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Monday, 11 December 2017

The Murphy Bills, Cures, and Change on the Horizon: An Update

The Murphy Bills

Over the past two years, two similar mental health bills--spearheaded by Representative Tim Murphy of (R-PA) and Senator Chris Murphy (R-CT)--garnered substantial bipartisan support. Purporting to establish more effective and efficient mental health care services and to empower families in supporting their loved ones, both bills (especially the bill passed by the House, and to a slightly lesser extent the bill that had not yet passed the Senate) foretold significant violations of people’s rights. Following the passage of the House version of the bill (H.R. 2646, or the “Helping Families in Mental Health Crisis Act”) over the summer, the future of the bills remained uncertain until November.

21st Century Cures

Meanwhile, a massive piece of legislation called H.R.34, or the 21st Century Cures Act (henceforth “Cures”), was in development. The product of a public and nonpartisan conversation with healthcare providers, researchers, and the public, Cures is a massive piece of legislation with a broad goal of “[expediting] the discovery, development, and delivery of new treatments and cures and [maintaining] America’s global status as the leader in biomedical innovation” (Committee on Energy and Commerce, 2016). Among its many provisions, Cures allocates several billion dollars for the advancement of various research initiatives, most notably Vice President Biden’s “Cancer Moonshot” and the BRAIN initiative which investigates diseases like Alzheimer’s. Beyond research funding, Cures aims to advance the development of new therapies by loosening FDA regulation requirements (thus facilitating the expedition of drug approval), incentivizing development of drugs for certain pediatric diseases, and “modernizing” the clinical trial process. Cures also aims to streamline the healthcare deliveryprocess, promoting the use of electronic health record systems to ensure continuity of care and improving education for providers about the latest medical innovations. 

It seems noble enough to allocate more federal money to research initiatives for conditions like cancer and Alzheimer’s, and when lagging FDA approvals keep life-saving treatments out of the hands of the critically impacted, increased flexibility and efficiency in this process seem ideal--except that with the “streamlining” process come concerns about compromised well being for people who take medications. Indeed, Senate Democrats’ concerns about safety and effectiveness were a significant factor in the Senate’s delay in accepting Cures, despite having been passed by the house in the summer of 2015. After all, speeding up the regulatory process for new life-saving or life-changing treatments doesn’t just benefit those impacted by illness. It makes the regulatory process less expensive for pharmaceutical companies and removes various obstacles in the process of bringing a new consumer product to their market. It likely comes as no surprise that pharmaceutical and medical device companies reported a remarkable $192 million in lobbying expenses, a substantial portion of which being directed to the passage of Cures. In light of these readily-evident corporate interests it might also, then, be unsurprising that 21st Century Cure does nothing to curtail rapidly rising prescription costs. 

A Change of Course

The immediate future of the Murphy Bills and Cures was still not entirely clear just a few months ago. Despite having passed the House in summer of 2015, various disagreements left the Cures stalled in the Senate. And then, in a series of events that was by turns bewildering, heartbreaking, and infuriating, Donald Trump became the president-elect of the United States. With concerns about the bill’s fate if it were delayed until next year, when Trump’s priorities may have overwhelmed the ongoing conversation about Cures, a renewed sense of urgency resulted in a substantial reworking of the bill around the Thanksgiving holiday. It was this reworking that added additional mental health reforms to be included in the bill, drawn primarily from Tim Murphy’s H.R. 2646 (“Helping Families in Mental Health Crisis”). Now benefitting from momentum and urgency of Cures, a large portion of H.R. 2646 was now up for vote. On December 7th, 2016--not even one month after Trump’s unexpected victory--the Senate passed Cures. On December 13th, President Obama signed Cures into law.

Where We Stand

Lauded as the most substantial mental health reform in more than a decade, Cures will bring about a number of changes. Though not incorporating every single aspect of H.R. 2646, most of the bill’s provisions are remarkably similar and, in many cases, basically identical. Some of the bill’s most concerning provisions include (but are not limited to):

  • Expanding Assisted Outpatient Treatment (AOT)--in other words, involuntary outpatient commitment--a program that utilizes court-ordered adherence to outpatient treatment (including medication).

  • Affirming and renewing a specific, concerted focus on “evidence-based programs and practices,” thus narrowing treatment options considerably and favoring practices which are supported by the prevailing medical model (and have the research funding that comes along with it).

  • Changing the definition of “peer supports” and decreasing funding for peer communities, limiting access to diverse treatment options and threatening the well being and even the very existence of critically important sources of community, wellness, and support.

  • Calling for examination of current HIPAA guidelines regarding provider-family communication, with the intent of clarifying the extent to which families have access to people’s private health information and potentially paving the way for large-scale violations of privacy and personhood.

What Now?

Congress uses an authorization-appropriation process to approve and allocate funds for a variety of government-funded programs. Very broadly speaking, this means that the process of approving (or authorizing) funding is separate from the process of actually appropriating federal funds for those projects. 21st Century Cures is an authorization bill. There may still be ways to impact the way that the provisions in Cures are actually carried out. 

Influencing the appropriation of funds and implementation of provisions in Cures requires, first and foremost, public awareness. Cures, while not without important provisions, is especially insidious in its use of euphemistic language. “Assisted Outpatient Treatment,” for example, sounds pretty benign, if not helpful. It is critical for people to understand how “assistance” can mean “force.” The “evidence-based” designation must be understood not as a pure and unassailable assessment of value but as a categorization fraught with questionable assumptions and noteworthy financial interests. Revealing the true meaning of legislation which has been meticulously crafted to appear beneficial is paramount. 

 

 

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