WASHINGTON _ It expanded telepsychiatry, prioritized care of the most seriously mentally ill, eased prescribing limitations for psychiatric drugs, increased outpatient treatment, fixed a rule keeping Medicaid recipients from physical and mental health treatment on the same day, and focused federal funding on proven treatments.
But U.S. Rep. Tim Murphy's signature mental health law means little to the poorest mental health patients if Congress repeals the Affordable Care Act without replacing it with something that protects the coverage that millions became eligible for in 2010.
The Affordable Care Act _ also known as Obamacare _ required companies to cover mental health services in order to sell policies under the law's insurance exchanges. A lot of companies had been reluctant to include such coverage under their most affordable plans because of increases in demand, cost and risk.
The law greatly helped young people by allowing them to stay on their parents' insurance plans until age 26, around the age a lot of mental illnesses first appear, said Sue Walther, executive director of the Mental Health Association in Pennsylvania. Its rule requiring coverage of pre-existing conditions also helped, she said.
Before the Affordable Care Act, insurance companies often charged people with mental illnesses very high premiums, rejected them outright or sold them plans that excluded coverage for their disease, she said. Lastly, she said, the act's Medicaid expansion provided benefits to the working poor who were previously unable to obtain benefits.
Pittsburgh psychiatrist Ken Thompson said the changes have been extremely important.
"Since the expansion happened we've seen a dramatic increase in the people who are able to get covered. ... Since people have challenges that start early in life, they can be requiring the services for much of their lives," said Thompson, former director of medical affairs at the Center for Mental Health Services in the Substance Abuse and Mental Health Services Administration.
"When you have a psychiatric challenge it's going to be hard to handle a lot of the red tape. Anything that makes coverage more difficult and makes people buy (their) own care is going to be very hard for people with psychiatric challenges," he said.
But Murphy's office said the congressman's mental health bill is doing much more to help than Obamacare, which he has forcefully opposed.
"The fact is the Affordable Care Act did not improve our federal mental health system. The real reforms were in Congressman Murphy's Helping Families in Mental Health Crisis Act, which was signed into law last month," Murphy spokeswoman Carly Atchison said. "Congressman Murphy is committed to a thoughtful approach in the repeal and replacement of the Affordable Care Act and, as always, to ensuring that families in mental health crisis receive real treatment."
But because it isn't clear how _ or if _ Republicans will replace the Affordable Care Act, outcomes are uncertain, and that raises concerns for patients and providers alike.
"Prior to the enactment of the Affordable Care Act, health insurance plans routinely used a wide array of practices to deny, delay and discourage use of services. These practices contributed to widening our country's already vast disparities in health status and quality of health care," the American Psychological Association and the American Psychological Association Practice Organization wrote in a joint letter to President Donald Trump.
Mental-health advocates are asking Republicans to keep many of the Affordable Care Act's provisions.
But Murphy, R-Pa., calls the law "a government-run, taxpayer-funded insurance monopoly" that has to go. And he isn't alone. Other congressional Republicans and Mr. Trump have made repeal a top priority.
"If there's an overall repeal then (Mr. Murphy's Families in Mental Health Crisis Act) becomes largely Band-Aids on a corpse. It's not treating anything," said Michael Campbell, director of the Interdisciplinary Mental and Physical Health Law Clinic at Villanova University.
Fewer people would receive treatment even as Murphy's legislation, which was designed to help them, remains intact, Campbell said.
Murphy's law says that when the federal government spends money, it should be on proven treatments. That's an admirable intent, Campbell said.
"But all the training and quality assurance doesn't do much if nobody has access to treatment to begin with," he said.
Walther doesn't doubt Murphy's commitment to helping the mentally ill.
"He needs to get out in front and explain that unless (Republicans) have a really good replacement plan, they can't repeal this law, because the people he cares about are going to be disproportionately hurt," she said.
In a written statement earlier this month Murphy assured that "we're not going to pull the rug out from underneath anyone" and promised "a stable transition to a better system."
Health care advocates hope that's true but is concerned that lawmakers will repeal the health care law before a replacement is ready or before there is time to evaluate what's in it.
Murphy "has been a good champion on a lot of mental-health issues, and as this debate continues I think there's a real danger about rushing to repeal without looking at what it means for these vulnerable populations," said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. "I would assume that Congressman Murphy is interested in seeing that (mental-health care) remains an essential benefit and that there would be parity.
"Any replacement of the ACA needs to make sure folks don't lose coverage. And we have to make sure that folks in Pennsylvania have to be able to access health coverage that allows them to continue treatment and not limit doctor visits or put caps on the services that they need," she said.
That puts Murphy in a difficult position of sticking with his party's repeal effort while protecting coverage for the mentally ill.
"I think the congressman has a very difficult game to play. He knows people need federal subsidies of some kind to cover their costs because they don't have the money," Thompson said.
"I think he's trying to figure out how to help his colleagues begin to understand what they are actually doing here. And I suspect that depending how thick his colleagues are, he could be in a very difficult position."
