful provisions of the bill has been eliminated. A number of other Senators stand up to support the bill, and while Elizabeth and a few others remain opposed, as I walk out of the lunch I’m convinced we will prevail with that final change.
On the following Monday night, the key vote, called the cloture vote, comes before the Senate. This is the vote that requires 60 to pass, and I get a call that Murray is stuck on an airport tarmac in Seattle and won’t make it for the final debate. Her staff asks me to make the final argument on the Senate floor for the Cures Act, which now includes the Mental Health Reform Act. I feel so proud as I explain to my colleagues that apart from changing the lives of millions of mentally ill people, this bill also gives the whole country hope that Democrats and Republicans can, every once in awhile, put politics aside and do something really, really good for the whole country.
That night, the procedural vote passes 85-13, and a couple of days later, the margin on final passage of the bill is even bigger, 94-5.
“Now, on to the next one.”
Two days later, my Chief of Staff opens her email box to find a message from Pete Earley – the author of the book that started it all. He writes, “What a fantastic Christmas present to those of us who love someone with a serious mental illness. Thank you. Senator Murphy’s championing of mental health reform will literally save lives and help thousands, including my family and my son. It is a monumental step. Now, on to the next one.”
Wow. The Mental Health Reform Act is the most important piece of legislation that I’ve ever authored and passed. And I’ve been a part of some pretty big ones.
And Pete is right on both fronts. The bill will save lives. But it is also just the beginning. The bill won’t come close to solving all the problems in our mental health system. There is so much work to do. But with this bill, we’ve proven that in just two short years, good policy can triumph over politics and the inertia of the status quo. Who knows what we can do next.
(I named Senators Chris Murphy, Bill Cassidy and John Cornyn as the most impactful mental health warriors in 2016 because of their championing of mental health legislation. I had named Rep. Tim Murphy in 2014.)