(3-13-17) What are we to think about Pennsylvania Republican Rep. Tim Murphy’s vote last week in the House Energy and Commerce Subcommittee to repeal the Affordable Care Act?
Ever since the Sandy Hook Elementary School shootings in 2012, Murphy has been a Capitol Hill champion for individuals with mental illnesses and their families. His dogged determination lead to passage of the Helping Families in Mental Health Crisis Act during the lame duck session in December, a major reform of mental health laws.
Yet last week, he voted along partisan lines to reject Obamacare – a move that every, yes, every major mental health organization strongly opposes.
The Republican’s repeal legislation as currently written will end Obamacare’s Medicaid expansion, which covers 1.2 million Americans with serious mental illness and substance abuse problems, as well as, scrap baseline coverage requirements. It also will do damage to mental health parity. These changes mean certain beneficiaries will no longer get coverage for mental health and substance abuse treatments guaranteed under the Affordable Care Act.
There are Republicans resisting Trump Care. Four Senate Republicans told Politico’s Brianna Ehley that they are deeply concerned about their party’s American Health Care Act (AHCA), which will replace Obamacare. In a letter to Senate Majority Leader Mitch McConnell, they declared “reform should not come at the cost of disruption in access to healthcare for our country’s most vulnerable and sickest individuals.”
Senator Chris Murphy (D.-Conn.), who championed the Senate version of the Helping Families In Mental Health Crisis act, predicted dire consequences in Politico if the Medicaid expansion is ended.
“Emergency rooms better start staffing up because their psychiatric units are going to be overflowing.”
Here’s what mental health groups have said about the Republican’s legislation.
The Nation quoted Andrew Sperling, the legislative director for the National Alliance on Mental Illness saying:
hough it is unclear what parts of the ACA might be repealed, if the 20 million people who benefited directly from Obamacare lose coverage, mental-health patients would suffer because “there would be fewer plans out there that would be required to comply” with essential-benefit mandates. Parity for zero is still zero. “Obviously, if you don’t have a health plan, you can’t be in compliance with parity.”
In a letter to the House,, NAMI’s executive director Mary Giliberti wrote:
The proposed reforms in the AHCA threaten to undermine the historic progress being made to improve mental health and substance use care… NAMI is deeply concerned with proposed provisions to convert Medicaid financing into a per capita cap model…Current estimates are that the per capita cap provisions would shift an alarming $370 billion in Medicaid costs to states over the next ten years. In the face of budget shortfalls, states will be forced to cut people from coverage, reduce health benefits and access to care, and/or reduce already low provider payments, escalating our nation’s healthcare workforce crisis…
Politico quoted Chuck Ingoglia, senior vice president of public policy at the National Council for Behavior Health saying:
“We are really worried about its implications for people living with mental illness and addiction issues.”
In an action alert sent to its members, it noted:
The (Republican bill) contains provisions that, if enacted, could devastate Americans’ mental health and addiction coverage and care.
Mental Health America’s President Paul Gionfriddo was more blunt. He said a full repeal of Obamacare “would be akin to Armageddon” for people with mental illness.
The Treatment Advocacy Center noted in a release:
The (Republican) bills would disastrously eliminate mental health as an essential health benefit from Medicaid, and with it the requirements to provide parity between mental health and other medical and surgical benefits… Experience shows us that without access to appropriate care, these individuals often end up receiving more expensive and less therapeutic care — provided by crisis centers, emergency rooms, homeless shelters and jails.
The American Psychiatric Association said in a release:
The American Psychiatric Association (APA) is deeply concerned that the proposed ACA replacement released last night will negatively impact care for people with mental illness and substance use disorders. ..As efforts are made to reform the health system, services for people with mental health and substance use disorders – and their families – must be maintained.
And the list of concerned group goes on-and-on, but wait, there is one organization that deserves special notice. Here is what the American Psychological Association said in a release:
The American Psychological Association voiced serious concern regarding the bill to repeal and replace the Affordable Care Act, arguing that it would reduce mental health and substance use coverage for millions of Americans enrolled in Medicaid and contribute to the loss of coverage for millions more individuals…An estimated 11 million Americans with incomes below 138 percent of the federal poverty level currently have coverage for mental health and substance use disorders, provided at parity with coverage for general medical services through Medicaid expansion plans. The current bill, called the American Health Care Act, would remove the requirement that Medicaid benchmark plans cover essential health benefits, which include mental health, substance use and behavioral health services.
Why is the APA’s concern worth noting?
Because on Friday — two days after he voted to repeal Obamacare in the House subcommittee – Rep. Murphy was honored by the APA for his “advocacy work and legislative accomplishment on mental health issues.” It presented him with the 2017 Outstanding Leadership Award, “given annually to the member of Congress who has done exceptional work on behalf of professional psychology.”
Much to his credit, Rep. Murphy did offer an amendment to the Republican legislation at the subcommittee hearing that would have protected mental health “parity” meaning that mental disorders had to be treated by insurance companies the same way physical health issues are addressed.
It was a bold and brash thing to do because Subcommittee Chairman Greg Walden (R.-Oregon) had said that he didn’t want any Republicans monkeying with the Republicans’ efforts to repeal the Affordable Care Act.
Before the final vote was taken, Rep. Murphy withdrew his amendment and all efforts by Democrats to protect parity were rejected by the Republican seven subcommittee member majority.
Rep. Joe Kennedy 111 (D.-Mass.) zeroed in on parity in the subcommittee hearing. His cousin, former Rep. Patrick Kennedy (D. R.I.), largely drafted and shepherded parity through Congress when he was in office.
The following exchange was between Kennedy and an attorney explaining the Republican legislation.
Kennedy: “Question for the legislative council, just to make sure I fully understand it. Based off of what you were saying, sir, – I understand the fact that this law does not impact mental health parity – but it was the combination of mental health parity and the ACA that included mental health benefits as part of the essential health benefits package. The parity just says if you offer mental health benefits, they have to be offered the same way that physical health benefits are — it does not mandate the offering of mental health benefits.
With the combination of the repeal language that we see on page 8, it means that mental health benefits are not required now, by federal law — that it would be up to the states to actually impose, so when we look at those essential health benefits, whether it’s mental healthcare or potentially for other health conditions, that is no longer essentially covered, or required to be covered by this version of this text, is that not correct?”
Attorney: “The text before us does remove the application of the central health benefits for the alternative plans in Medicaid.”
Kennedy: “It does remove them — including mental health. Yes, thank you.”
Kennedy then made this statement:
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