Obama's gun plan: Three takeaways for health care

President orders executive actions to improve mental health care

President Obama on Wednesday announced nearly two dozen executive actions and proposals aimed at curbing gun violence, including several mental health and health policy directives.

The proposals came in response to last month's mass shooting in Newtown, Conn. and a series of similar, deadly events in recent years. They were developed by a special task force led by Vice President Biden, following meetings with more than 220 groups, including public health organizations and medical societies.

The president's proposals could have a ripple effect across the health care industry. The Daily Briefing identifies three key takeaways.

1. Initiatives to improve mental health treatment, reduce stigma

In his speech, Obama said the package includes orders for his administration to issue final rules implementing the Mental Health Parity Act, which was signed into law in 2008.

The plan also includes several Affordable Care Act (ACA)-related actions, including sending letters to state health officials clarifying the types of mental health and substance use disorder treatments that will be considered "essential benefits," which are required in health plans that will be offered through the ACA's health insurance exchanges. 

The actions also clarify that the ACA does not prohibit physicians from asking patients about gun ownership or reporting threats of violent behaviors to law enforcement authorities. Obama's plan included an action to "address unnecessary legal barriers," such as HIPAA restrictions that may hamper background checks.

Meanwhile, the president appointed HHS Secretary Kathleen Sebelius to lead a "national dialogue" on mental health that would reduce the stigma associated with mental illness that prevents many individuals from seeking treatment.

2. New program for screening of students, young adults

The president's plan also proposes a new program—Project AWARE—that aims to reach 750,000 youths with mental illness and refer them to treatment.

The project would include $15 million to train teachers and other adults to detect and respond to mental illness in children, and an additional $40 million to bolster mental health services in schools and other community institutions. The proposal calls for training 5,000 more social workers, counselors, and psychologists with a focus on treating students and young adults.

3. Efforts to boost gun-related research

The package also includes a presidential memorandum directing CDC to "research the causes and prevention of gun violence," despite a congressional order barring researchers from using funds to "advocate or promote gun control," USA Today reports. 

Obama's plan notes that gun violence research is "critical public health research" and does not amount to advocacy. His plan also called for Congress to fund research to explore the effects violent video games "have on young minds."

The president's fiscal 2014 budget request will ask Congress to provide CDC with $10 million in funding to study gun violence and possible links to violent movies and video games. The administration also will seek an additional $20 million to bolster the CDC's National Violent Death Reporting System. 

A senior administration official said that CDC will immediately begin researching the causes of gun violence and how to prevent it.

Experts, lawmakers respond

Medical groups, including the American Public Health Association, praised the reforms as "life saving."

Michael Fitzpatrick—executive director of the National Alliance on Mental Illness—said Obama's plan includes "things we've been asking for, for years." He added that the president's speech would help remove the stigma of mental illness.

However, some of the plan's actions sparked controversy. Rep. John Fleming (R-La.) on Wednesday criticized the plan for "pushing the government further into the exam room." He argued that doctors have no right to ask patients about gun ownership, and added, "There are existing laws which ensure that doctors alert law enforcement to criminal activities that they become aware of in the course of their practice." 

Others challenged the administration's attempt to strengthen the federal background database, which is used to ensure, among other things, that individuals purchasing guns do not have a serious mental illness.

Richard Bonnie, a professor of medicine and law at the University of Virginia, said improving reports to the system is difficult to achieve because "mental commitment proceedings are handled in very different ways from state to state and even from locality to locality within a state." He added that imposing reporting duties on doctors "could deter patients from seeking treatment" (Pittman, MedPage Today, 1/16; Baker, "Healthwatch," The Hill, 1/16; Szabo, USA Today, 1/16; Martinez, "Hillicon Valley," The Hill, 1/16; Adams, CQ HealthBeat, 1/16 [subscription required]; Cheney, Politico , 1/17); Kasperowicz, "Floor Action Blog," The Hill, 1/16; Dennis/Sun, Washington Post, 1/16). 


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