Leaders of the Grand Old Party (and 15,000 journalists) descended on Tampa, Fla. this week for the Republican National Convention. On Tuesday, the GOP adopted a 33,000+ word platform. A closer look shines light on how GOP leaders might set policies for treating serious mental illness, one of the most crucial health problems facing the United States.
The word ‘mental’ appears six times in the GOP platform — not enough make it into this Wordle.
1. No federal dollars for universal mental health screening programs. Supporters calls these programs a cornerstone of suicide prevention programs, especially for children and teenagers. But the issue has sparked controversy because of concerns about overmedicating children and teenagers, the link between antidepressants and increased risk of suicide in some young people, and ethical dilemmas about screening people if you don’t have resources to treat them (for more, see this excellent overview article from the L.A. Times). The GOP makes its position clear. “We support keeping federal funds from being used in mandatory or universal mental health, psychiatric, or socioemotional screening programs,” it states (p.37).
2. Better treatment for veterans… including faith-based healing? “We must make military and veterans’ medicine the gold standard for mental health care,” the platform holds, but adds, “with military suicides running at the rate of one a day, with post-service medical conditions, including addiction and mental illness, and with the financial stress and homelessness that is often related to these factors, there is an urgent need for the kind of counseling that faith-based institutions can best provide.” (pp. 43-45)
3. Deep cuts and a radical makeover of Medicaid, the single largest U.S. payer for people with mental illness. The platform calls the program ”simply too big and too flawed to manage in its current condition from Washington” (p.23). The solution? Give states block grants, chunks of money they can use with few restrictions to ”improve the quality of care” for people on disability and help poor-but-healthy adults buy private insurance (p.34).
4. An allusion, at best, to mental health parity — the idea that insurance companies should provide the same level of coverage for mental and physical health care. “We believe that all Americans should have improved access to affordable, coordinated, quality healthcare, including individuals struggling with mental illness,” the platform states on page 40.
But it doesn’t say insurance companies should follow parity laws, an omission that could be intentional. Mitt Romney and Paul Ryan want to repeal the Affordable Care Act — which, beginning in 2014, will prohibit companies from denying people health insurance because they have a history of mental illness or substance abuse. Starting the same year, the law will also require most plans to offer mental health coverage as part of their basic benefits packages.
In 2008, Paul Ryan also voted against a mental health parity bill that passed the House 268-148. (Forty-seven Republicans voted for it.) Ryan’s motivations weren’t clear, but the New York Times reported employers and insurance companies fought the bill because it would require mental health insurers to cover every condition listed in the Diagnostic and Statistical Manual of Mental Disorders, from schizophrenia to caffeine intoxication.
Perhaps one of the 15,000 journalists in Tampa will ask GOP leaders to spell out their plans for improving and expanding mental health care and parity. These are questions that politicians in every party and at every level of government should be wrestling with.
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I’ll be glad when the election is over.