The link above tells something of the state of mental health politics at the federal level at the moment. All questions are unanswered at the moment. Some things are more likely and some less, but the truth is no one knows.
There are a lot of obstacles to anything happening. No one has yet went broke betting on Congress to do nothing about anything important. The article talks about some problems or issues that must be resolved. The problem is not what is wanted. There seems to be a consensus that things are a mess and something needs to be done. But the list “that we ought to do something about” that is still waiting for action is long and getting longer. Mental health has been on that list for a long time. So far that place has been way past secure.
For a bill to become law each house must agree to a bill. They must get together to come up with a bill that resolves the differences between the two different versions they bring into the committee. Each house must approve the in common version. President Obama must agree to all of it. A lot of agreeing for people not good at agreeing and a lot of space to mess things up in.
I have a lot of questions. Here is my partial list of obstacles and issues that will effect not only what bill but whether or not there is even any bill.
1. Republicans will not accept a Democratic victory. Democrats will not accept a Republican victory. If this somehow becomes more rather than less a partisan matter what will that do to its chances of success?
2. How, if at all, is this affected by the presidential campaign?
3. How will rising tensions involving Obama’s Supreme Court nominee affect the bipartisan coalition in the Senate?
4. What is Obama’s bottom line? Are there provisions in either bill – particularly the Murphy Bill that he just won’t sign off on?
5. There are two possible issues involved in the bill that are more party sensitive than others : human and civil rights and guns and violence. Many Democrats are going to have a major problem with Murphy on issues of coercion and human rights. Many Democrats are going to have problems with any mental health bill that in any way pitched as an answer to gun violence. How this conflict is managed will have a lot to do what kind if any final arrangement is made.
6. The leaders in the House say they want Democratic concerns with the Murphy Bill addressed. Rep. Murphy seems largely unskilled at compromise. How much pressure will be put on him to meet people in the middle? The leaders in the House seem to want a bill that has a chance of finding an open door in the Senate and at the White House. They have the numbers should they decide to act. At what point do they give up on getting Murphy to compromise and just vote the bill through?
7. How does the new Democratic House bill affect the discussions on the Murphy Bill and the process of it being voted on?
8. If the Senate acts first and votes on a bill that repudiates the Murphy Bill how will that affect the version of the bill the House votes on ?
9. When the Senate bill gets to the floor for amendments how will that affect the bipartisan coalition that seems to be there now? Some amendments will be suggested that are controversial and may divide people along party lines .
10. Senator Cornyn’s Bill may be added as an amendment on the floor. The Senate Republicans seem to put everything into one all encompassing Bill. Democrats say they can’t vote for that bill because it has provisions in it that would give people easier access to guns. His bill is approved by the NRA. Sen. Cornyn is the second ranking Republican in the Senate. If he decides to push it what will happen?
11. What about funding? Given the climate, particularly in the House, is a bill that increases money spent going to be approved. Is it possible to have a bill that approves little or no new services actually really change much?
12. Removing the IMD exclusion, thus allowing more psychiatric hospitalization is high on the shopping list of several people. It is probably the single biggest ticket item. Is it likely to make the cut in the final bill?
13. Given the emphasis on increased funding for psychiatric hospitalization is it possible or likely that anybody will buy the argument that increased funding for community services is equally important or even more fundamental? The incredible decrease in funding for community services you could argue makes increased funding for hospitalization actually counter-productive.
14. Will the Senate agree to a bill that has AOT as a featured part?
15. Will Rep Murphy agree to a bill that does not destroy Samhsa?
16. Will Rep. Murphy agree to a final bill that does not rewrite Hippa?
17. Will Senate Democrats agree to a final bill that eviscerates the protection and advocacy system?
18. If the Senate and the House pass widely differing bills will they be able to reach a compromise agreement?
19. Are there things Rep Murphy will not compromise on even if it means no Bill will be passed?
20. Are there things Lamar Alexander will refuse to compromise on even if it means no Bill?
21. What if no one blinks? Will they just decide to point fingers and blame each other?
Believe it or not this just begins to scratch the surface of different factors that will determine what if any kind of Bill passes.
One thing also to remember is that this will drastically affect the future. If Tim Murphy comes out of this as the de-facto mental health czar the direction of the mental health system will be determined for years to come. The possible effects of the whole discussion are staggering.
Let your Senators and Representatives know what you want. Let them know what provisions will mean you will be personally injured. What we do matters. It would be helpful to find a somewhat united message. I think Rep. Murphy will feast on our divisions and try to use them to help him to ultimate victory.