I told Sue Abderholden that I’d come to check out the new NAMI-MN headquarters on University Avenue. She obliged with a tour of a sleek, spacious suite that’s well-suited to the growing operation — 30 staffers plus frequent volunteers — that the Minnesota chapter of the National Alliance on Mental Illness has become on Abderholden’s 16-year watch as executive director.
Then I confessed my real purpose: I’d come to check on Sue. What was supposed to be a relatively tame legislative session for one of the Legislature’s most durable and respected human services lobbyists has turned into anything but.
A few months ago, Abderholden expected to spend the short 2018 session asking lawmakers to make Minnesota more compliant with the federal requirement that health insurers cover mental health treatment on par with other medical services. It’s important but down-in-the-weeds policy work, stuff that doesn’t usually involve wind-whipped protest marches or past-midnight hearings.
Then, six days before the Legislature reconvened, 17 high school students and teachers were shot to death in Parkland, Fla. Pols and pundits of a variety of political stripes were suddenly talking both sense and nonsense about the role of mental illness in gun violence and school safety.
For a few weeks, Abderholden made one statistic her mantra: Fewer than 4 percent of violent crimes are committed by people with a mental illness.
“It’s one of those double-edged swords,” Abderholden said of the attention that Parkland brought her work. “On the one hand, we could use it to get more funding and expand services for people with mental illness in this state. But on the other hand, we don’t want to link violence and mental illness, because that actually prevents people from coming forward and seeking treatment.”
So all the while stressing that victims of mental illness ought not be feared as potential mass murderers, Abderholden has been counseling lawmakers in both parties about what they could do to improve mental health services for young people. I detected her handiwork when DFL Gov. Mark Dayton put $5 million into his fiscal 2019 budget request for school-based mental health services, and House Republicans responded with a similar sum on March 29.
Abderholden is grateful for those proposals but is asking for more. Reaching all the schools that still lack co-located mental health services would take two to three times more than the politicians are offering, she said.
Just as she was making headway on that front, a major threat arose to years of mental health policy progress in Minnesota. On March 12, Republican legislators announced their intention to make employment a condition of enrollment in Medicaid health insurance coverage for low-income “able-bodied” adults.
That’s the sort of thing that will keep a good lobbyist at the Capitol late into the evening and awake with worry hours after she gets home.
Requiring Medicaid recipients to work if they are not physically disabled may sound reasonable at first blush. Minnesotans’ work ethic is the stuff of legend. Most folks believe that a job is a potent elixir for a lot of life’s problems.
But when one of life’s problems is mental illness, Abderholden explained, uninterrupted access to treatment is a crucial precondition to being able to get and keep a job.
“Medicaid expansion for the mental health community has been a godsend,” she said. Some 40,000 Minnesotans access mental health treatment via Medicaid. Before that option became available in 2011 for low-income adults, 18- to-30-year-olds were the largest population cohort without health insurance, she said. Those are precisely the years in which schizophrenia, depression, bipolar disorder and other serious mental illnesses emerge.
The Republicans’ bill would allow for exemptions from the work requirement for someone determined to be “mentally unfit for employment.” That compassionate-sounding exemption could well be cruel in its implementation, she says. “Why would we tell a 24-year-old who has just been diagnosed with schizophrenia that the only way he can get the treatment he needs is to swear to the government that he will never work again?”
The people NAMI represents want to work, she attests. If the state of Minnesota wants that, too, it would do better to help mental illness patients find jobs with the flexible hours and stable environments that would enable them to both work and get treatment. “Creating barriers to health insurance is the last thing you want to do to,” she said.
Those are just some of the arguments against the Medicaid work requirement proposal. A coalition of more than 100 advocacy organizations has formed to counter the GOP’s arguments for work requirements. Save the state money? No, the loss of federal matching dollars and high administrative costs would do the opposite. Encourage more to work? Seventy percent of Medicaid enrollees ages 19 to 45 already do. That nearly matches the adult workforce participation rate last year in the state as a whole.
Lobbyists like Abderholden are working overtime to lob such facts at the fast-moving work requirement bill, hoping to slow it down. So far, they haven’t succeeded. The bill appears to be propelled less by facts and figures than by a sense that work requirements would play well for Republican candidates in 2018 — especially if the requirements are stopped this year not by lobbyists’ good arguments, but by a DFL governor’s veto.
If that’s the GOP plan, Abderholden can look forward to another tough session in 2019.
Lori Sturdevant is a Star Tribune editorial writer and columnist. She is at firstname.lastname@example.org.