New hope for mental health reform

Greg Nash

Senators are quietly negotiating a bipartisan mental health reform bill that they plan to consider in mid-March, even as a parallel effort in the House struggles to move forward.

The hope is that the mental health overhaul can become a rare legislative achievement in an election year, but the window for action is closing. 

Sen. Lamar AlexanderLamar AlexanderObama meets a crossroads for his healthcare law Music streamer Spotify joins Gillibrand’s push for paid family leave GOP senators avoid Trump questions on rigged election MORE (R-Tenn.), the leader of the Senate Health Committee, is drafting a bill with ranking Democrat Sen. Patty MurrayPatty MurrayWhat the 'Bernie Sanders wing of the GOP' can teach Congress Senate Dems demand answers from Wells Fargo over treatment of military A fight for new rights MORE (Wash.) and Sens. Chris MurphyChris MurphyPodesta floated Bill Gates, Bloomberg as possible Clinton VPs Dem senator calls for end of Saudi support in Yemen after funeral bombing Dems to McConnell: Pass 'clean' extension of Iran sanctions MORE (D-Conn.) and Bill Cassidy (R-La.). The Obama administration is also involved in negotiations.   

They are working to mold the bill ahead of a committee markup planned for March 16. 

“Negotiations are proceeding and really positive,” Murphy said. “It has the potential to be something really meaningful.”

The bill will likely include multiple pieces from a measure introduced last summer by Murphy and Cassidy. 

The two senators have noted that one in five adults, or roughly 44 million people, experience mental illness per year, which they say points to the need for greater assistance. The number of available psychiatric beds has actually declined by 14 percent in recent years.

The negotiators are still deciding which parts of the original Murphy-Cassidy bill to include in their rewrite.

The first bill would have created a new assistant secretary to oversee mental health and provided grant funding on topics like early intervention for children who demonstrate risk factors for mental illness.

The House is watching the Senate’s effort closely.

Rep. Tim Murphy (R-Pa.) has championed his mental health bill for years, but it has been stalled over a range of objections. Speaker Paul RyanPaul RyanRNC chairman: Ryan one of 'brightest stars' in Republican Party Gingrich: 'Of course' we can afford to have president with split personality Could a President Clinton heal a divided nation? MORE (R-Wis.) has pointed to the measure as the party’s response to mass shootings, but Republicans and Democrats on the House Energy and Commerce Committee have been clashing over the details for months. 

Rep. Joe Pitts (Pa.), the Republican chairman of the health subcommittee, told The Hill that “one option” for the House would be to move forward a smaller version of Murphy’s bill focused on areas where there is consensus with Democrats.  

Murphy, however, has been passionate about the need to pass his bill closer to its current form. “But, you know, Congressman Murphy wants to do his bill,” Pitts said. “We may have to move a Republican version of his bill.”

Pitts said Murphy has been the lead negotiator with Democrats, while Energy and Commerce Committee Chairman Fred Upton (R-Mich.) tries to get Murphy to agree to some changes to move the process forward.

Asked if Republicans might move forward without Democrats, Upton said: “I hope not. I want to bring people together. That's my game plan.” 

Still, progress on the negotiations has been slow.  

“I mean we’re still trying, but no, we haven’t made a lot of progress,” Pitts said.  

The process appears to be going more smoothly in the Senate. 

The Senate bill makes changes to the Substance Abuse and Mental Health Services Administration (SAMHSA), a unit of the Department of Health and Human Services. Therefore, senators are making sure the administration is on board. 

“We've been working with the administration on it,” Sen. Murphy said. “There's a lot of SAMHSA reforms in the bill, so we've been working to make sure that the administration is supportive.” 

The Senate bill is also expected to include measures to fight the epidemic of prescription drug and heroin abuse, an area of bipartisan concern.

The bill headed for markup in the Senate Health Committee will be narrower than the House’s version because it has to stay within the committee’s jurisdiction. Still, the plan is to add elements from other committees once it hits the floor.

One important addition from the Finance Committee would lift the restrictions on Medicaid paying for care at mental health facilities, known as the “IMD exclusion.” That limitation is seen as a major barrier to people having access to care, but easing it could also be costly for the government.

Repealing the IMD exclusion has proven problematic on the House side, given that the Congressional Budget Office scored it at costing around $40 to $60 billion over ten years, a daunting sum. The cost of the House bill has led to objections on the Republican side as well, and Pitts said lawmakers were working to bring the cost down.  

Sen. Murphy, though, said that adding in funding pieces like the Medicaid provisions down the road would be crucial for his support. 

“Listen, I think it's a judgment call whether this bill is worth doing without any new money, and so I continue to think that mental health reform is difficult to sell to the advocacy community if you're not expanding capacity, but that discussion will have to wait until we get to the floor,” Murphy said. 

A potential obstacle for passing the bill could be the issue of guns. The Health Committee is in talks with Sen. John CornynJohn CornynReport: Investor visa program mainly funds wealthy areas GOP senators avoid Trump questions on rigged election Conservatives backing Trump keep focus on Supreme Court MORE (R-Texas) about merging their mental health reforms with the Texan’s proposal to improve treatment for people facing imprisonment.  

Sen. Charles SchumerCharles SchumerImmigration was barely covered in the debates GOP leaders advise members to proceed with caution on Trump Senate Dems demand answers from Wells Fargo over treatment of military MORE (D-N.Y.), last month denounced certain sections of Cornyn’s bill, saying they would make it easier for mentally ill people to get guns, which Cornyn strongly denied. 

The fight over filling the Supreme Court vacancy also threatens to poison the well for bipartisan legislation of any kind.

But Sen. Murphy noted that, “Clearly the floor is not shutting down, at least this week.” 

He added: “I think the window is getting narrower and narrower, especially once we know we have a nominee.”