The Republican Party really shouldn’t get anywhere near this distraction, not with their record on making mental health care available to American citizens. [AmerBlg] It doesn’t do to blather on about Guns and Mental Health in one breath and then take 50+ votes to repeal the Affordable Care Act in the next.
Before the passage of the Affordable Care Act about 1/3rd of those who did have health insurance in the individual market had no coverage for substance use disorder to services, and 1/5th had no coverage for mental health services, including outpatient therapy, and inpatient crisis intervention and stabilization. Additionally, even when a person did have coverage there was no guarantee mental health services would be covered comparably to medical and surgical care. The situation in the small group market was a bit better, coverage for substance abuse and mental health services was more common, but many states did not have “parity” laws requiring comparable coverage with medical and surgical treatment. Then, there were those 47.5 million Americans who didn’t have any health insurance, and the 25% of uninsured adults who have a mental health condition, a substance abuse problem, or both. [ASPE]
After the passage of the Affordable Care Act mental health and substance abuse are categories covered as part of the package of Essential Health Benefits. With the finalization of rules as of January 1, 2014 consumers buying health insurance policies can be confident that the health plan will cover mental health services, and importantly, that there will be parity for mental health and substance abuse treatment coverage. [ASPE]
And what was the Republican reaction? “Repeal.. Repeal.. Repeal…” at least 50+ times. [WaPo]
January 8, 2011: There was a mass shooting in Tucson, AZ six were killed, eleven others wounded including a member of Congress, Rep. Gabby Giffords. January 19, 2011: The House votes to repeal the Affordable Care Act. On February 19, 2011 the House passed an FY 2011 continuing appropriations bill with several amendments to “severely limit” the implementation of the Affordable Care Act. The measure passed with no Democratic support. Further votes were taken to carve up and diminish the provisions of the Affordable Care Act on March 3, 2011, April 13, 2011, and April 14, 2011. On April 14, 2011 a House resolution advised the Senate to defund all mandatory and discretionary spending associated with the Affordable Care Act. April 15, 2011 the Republican controlled House passed its version of the budget repealing and defunding the Affordable Care Act. During the four months after the Tucson Shooting the Republican controlled Congress spent much of its time trying to defund, limit, or outright repeal the law requiring health insurance companies to include mental health services as an “Essential Benefit” and on par with coverage for medical and surgical treatment. And, they weren’t finished. Republicans tried to gut the Affordable Care Act provisions on May 3, 2011; May 4, 2011; May 24, 2011; and on August 1, 2011 the Budget Control Act cut some mandatory and discretionary funding tied to the Affordable Care Act.
October 12, 2011: Eight people were killed and another critically wounded by a shooter in Seal Beach, California. Ironically, on October 13, 2011 the House passed the “Protect Life Act” preventing any funding from be applied to abortion procedures. More Congressional incursions were made on the Affordable Care Act on November 16, 2011, December 13, 2011, and December 16, 2011. On February 1, 2012 Congress voted to repeal a long term care insurance program (CLASS). February 17, 2012 the House voted to cut funding for Louisiana’s Medicaid program by $2.5 billion, and cut $11.6 billion including $5 billion from the Public Prevention and Health Fund. The cut to the Medicaid program was significant because Medicaid is the insurance provider for low income people, some of whom might be in need of substance abuse or mental health care treatment. On March 29, 2012 the House version of the FY 2013 budget called for repealing and defunding the Affordable Care Act.
April 2, 2012: A former student at Oakland’s Oikos University opened fire in a classroom, seven were killed and three wounded. The House attacked the Affordable Care Act again on April 27, 2012, and more significantly voted on May 10, 2012 to replace the automatic budget cuts to the Defense Department by defunding and repealing portions of the Affordable Care Act. June 7, 2012 the House voted to repeal the medical device tax, and limit the reimbursements for over the counter medications. On July 11, 2012 the House voted to repeal the Affordable Care Act.
July 20, 2012: 12 people were killed and another 58 were injured in the shooting at the Aurora, Colorado movie theater. Yet again, opponents of gun safety regulations noted that the shooting was the result of mental illness.
August 8, 2012: A shooter gunned down six people and injured three others at a Sikh Temple in Oak Creek, WI.
September 28, 2012: Six were killed and two injured in a workplace shooting in Minneapolis, MN.
October 21, 2012: Three died and four were injured in a shooting in Brookfield, WI.
