The news from Congressman Murphy’s office last night was certainly an attention getter. Here is the lead sentence from his press release - “After a long day of negotiations, Congressman Tim Murphy (PA-18) announced he successfully secured an additional $15 billion in the American Health Care Act, along with a requirement that states must use the additional resources for mental health and addiction treatment.” He went on to state that “This $15 billion investment, which is three times the size of the federal mental health block grant, represents the largest surge in behavioral health funding in recent history. “
While I will be the first to say that I admire Congressman Murphy for his tenacity and relentless pursuit of funding for services for those with mental illness, in this case, he is, unfortunately, being mesmerized by the 15 billion dollar shiny penny dangling in front of him.
Dedicated Funding for Mental Health (Which Should Be a Good Thing) Is Canceled out by AHCA Cuts to Medicaid Expansion, Essential Health Benefits, and Block Granting Medicaid
How is it that the Congressman does not see the cognitive dissonance associated with celebrating a commitment to funding dollars that will be used by states at their discretion while at the same time repealing the Essential Health Benefits (EHB), ending Medicaid expansion and allowing states to block grant Medicaid? Children’s mental health advocates involved with the family movement over the past thirty years know the stories too well of how coverage access for mental health services can vary wildly from state to state. As the only practicing psychologist in the House of Representatives, I have to believe that Congressman Murphy is aware of the devastating impact this will have on families who have children with serious mental health needs and their ability to get much-needed services.
At the core of the AHCA is the zeal to push responsibility back to the states. Sounds so right, doesn’t it? But as some old time advocates who were raising kids with serious mental health challenges in the 80’s and 90’s, which is when I became totally immersed in the world of children’s mental health, the notion of “letting states decide” comes with serious risk for those with the most need. That tension between state and federal law is precisely why national advocacy groups formed and continue to form. The current version of the AHCA creates a lottery scenario, where depending on where you live, and the generosity, or lack thereof, of state decision makers, will dictate what services are available to you.
Unfortunately, I don’t read any expressed concern from Congressman Murphy in any of his press releases about this conundrum. From a press release earlier this week, Congressman Murphy stated that “When the Helping Families in Mental Health Crisis Act was finally signed into law, it was a proud moment of hope for all the patients who had been left out of America’s healthcare system. But we have more work ahead of us to help those living with mental illness or an addiction disorder. The American Health Care Act reflects our commitment to deliver treatment before tragedy.” And from the press release last night, this: “Working alongside President Trump and Secretary Price, we're going to keep our promise to deliver treatment before tragedy.”
OMB Director Mick Mulvaney Makes the AHCA Conundrum Easy to Understand
Maybe Congressman Murphy agrees with Office of Management and Budget Director Mick Mulvaney. In a recent interview with with 'CBS This Morning' anchor Alex Wagner, Mulvaney was quoted stating that “Americans upset that the Republican plan to repeal and replace Obamacare would cut requirements for so-called essential services like maternity care and addiction treatment should ‘figure out a way to change the state that you live in’ if the bill ends up becoming law.”
On the topic of Essential Health Benefits, Mulvaney said that “States not only have the ability to require those services, many of them already do. What we're doing is taking away the federal controls of these systems. If you live in a state that wants to mandate maternity coverage for everybody, including 60-year-old women, that's fine. If there’s a state that wants to do it different, you can do that as well.”
“What if you live in a state that doesn't do that?” Wagner asked Mulvaney, to which he replied: “then you can figure out a way to change the state that you live in.”
And that, ladies and gentlemen, is a chilling, succinct and accurate assessment of what the American Health Care Act promises. If you don’t like what is going on in your state, then move. In fairness to Mulvaney, he went on to say that individuals could work toward making changes with their state legislatures, but I tend to find that the first response to a question resonates with where the heart lies.
Oh, how I wish OMB Director Mulvaney and Congressman Murphy could have joined me over the past 30 years in the thousands of conversations I have had all across America with families who have children with serious mental health challenges. The stories of forced migration across county and state lines in a desperate attempt to get appropriate services will chill you to the bone. (For those of you who want to understand better the importance of Essential Health Benefits I encourage you to read Daniel Dawes book, 150 Years of ObamaCare.)
Stop Chasing the Shiny Penny
There is no doubt in my mind that Congressman Murphy cares deeply about improving mental health services in America, and his continued efforts for reform are much appreciated. However, I believe the approach he is advocating is, unfortunately, chasing the shiny penny that promises instant success by fully turning the decision-making about who gets what services over to the states. History has shown us the folly of this type of thinking. The Affordable Care Act, for all of its warts and bruises, was, and is, a step in the right direction for ensuring appropriate services for all. Let’s not repeat history.
Note: 3:40 PM, March 24, 2017 - House leaders have pulled their bill to repeal and replace Obamacare just ahead of a planned vote. However, advocates must continue to educate their elected officials on the important components of the Affordable Care Act that must remain to ensure appropriate health care options for families who have children with behavioral health challenges.