THE PROGNOSIS

Sure, there are lots of loopholes that could allow those with serious mental illness to purchase a firearm in the United States – but they’re not the ones committing most of the gun violence.

As the gun-control debate rages following last week’s deadly Florida school shooting, President Trump and other gun rights advocates have emphasized restricting firearms access for the mentally ill – a familiar refrain for many conservatives who want to stem the tide of school shootings but resist stricter gun laws.

Trump tweeted this Thursday morning:

At an emotional and sometimes fiery CNN town hall Wednesday night, a spokeswoman for the National Rifle Association responded to a question about whether it should be harder for people to obtain semiautomatic weapons by calling Florida shooter Nikolas Cruz an “insane monster” who never should have been able to get a gun.

“This individual was nuts, and I — nor the millions of people that I represent as a part of this organization that I'm here speaking for — none of us support people who are crazy, who are a danger to themselves, who are a danger to others, getting their hands on a firearm,” said Dana Loesch.

Yesterday her boss, NRA chief executive Wayne LaPierre, said gun-control advocates want to "sweep right under the carpet the failure of school security, the failure of family, the failure of America's mental-health system and even the unbelievable failure of the FBI." He was speaking at the Conservative Political Action conference, which was covered by The Washington Post's Dave Weigel and Mark Berman.

C-PAC attendees also stressed mental health over gun control:

Florida is among 13 states that participate to the fullest extent in the National Instant Criminal Background Check System, a database known as NICS, which indicates who can’t legally be sold a gun. But it’s hardly surprising that Cruz, who is accused of killing 17 people in Parkland, was never entered into the system, given how hard it is for someone to be registered in NICS based on mental illness.

Here’s why: Cruz was never mandated inpatient treatment. In 2016, mental-health investigators gave Cruz a psychiatric evaluation because of a Snapchat video in which he was shown cutting his arms and saying he wanted to buy a gun, but investigators chose not to hospitalize him. At the time, his adoptive mother said her son suffered from depression, ADHD and autism.

Being involuntarily committed to a psychiatric hospital is the chief way the names of the mentally ill are entered into NICS. First, a court would have to determine such individuals are a danger to themselves or others and mandate treatment. But then space would have to be found for the patient at an inpatient center — and there is a well-documented shortage of beds.

“The number of inpatient beds has dropped so dramatically it’s almost impossible to be admitted,” Liza Gold, clinical professor of psychiatry at Georgetown University School of Medicine, told me.

The other way those thought to be mentally ill can be entered in NICS is if a court finds them not guilty of committing a crime or incompetent to stand trial by ruling them “mentally defective" -- an archaic term still used in legal proceedings. But that category includes only a small number of individuals suffering from serious mental illness, Gold said.

And here’s a catch: Making sure every seriously mentally ill person in the United States is entered into NICS wouldn’t necessarily prevent shootings. Recent studies have shown that fewer than 1 percent of people with serious mental illnesses have used a firearm to kill a stranger.

Just compare the names in the NICS database with those who are actually blocked from buying a gun. While 30 percent of the names in the database are those with a mental illness, they make up fewer than 2 percent of those who attempt to buy a gun and are rejected.

“What that tells me is that people who have been involuntarily committed to psychiatric hospitals are really not the people going out and buying guns,” Gold said.

Still, there are certainly examples of mass shootings carried out by individuals who are clearly deeply troubled. Experts say it’s a logical move to keep firearms away from those with serious mental illness such as schizophrenia or bipolar disorder, especially in the first year after they've been released from a treatment facility because that’s when patients are at greatest risk of relapse.

Politicians on both sides of the aisle tend to agree; After the 2007 Virginia Tech shooting, Congress passed a measure tightening up NICS to ensure participating states provided all the necessary documents indicating whether someone had a history of severe mental illness or violence that could disqualify them under federal law from being sold a gun.

But as Trump promises better mental-illness reporting, don’t forget that he and GOP lawmakers did away last year with an Obama-era regulation blocking the sale of firearms to people deemed by the Social Security Administration to be so severely mentally ill that they couldn’t hold down a job or cash their own benefit check.

