America’s gun violence crisis fuels our mental health crisis
On a snowy Friday morning in Baltimore’s Sandtown neighborhood in 2019, I visited Matthew A. Henson Elementary School to learn about a successful youth entrepreneurship program. As I sat with the program’s founder, the school’s loudspeaker interrupted us.
A voice boomed: “Code Green! Code Green!”
I had never heard of a Code Green, but for the students and teachers at Henson, this was routine. It meant there was an active shooting within blocks of the campus and they were on lockdown until given the all-clear.
Later that day, I learned that Corey Dodd, father of two students, was shot and killed moments after dropping his twins off at the school. My heart broke for those two girls, his wife who found her husband lying on the sidewalk, his friends and family. But also for all the students, teachers and parents for whom this wasn’t the first Code Green, nor would it be the last.
When we talk about the gun violence epidemic, the focus is usually on the number of persons killed or injured. But this doesn’t come close to describing the massive scope of this crisis. We ignore the ripples of grief and trauma that wash over a community and leave invisible wounds, especially devastating to children.
Growing up in a violent neighborhood not only erodes any sense of safety or security, it alters your brain chemistry. Scientists have documented how violencebased trauma and fear for one’s safety inject damaging amounts of the hormone cortisol into the brain. This is particularly damaging to the growing brains of children, and it makes it hard for them to sleep, learn and process emotions. It dramatically impacts brain development, making these young people more likely to develop posttraumatic stress disorder, anxiety and depression.
A study published in JAMA Pediatrics looked at pediatric emergency department admissions in Philadelphia between 2014 and 2018. After adjusting for all variables, it found that kids living within four to six blocks of where a shooting took place were more likely than others to use an ED for mental health symptoms in the two months after the shooting. Unsurprisingly, it was even more likely if they had been exposed to multiple shootings or lived closer to the scene.
Communities plagued by daily violence undoubtedly bear the worst of it, but no American is immune to the trauma that guns inflict. A majority of teens worry their school could be next, and more than three-quarters of adults feel stressed about the possibility of a mass shooting. Movie theaters, malls, parades, office buildings, places of worship— wherever we go, most of us can’t shake the anxious feeling of “what if.”
There is just no doubt that a conversation about gun violence has to include a conversation about mental health. I was glad that the Bipartisan Safer Communities Act, of which I was the lead sponsor, provides
$13 billion to expand school-based mental health programs, train more providers, and improve access to mental health services for everyone.
But an investment in mental health won’t end the gun violence epidemic. It’s treating the symptoms, not the cause.
America faces both a mental health and gun violence crisis, but only one of them fuels the other. And contrary to the gun lobby’s talking points, it’s the guns fueling our mental health crisis—not the other way around. In fact, people with mental illness are far more likely to be victims of violence rather than perpetrators.
We should continue investing in mental health programs that help survivors, families and communities learn to cope, but the most meaningful action we can take is to build upon the Bipartisan Safer Communities Act and take steps to ensure gun violence impacts fewer people. Passing universal background checks and banning assault weapons are proven ways to save lives and keep guns out of the wrong hands.
When tragedy strikes, that community is forever changed, and the very least we can do is help them pick up the pieces. But that will never be enough. Every child deserves to grow up free from the fear of gun violence. And that future is only possible with deliberate action from Congress.
The last two years have reminded us how essential our health is to our nation’s success. While our recovery from the pandemic hasn’t been easy, our healthcare system has led the way. And many of our recent achievements would not have been possible without the leadership of President Joe Biden and Congress.
We made a major down payment in our healthcare system with the American Rescue Plan. Just weeks ago, the Inflation Reduction Act followed, with the largest investment in Americans’ health since the Affordable Care Act.
The Inflation Reduction Act extends critical subsidies for premium costs for lower- and middle-income workers and their families, caps out-of-pocket prescription drug costs for Medicare Part
D beneficiaries, and finally cuts down on these exorbitant costs for all Americans. Medicare can finally negotiate the price of high-cost prescription drugs and drug companies will pay Medicare rebates when they hike their prices faster than inflation. Millions of Americans will save an average $800 per year on their premiums with the extension of the enhanced premium tax credits.
Thanks to these investments and last year’s Special Enrollment Period for health insurance, more than 35 million Americans are enrolled in coverage made possible by the Affordable Care Act. This is a record high.
While there is much to applaud, what is still ailing our healthcare system? Plainly, it’s politics. The future of our system lies at the mercy of a political game of tug of war.
As we pull toward lowering costs and expanding access, our counterparts tug toward rolling back access and restricting rights. We are for progress, and the other side is for turning the clocks back. Leaving women with fewer rights today than a generation ago. Actively blocking efforts to lower costs for families or capping the price of insulin in favor of protecting pharmaceutical companies.
