Resistance from some Republicans is delaying a major mental health reform bill that GOP leaders have billed as their response to mass shootings.
The bill passed out of the Energy and Commerce Health Subcommittee earlier this month, raising the hopes of some advocates that it could promptly move to consideration from the full committee.
{mosads}But some GOP lawmakers and aides have asked to postpone a full committee markup of the bill until various objections are worked out. That process has set the timeline back to early next year.
Still, even lawmakers who have problems with the measure say they are committed to reaching an agreement on a bill that has been stuck since 2013, when Rep. Tim Murphy (R-Pa.) first proposed it in response to the 2012 elementary school shootings in Newtown, Conn.
Rep. Joe Pitts (R-Pa.), the chairman of the Health panel, said some Republicans are worried about the bill’s “fiscal impact.” He said a full committee markup could be put off until early next year in an effort to reach some bipartisan consensus.
The Congressional Budget Office (CBO) projected the bill’s price tag at $46 billion to $66 billion over 10 years, a daunting sum but one that Murphy called “a grain of sand in the beach” compared to recent bipartisan Medicare reform legislation on the so-called “doc-fix.”
Most of the cost comes from a provision that allows Medicaid to cover more care at mental health facilities, and Pitts said members are working to bring the number down. The provision has already been scaled back since the CBO projection.
“It is a concern, and [Murphy’s] working on the bill to try to get the cost down,” said Rep. Bill Flores (R-Texas), chairman of the conservative Republican Study Committee. “Philosophically, he’s headed in the right direction. This is an issue we’ve got to deal with. We’ve got to find a more cost efficient way to do it.”
On Wednesday, Murphy forcefully denied that Republicans had raised problems with his bill.
In a brief interview, he interrupted a question about how he is addressing Republican concerns to say there weren’t any.
“No there’s not,” he said. “Nope. There were some misunderstandings in terms of wording, but they’re very supportive.”
In a phone interview on Thursday, Murphy said, “Like any piece of legislation, members are engaging to work together to make sure that we have perfecting language to work things out.”
Before the subcommittee vote on the bill, several members struck agreements with Murphy to iron out provisions within it — and that back-and-forth is still ongoing, a GOP aide confirmed.
With those conversations in the works, Republican staffers on the Energy and Commerce Committee have recently been in talks about delaying the markup.
“There have been a number of ‘I pledge to work with you,’ gentleman agreement-type things,’” the GOP aide said. “Now, it’s time to see if that happens.”
More vocal objections to the bill are coming from the other side of the aisle. Almost all of the Democrats on the panel oppose the bill in its current form, and they have accused Republicans of cutting them out of the process.
At a marathon, two-day subcommittee markup this month, Rep. Frank Pallone Jr. (N.J.), the committee’s top Democrat, argued Murphy had often been more interested in media appearances than negotiating.
“There’s never been an effort to actually address our concerns,” Pallone said.
“Oftentimes instead we’ve seen Mr. Murphy go out on the road, talk to the newspapers, do all kinds of media events, but never actually address our concerns.”
Democrats oppose a controversial provision that awards a 2 percent increase in federal grants to states with what are known as assisted outpatient treatment (AOT) laws, where judges can mandate treatment for patients with serious mental illness.
The bill also changes the health privacy law known as the Health Insurance Portability and Accountability Act, or HIPAA, with the aim of allowing caregivers and family members to have more information about a mentally ill person’s care.
Democrats, as well as some Republicans, have fretted about the privacy implications of those changes.
Republican Rep. Morgan Griffith (Va.) said he is uneasy about the HIPAA changes and will meet with a group of Republican and Democratic lawmakers who are lawyers after Thanksgiving to try to work out new language.
“I think that Dr. Murphy realizes that we’re really not trying to kill the bill, we just have deep feelings that we’ve got to do something a little different to make it work right legally,” Griffith said.
Democrats have also argued that that the bill could cut substance abuse treatment funding and gut the Substance Abuse and Mental Health Services Administration, which Republicans deny.
Murphy’s bill did get a boost from Speaker Paul Ryan (R-Wis.) on Sunday, who pointed to the bill when asked by CBS’s “60 Minutes” about his response to gun violence.
However, Energy and Commerce Committee Chairman Fred Upton (R-Mich.) noted the new Medicaid spending at the subcommittee markup earlier this month and said he would have to speak to Ryan about it.
Despite the ups and downs, backers see hope for getting mental health reform done: there is a similar bipartisan bill in the Senate from Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.).
Pitts said the committee is working with the Senate and trying to get House Democrats on board.
“We’re trying to work through those things to see if we can come up with a bipartisan compromise, that’s our goal, get it signed into law,” he said. “But, you know, it’s taking a while.”