By Peter Sullivan
November 3, 2015
Rep. Tim Murphy (R-Pa.) on Tuesday introduced an updated version of his sweeping mental health reform legislation that seeks to allay some of Democrats’ concerns.
The move comes the day before the bill is marked up in the House Energy and Commerce health subcommittee. The measure, billed as the Republican response to the mass shooting in Newtown, Conn., when it was first introduced in 2013, has been controversial and delayed for years, but is now moving forward.
The bill has some bipartisan support — 43 of its 154 cosponsors are Democrats — but Democrats on the Energy and Commerce committee have raised objections to several core parts.
The new bill was only shared with committee Democrats on Tuesday morning, and ranking member Rep. Frank Pallone (D-N.J.) said he still has to review the changes, but cannot support the bill in the form it had been in previously.
One of the most controversial parts of the bill incentivizes states to adopt what is known as Assisted Outpatient Treatment (AOT), where judges can mandate treatment for patients with serious mental illness.
Committee Democrats had warned that the bill as written would have rescinded federal funding from states that do not have AOT laws. The updated version of the bill seeks to clarify that funds will not be rescinded, only that states that have the laws in place will be rewarded with a 2-percent increase in funding.
Democrats still object to that incentive. “The use of the court system and law enforcement to force individuals into care is a dramatic departure from how individuals, particularly those who pose no imminent threat to themselves or others, obtain health care services in this country,” wrote 19 committee Democrats in a letter earlier this month.
Another controversial area of Murphy’s bill is its changes to a health privacy law known as the Health Insurance Portability and Accountability Act, or HIPAA. The changes are aimed at allowing caregivers and family members to have more information about a mentally ill person’s care.
Murphy added in language from a bill from Democratic Rep. Doris Matsui (Calif.) that would provide training for doctors and patients about what the privacy law allows. But the bill still makes changes to the underlying law that some Democrats object to, warning that they think the loss of privacy protection would deter mentally ill people from seeking care.
There have also been questions about how to pay for Murphy’s bill, and the updated version makes some changes that could help it cost less.
The Congressional Budget Office estimated Tuesday that the previous version of the bill would cost $3 billion over ten years. If certain provisions freeing up Medicaid to spend more on mental healthcare were included, though, the cost would spike to between $46 and $66 billion over ten years.
In the new version, provisions that would have eliminated a lifetime limit on Medicare’s coverage of care at psychiatric hospitals has been removed. An expansion of grants for community mental health centers has also been removed.
The repeal of a ban on Medicaid paying for care at certain mental health facilities has also been pared back.
Murphy on Tuesday thanked Democrats on the committee for recent conversations with him, saying “I know we can come to a solution to this.”