The American people deserve a healthcare system that puts them first. From my perch on the Ways and Means Committee, progress means building on our recent accomplishments to make healthcare even more affordable, accessible and equitable. Permanently extending the American Rescue Plan’s enhanced premium tax credits will ensure no American is paying more than 8.5% of their income on health premiums.
We must close the long-standing gap in Medicaid coverage. This will not only provide millions with immediate health coverage, but also close some of the deepest racial fault lines in our system.
Our seniors and people with disabilities are in desperate need of better support and care. We’ve made great strides, including making hearing aids accessible over the counter. Now is the time to bolster these efforts by expanding Medicare coverage to include services for people with hearing loss.
Another major piece of our pandemic recovery is rooted in jobs, and the healthcare sector plays a vital role in opening opportunities to hardworking Americans. This means better supporting our longterm care workers and widening the career pathways for students from historically underrepresented backgrounds. Investing in health careers means better care, more good-paying jobs and fewer worker shortages.
We are also beginning to see the effects of the climate crisis on health—and the need to support healthcare providers across the country in climate mitigation efforts. Through a request for information, I started a public dialogue on the importance of climaterelated risks and carbon emissions in the health sector, and it’s clear the federal government must lead on the path forward.
Progress is well within legislative reach if we can work on a bipartisan basis and focus on what’s best for our healthcare system. The key lesson of the last two years is clear: Your health is your wealth. We need to do whatever it takes to rid our system of the ailments holding us back.
After years as a practicing podiatrist, I came to Congress because I saw people serving in government—who had never taken care of patients—making healthcare decisions that interfere with the trusted and sacred relationship between doctor and patient. For the sake of patient health, Washington needs to get out of these honest and confidential interactions that physicians build with their patients.
Patients should be empowered to have access to the latest innovations and treatments that the American scientific community has to offer.
Government bureaucrats and actuaries see statistics and costs on a spreadsheet. In their process, do they envision an actual patient in need of help? Bureaucrats are not the medical professionals who actually see and know the people they rule over. Providers are ethically and legally responsible for the patients who have entrusted them with their care. Left alone, physicians and patients become a team, together deciding what prescriptions, therapies and treatments are best.
Unfortunately, Washington has seized more medical power from patients and providers than ever, thanks to the so-called Inflation Reduction Act. If the prescription drug price controls in this law had been enacted in the past decade, many of the currently approved therapies might never have made it to market. As someone who has been involved in medical care, I am deeply concerned about the real-world impact that this law will have on patients, especially those waiting for a cure or enhanced treatment.
The Lower Costs More Cures Act of 2021 includes 36 bipartisan provisions that would lower out-of-pocket spending on prescription medications and empower patients’ access to the very best medical therapeutics, diagnostics and technologies, without harming new innovations. House Speaker Nancy Pelosi (D-California) has kept that bill from coming to the floor for a vote, preferring her own agenda. We all want lower drug costs, and we can accomplish that. Innovations save lives and long-term medical costs. As co-chair of the GOP Doctors Caucus, I’m always looking for ways to put patients at the center of policy discussions. The full House just passed the Improving Seniors’ Timely Access to Care Act of 2022. This legislation will help ensure that seniors receive the care they need, when they need it. By making needed adjustments and modernizing Medicare Advantage’s “prior authorization” system, physicians can begin to get back to what they do best: caring for and treating their patients without delay.
Physicians recommend a care plan to their patients after thorough examination, testing and a review of their personal medical history. Despite this, in our current system, many insurers demand that patients adhere to “step therapy” protocols, often referred to as “fail first,” resulting in time-consuming and unnecessary delays in care. Instead of receiving what was originally prescribed by the physician who knows the situation best, patients are first forced to try alternative treatments. This can be very dangerous. Fellow physician Rep. Raul Ruiz (D-California) and I have introduced the bipartisan Safe Step Act, which would provide guardrails by requiring insurance companies to have a clear and rapid process to allow coverage for the medication or treatment that is best for the patient.
Other healthcare-related proposals have broad bipartisan support, which I hope Congress will focus on over the next several months, including taking decisive action to secure our medical supply chain.
In most circles, talking about “healthcare” focuses on insurance plans, not actual health. Aside from suicides and overdoses, the U.S. does well as far as extending your “lifespan.” We all win when we also focus on “healthspan”— keeping people as healthy as possible for as long as possible. Extending your healthspan requires being proactive as well as reactive. It’s important to incentivize prevention, early diagnosis and treatment. Being well saves lives and dollars.
Enhancing and empowering the physician-patient relationship is better for our health, as individuals and as a nation. It can be done.