Psychologists dispute Murphy linkage of opioid crisis to Obamacare

March 22--U.S. Rep. Tim Murphy describes himself as "the only practicing psychologist in elected federal government." He may also be the most visible practicing psychologist to back repealing Barack Obama's Affordable Care Act.

While many mental-health advocates are defending the ACA against a Republican repeal effort, the Upper St. Clair Republican argues the former president's reforms have betrayed those with behavioral health concerns.

"Skyrocketing rates of suicide and drug overdose deaths prove the ACA did little to provide treatment before tragedy," he said on Twitter last week.

Skyrocketing rates of #suicide and drug overdose deaths prove the #ACA did little to provide #treatmentbeforetragedy pic.twitter.com/zBQw41uO9Q

-- Rep. Tim Murphy (@RepTimMurphy) March 16, 2017

Major mental-health organizations don't see it that way.

The American Psychological Association, for one, warned that the GOP's repeal bill, called the American Health Care Act, would scale back Medicaid payments that benefit low-income Americans, including those with behavioral health problems. The APA also cited a Congressional Budget Office study, which projected that as many as 24 million Americans could lose insurance coverage as a result of repeal.

While Republican's have scoffed at that number, the APA called those cuts "unconscionable in light of the large unmet need for mental and behavioral health and substance use services."

"How does he square his support for the repeal with his own organization being against it?" said David Allen, a Greensburg resident and Murphy constituent who serves as the training director for Counseling Psychology at West Virginia University.

Mr. Allen, like others in his field, praised Mr. Murphy's advocacy for mental health in other contexts. Most recently, Mr. Murphy championed reforms in 2016's 21st Century Cures Act, which advocates hailed for improving treatment standards and options. An APA sister organization gave Mr. Murphy an award for his role in the legislation earlier this month.

But "given his promotion of mental health, it very much does surprise me that he would support repeal," Mr. Allen said.

A vote on the repeal legislation is slated for Thursday. Mr. Murphy has indicated he expects to vote for it, and defended the GOP effort in an opinion piece that ran last week in the online political journal The Hill. The Post-Gazette reprinted the piece on Sunday.

In it, Mr. Murphy argued that during much of the Obama administration, "Americans in mental health and addiction crisis were treated as second-class citizens." The administration, he wrote, was slow to implement "parity" provisions -- those that ensure equal coverage for behavioral and physical conditions. "[M]illions of Americans with behavioral health conditions [were] still fighting the insurance industry years after the bill was signed into law."

Mr. Murphy also suggested that the Medicaid expansion may be less than meets the eye. In some states, he wrote, "expansion of Medicaid simply resulted in many governors switching out state dollars for federal dollars," reducing the net benefit for those who need.

Even the ACA's defenders acknowledge some of those criticisms. In a 2016 report, for example, the National Alliance on Mental Illness said, "Consumers continue to face significant challenges finding a provider ... and paying the bill for mental health care." Nearly one-quarter of those NAMI surveyed said their insurance network didn't include a mental health prescriber.

But NAMI itself opposes repeal, warning that it would "leav[e] millions of people, including people with mental illness, unable to afford mental health care." Other groups, including the American Psychiatric Association, have expressed either concerns or opposition to repeal.

"We have a lot of violations" with insurers trying to limit coverage for treating addiction, acknowledged Louis Baxter, who chairs the American Society of Addiction Medicine. But the situation has gotten "slightly better," he said, and "all of those gains are at risk" if repeal takes place. In any case, he disagreed that rising drug overdose rates proved the ACA's shortcomings.

"What's driving a lot of the OD deaths has to do with the rise of [opiod medication] and heroin use" -- a crisis that would "absolutely" get worse after appeal, he said.

Mr. Murphy's office referred questions about his position to his editorial and other public statement. But Paul Gionfriddo, president and CEO of advocacy group Mental Health America, surmised that Mr. Murphy faced a difficult quandary.

"Medicaid expansion has offered extraordinary benefits to people with addiction disorders and serious mental illness" he said. But Mr. Gionfriddo, who served as a state legislator in Connecticut for 11 years, said that in politics, "You have to look at the long game."

Repeal "was a strong party-line vote" that Republican leaders were committed to. "If I were advising him politically, I wouldn't tell him to fall on his sword for this. Tim hasn't burned his bridges with leadership. So there's an opportunity to get more done down the road" on mental health issues.

Mr. Gionfriddo said he had "all good things to say about [Mr. Murphy's] efforts to protect these services." He noted Mr. Murphy sought to add an amendment to the repeal bill reaffirming mental-health parity, but later withdrew it.

That withdrawal "should give people a clue on how leadership is so strong" in trying to move the legislation," he said. "If you want to pressure someone about this, it should be [Speaker of the House] Paul Ryan, who designed the bill."

But Mr. Murphy has "been singled out as being progressive on these issues, so now he's under the microscope."

Chris Potter: cpotter@post-gazette.com

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