Sen. Chris Murphy, D, celebrated passing mental health reform legislation late last year amidst a landslide of bipartisan support.

But the Democratic U.S. senator is now skeptical the Trump administration will implement aspects of the bill he believes are most important for Connecticut — a chunk of funding for states to fight the opioid epidemic and provision requiring insurance companies treat mental health care equally to physical health care.

“This administration has been horrific when it comes to health care in their first three months so I’m not optimistic, but I’ve pushed everyone in this administration to implement the mental health provisions of the 21st Century Cures Act and nobody has told me no yet,” Murphy said in a recent interview.

21st Century Cures

President Barack Obama signed the 21st Century Cures Act into law in December after it glided through Congress, garnering overwhelming Republican and Democratic support alike. The Senate passed the legislation Dec. 4 by a 94 to 5 vote. It included the Mental Health Reform Act, co-written by Murphy and U.S. Sen. Bill Cassidy, R-La. Several weeks after its passing, Murphy appeared at St. Vincent’s Behavioral Health Services in Westport to talk about the newly-minted law.

21st Century Cures aims to hasten drug development and also allocates billions in funding for the National Institutes of Health and in state grants to combat the opioid epidemic.

Among the contingent of senators voting against it, U.S. Sen. Elizabeth Warren, D-Mass., was one of the law’s vocal critics, claiming it gave too much to pharmaceutical companies and lowered drug and medical device safety standards. Some consumer advocacy groups also pushed back against the bill, concerned it will weaken drug standards.

But mental health advocates offered a wave of support. The National Alliance on Mental Illness issued statements applauding the 21st Century Cures Act’s passage of the House of Representatives and Senate and lauding it as a positive step toward improving America’s mental health system.

Murphy tabbed the state grants — totaling $1 billion spread across the country — and the law’s requirement that insurance companies pay for mental health patients’ care as equal to other care as the most important for Connecticut residents. The latter provision, an update to mental health parity requirements, would aim to ensure easier, better reimbursement for mental health care from insurers. Murphy noted the $1 billion in funding won’t solve the opioid crisis impacting much of the nation but serve as a “solid down payment.”

Both provisions would require President Donald Trump or his appointees to execute the provisions.

“The provisions that require insurance companies to pay for more mental health care need to be enforced by the administration,” Murphy said. “I’ve met with everyone in the administration who would be responsible for enforcing the mental health parity provisions of the law and though I haven’t gotten any commitments that they will be enforced, nobody’s told me that they aren’t.”

Meanwhile some remain concerned about the law’s state grants for opioid addiction prevention and treatment programs. The first year of grants were distributed in April under Trump’s Health and Human Services Secretary Tom Price, a former Republican congressman.

Connecticut received a $5.5 million grant, among $485 million spread across all 50 states and six U.S. territories. When announcing the grants in April, Price said the remaining half-billion in grants will follow next year, the Associated Press reported.

“Both Republicans and Democrats supported that emergency funding,” Murphy said, “but the Trump administration has been pretty awful on the issue of health care and confronting the opioid epidemic so I’m worried they’re not going to release the rest of the money.”

Despite Price’s April announcement, Fairfield County advocate reflected Murphy’s concern. Margaret Watt, executive director of the state’s Norwalk-based Southwest Regional Mental Health Board, said there are concerns the second round of grants may not come next year and the federal government has yet to give a solid commitment. This year’s grants won’t go far, she noted, if there is not another round of funding so new programs can be built and continue beyond a year.

“It’s a step in the right direction,” she said of Connecticut’s initial $5.5 million grant, “but I think people need to put their money where their mouth is.”

Health care under Trump

Along with what Trump might not deliver are changes he may. Among them, Murphy said health care legislation as passed by the House would be “catastrophic” for Americans in need of mental health treatment, echoing mental health advocates’ concerns.

