Featured on USA Today. Author: Rep. Joe Kennedy III (D-Mass.)
A mental health problem at the highest level,” President Trump said after a shooting in Sutherland Springs, Texas left 26 parishioners dead. “Mental health is often a big problem underlying these tragedies,” House Speaker Paul Ryan said after a gunman killed 17 students and teachers at Marjory Stoneman Douglas High School.
If Republican leaders are talking about mental health, it’s generally for one reason — to avoid talking about guns.
By any measure, the claim that mental illness is to blame for gun violence is false. The United States does not have a disproportionate number of people suffering from mental illness, but we do have a disproportionate number of guns, mass shooters and deaths by firearm. Only 3% to 5% of violent crimes are committed by mentally ill people, and they themselves are roughly 10 times more likely to be the victims of violence than the general population.
Still, Trump and Ryan are right that we have a mental health crisis in this country. What they don’t mention is that it's driven by the Republican Party’s systemic erosion of health care and coverage. Specifically, their efforts to decimate the single largest source of funding for mental health and substance use disorder treatment in the United States — Medicaid.
Medicaid covers 75 million Americans, 50 million of them children, elderly or disabled. For those with mental illness or a substance use disorder, Medicaid is often a lifeline to treatment they otherwise would go without. Today, in the midst of a devastating opioid epidemic, it covers nearly 40% of non-elderly adults with an opioid addiction and 26% with a serious mental illness.
Put another way, you can’t champion mental health reform or opioid treatment with one hand and aim to gut Medicaid with the other. Nonetheless, Trump and the GOP have spent the last 15 months working to do just that.
First, it was their ill-fated effort to "repeal and replace" the Affordable Care Act, which would have cut Medicaid by more than $800 billion, ended the ACA’s Medicaid expansion and imposed arbitrary caps on benefits for people left in the program.
The American public rejected their plan. But the administration, undeterred, proposes to cut the program by $800 billion in its latest budget. And Trump and his team have brought their vendetta against Medicaid to the states, giving local officials and administrators unprecedented authority to limit coverage and benefits.
Last month, states like Kentucky, Indiana and Arkansas got a green light to cut Medicaid access for people who lose their jobs and restrict the ability of families to keep the health care they need to get back on their feet. States like Ohio tell us this is a deeply flawed approach; having Medicaid coverage makes people more likely to work. For most Americans, this is common sense. It is exceedingly difficult to find or keep a job when you cannot meet basic health care needs for yourself or your family.
Which explains why today nearly 80% of adults on Medicaid live in a family where someone is employed, 60% work themselves and the vast majority of those not working are in school, caring for a loved one, or facing serious physical or mental illness that makes work difficult if not impossible.
When you hear the Republican talking point that these reforms are intended only for folks who make too much money to “deserve” assistance, look at Alabama. Its proposed work requirement would apply to parents and caretakers living below 18% of the poverty line; or less than $4,524 for a family of four for an entire year.
Many of these families will lose coverage not because they refuse to work but because they are unable to comply with the onerous bureaucratic demands that come with work requirements. Furthermore, the Trump administration is not allowing states to use Medicaid funds for things like job training, child care and transportation that would help people find work again. These challenges will hit the mental health community in particular. Mental illness is chronic and stigma often compounds the difficulty of navigating a job — stigma that is carelessly reinforced every time a Republican elected official blames the mentally ill for causing this country’s gun violence epidemic.
Tragically, work requirements are just one of the ways this administration is targeting our mental health infrastructure. States like Arizona and Wisconsin have asked for federal lifetime limits on Medicaid beneficiaries that the government deems “able-bodied,” a move that puts government officials in the business of making medical decisions and deciding the merit of our health challenges. States like Kansas have proposed ending Medicaid coverage after as little as 36 months. As anyone with depression or a substance use disorder (not to mention cancer or heart disease or diabetes) would tell you, healing seldom complies with a three-year deadline.
“We’ve been dreaming about this since … you and I were drinking at a keg,” Ryan mused to a fellow conservative last year about capping Medicaid spending.
For the sick and suffering among us, Medicaid is survival. The next time we see GOP leaders excuse their inaction on gun violence by scapegoating those with mental illness, let’s take a cue from the brave student survivors in Parkland and call BS.
Rep. Joe Kennedy III, D-Mass., is a member of the House Energy and Commerce Committee. Follow him on Twitter: @RepJoeKennedy