December 14, 2012: Newtown, CT; 27 died including 20 first grade children. On December 20, 2012 the House voted once more to replace discretionary spending cuts enacted as part of sequestration by defunding and repealing several provisions of the Affordable Care Act. On January 1, 2013 the “fiscal cliff deal” passed the House including the repeal of the CLASS Act and cutting funds for the Consumer Operated and Oriented Plan.
On May 16, 2013 the House voted to repeal the entire Affordable Care Act.
June 7, 2013: Five people were killed in a shooting incident in Santa Monica, CA which ended on the campus of Santa Monica College. On July 17, 2013 the House voted to delay the implementation of the Affordable Care Act for employers by one year. Also on July 17, 2013, the House voted to delay the implementation of the individual mandate. On August 2, 2013 the House voted to prevent the IRS from implementing or enforcing any portion of the Affordable Care Act.
September 16, 2013: 12 were killed and 3 injured in a shooting at the Washington, DC Naval Yard. On September 20, 2013 the House voted to approve a short term FY 2014 continuing resolution in which the Affordable Care Act was fully defunded, including the prohibition of all discretionary and mandatory spending, and rescinding all of its unobligated balances. On September 29, 2013 the House voted again to repeal the medical device tax, and to delay the implementation of the Affordable Care Act by another year. September 30, 2013, the House voted to delay the individual mandate, an action which would effectively render the law inoperable.
Votes were taken in the House on October 17, 2013; November 15, 2013; January 10, 2014; January 16, 2014, March 5, 2014 to weaken the enforcement of the Affordable Care Act. More such votes were taken on March 11, 2014; March 12, 2014; and, March 14, 2014. [LAT]
April 2, 2014: Three were killed, sixteen injured in Fort Hood, TX, scene of a previous shooting in 2009.
On January 28, 2015 Rep. Bradley Byrne (R-AL) introduced H.R 596, a bill to repeal the Affordable Care Act. The measure passed the House on February 3, 2015. [RC 58]*
May 23, 2015: Six dead, seven wounded in Isla Vista, CA. June 18, 2015: Nine dead at the Emanuel AME Church, Charleston, SC. October 1, 2015: Nine dead, nine injured in Roseburg, OR. Meanwhile, the Huffington Post asked Senators what might be done about the carnage:
“If there’s one issue that these senators wanted to talk about when asked about gun violence, it was the mental health component. Nearly all of those who were interviewed said their attention is on that aspect of the problem, instead of on gun laws.
“What I’ve been focused on, and I think it very much relates to, unfortunately, too many of these mass shootings, is improving our early intervention mental health system,” said Sen. Kelly Ayotte (R-N.H.). “Hopefully we can take some immediate action and find common ground.” [HuffPo]
Improving our “early intervention mental health system?” What appears to be more than slightly inane (if not outright insane) is to believe that repealing the Affordable Care Act — such that we cannot assure health insurance coverage for substance abuse and mental health problems, on par with coverage for medical and surgical treatment – is going to augment our attempts at “early intervention,” – or for that matter, for intervention at any stage.
Unless, and until, the Republicans are willing to stop trying to repeal the law that requires mental health treatment coverage as part of an Essential Benefit package, and stop attempting to repeal the provisions saying that the coverage must be on par with other medical and surgical treatment benefits, the noise about “doing something about mental health” is just that – a distracting noise.
Unless, and until, the Republicans are willing to put legislation into the hopper (and bring it to the floor for a vote) increasing (1) federal support for mental health care services, and (2) increasing the number of low income people in the Medicaid program who have access to expanded coverage, then they’ll have to pardon those who say the “mental health” rhetoric is a hollow, shallow, attempt to distract the nation from any serious and substantive discussion of gun violence as a public health issue.
References: Congressional Research Service, “Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act, July 8, 2015. (pdf) Los Angeles Times, Deadliest Shooting Rampages, October 1, 2015. Washington Post, House has voted 54 times in four years on Obamacare,” March 21, 2014. AmericaBlog, “Republicans are using mental health as an excuse to do nothing about gun violence.” October 6, 2015. International Business Times, “Republicans’ Mass Shooting Response Focuses Not On Gun Control But On Mental Health Reform,: October 5, 2015. Huffington Post, “Despite Mass shootings, Republicans won’t touch gun laws,” October 6, 2015.
*Nevada Representatives Amodei, Hardy, and Heck, voted in favor of H.R. 596. Representative Titus voted no.