The American Health Care Act would repeal and replace the Affordable Care Act, also known as Obamacare, and was passed without a score from the nonpartisan Congressional Budget Office, which since found the bill would leave would leave 23 million more people uninsured by 2026 than the current law. It would significantly curtail Medicaid, health insurance for the poorest Americans, and allow states to opt out of the ACA’s requirement that insurers cover patients with pre-existing conditions, which could range from cancer to mental health disorders such as anxiety or depression.

Murphy said the AHCA would mean hundreds of thousands of Connecticut residents losing health insurance, many of them patients suffering from mental illness. He added it would “dramatically” raise costs for people that maintained insurance coverage and disproportionately affect people with mental illness, who tend to have higher out-of-pocket insurance costs.

The senator wouldn’t expect Connecticut, a deeply blue state, to get rid of protections for people with pre-existing conditions.

“But there’s no guarantee,” Murphy added. “Connecticut could remove the protections for people with pre-existing conditions and that would result in costs for people with mental illness going up four or five-fold.”

In the mental health community, the American Health Care Act has spurred fear that many patients could lose insurance and that pre-existing mental health conditions could block people from coverage. But Watt foresees the state protecting the aspects of Obamacare it can, including pre-existing condition protection.

“Right now it feels like everything is in flux so there’s definitely fear around that,” Watt said.

The Senate’s version of the bill is being written under wraps by a group of male Republican senators. Republican leadership has expressed desire to push for a vote before July 4. Despite his initial Rose Garden celebration of the House bill, Trump reportedly called the legislation “mean” in a meeting with Republican senators Tuesday and expressed support for the senate version to veer from the House repeal and replacement, CNN reported.

Teetering between moderate and more conservative Republican senators’ warring desires, it is currently unclear whether the bill will have the support it needs. Democrats’ support — including Murphy’s — is likely unattainable.

“I don’t anticipate voting for anything that comes out of this secret closed-door male-only Republican health care process,” Murphy said. “I’ve begged my Republican colleagues to sit down and work with Democrats to keep what works in the Affordable Care Act and fix what needs improvement, but they’ve rejected all of those requests. As long as they’re writing this bill behind closed doors, I can’t imagine it’s anything that I’ll be able to support.”

Trump has also taken a stab at a stated priority — the country’s crisis of opioid addiction and overdoses. He placed New Jersey Gov. Chris Christie at the helm of a task force to combat the epidemic in late March.

Murphy called the effort “window dressing” and claimed Trump’s administration has “waged an all-out war on people with addiction.”

“People in Connecticut don’t need a task force, they need insurance coverage. They need outpatient clinics and detox centers,” he said. “If President Trump has proposed ripping the guts out of the addiction medicine system in this country, this task force is pointless.”

Mental health woes in Connecticut

Among Murphy’s persisting concerns with Connecticut’s mental health system is its fragmentation.

“In Connecticut we still have a very disjointed system and clearly the federal government can provide more resources, but the state has to unsilo its mental health delivery system,” he said. “There’s lots of good intentions in the mental health system in Connecticut, but they’re often badly uncoordinated.”

In the realm of health care, silos refer to groups that provide care within a health system but do so separately without collaboration or significant communication between programs or various health providers.

Watt recognized the concern but sees a more pressing one: the state’s funding for its public mental health services. Mental health providers want less fragmented care, but structural change is difficult when providers feel they’re in crisis mode as funding shrinks, she said.

“Mental health services are really, really crunched,” she said, noting long wait lists for services, programs under damaging transitions to run on lighter budgets and clients’ needs at risk.

Two state-run transitional residence programs — in Norwalk and Bridgeport — that offered mental health services for people returning from homeless shelters, hospitals and prisons were shuttered due to budget cuts last year, among a flurry cuts to save the state millions. Watt noted there is no private equivalent for the programs. She knows of mental health facilities with wait lists running over 100 patients long.

Watt described state-funded programs transitioning to be open longer hours with fewer staff members and more clients. The result, she said, is heavier caseloads and burnt out staff — though a trimmer budget.

“Transition is very stressful for people,” she said. “I see the different mental health providers working very hard to make things work.”

lweiss@hearstmediact.com; @LauraEWeiss16