At the time, many Republicans viewed the rule as violating the constitutional right to bear arms and stigmatizing those with mental illnesses – and the American Civil Liberties Union and other disability rights groups agreed.

Regardless of tweaks made to the system over the years, it’s implemented overall in a “scattershot” way, said Christopher Slobogin, a professor of law at Vanderbilt University who is an expert on mental-health issues.

“It’s fair to say there hasn’t been enough money or energy put into the whole project of making sure people who are mentally ill and considered dangerous are kept away from firearms,” Slobogin told me.

Some on Twitter were indignant at Loesch's comments about the mentally ill. Moms Demand Action's Shannon Watts: 

Author Maureen Johnson: 

Ella Dawson, social media editor for TED.com: 

The Atlantic's Vann R. Newkirk II:

Business Insider's Josh Barro: 

Via NBC News's Andrea Mitchell: 

Brian Klaas, a fellow at the London School of Economics:

AHH, OOF and OUCH

AHH: The Post's Maria Sachhetti tells the story of a young immigrant with just three months left in medical school who now faces deportation as the Trump administration seeks to end the Obama-era DACA program. "Rosa Aramburo sailed into her final year of medical school with stellar test scores and high marks from professors," Maria writes. "As she prepared to rank her top three [residency program] choices last week, Congress rejected bills that would have allowed her and other 'dreamers' to remain in the United States, casting new doubt on a career path that seemed so certain a year ago."

"Employers and universities that have embraced DACA recipients over the past six years are scrambling for a way to preserve the program," Maria writes. "They are lobbying a deeply divided Congress, covering fees for employees and students to renew their permits, and searching for other legal options — perhaps a work visa or residency through spouses or relatives who are citizens. Some companies have considered sending employees abroad.

These "dreamers" are working at top employers all around the country. More than 160 DACA recipients are teaching in low-income schools through Teach For America. Thirty-nine work at Microsoft, 250 at Apple and 84 at Starbucks. To employers, the young immigrants are skilled workers who speak multiple languages and often are outsize achievers. Polls show strong American support for allowing them to stay, Maria notes.

"Human-resources experts warn that employers could be fined or go to jail if they knowingly keep workers on the payroll after their permits have expired," Maria writes. "And while the White House has said that young immigrants who lose DACA protections would not become immediate targets for deportation, Immigration and Customs Enforcement says anyone here illegally can be detained and, possibly, deported."

OOF: Yesterday a federal judge sentenced Florida eye doctor Salomon Melgen -- who was involved in legal allegations ending in a hung jury connected to Sen. Bob Menendez (D-N.J.) -- to 17 years in prison and $42.6 million in fines for stealing $73 million from Medicare in one of the program's biggest fraud schemes. The sentence is for 67 crimes committed by Melgen, including submitting false claims and falsifying records in patients' files.

"Prosecutors said Melgen was the nation's highest-paid Medicare provider for five straight years," the AP reports. "Evidence showed his business was built on fraud. Melgen convinced many elderly patients to undergo often painful tests and treatments they didn't need."

A separate case involving Menendez -- accused of being bribed by Melgen -- was dropped last year after the trial ended in a hung jury. 

OUCH: Adding work requirements to Medicaid could cost Kentucky nearly $187 million in the first six months, CQ reports. Republican Gov. Matt Bevin projects the requirements will eventually save money, but the state must first create complex electronic systems and implement other ways to track work hours and monthly premium payments. Bevin's revised 2018 budget says the federal government would cover most of the extra costs, but the projection still illustrates the price of the Medicaid changes being considered by at least 10 states.

“In Tennessee, a Medicaid work requirement proposal in the legislature would cost the state an estimated $18.7 million each year and the federal government more than $15 million annually, according to a state fiscal analysis,” reporter Misty Williams explains. “And in Virginia, a recent government analysis showed adding a work mandate could cost the state tens of millions of dollars over the next couple of years.”

Despite the upfront costs, Kentucky officials say the new work requirements will create an estimated $2.4 billion in savings to the state and the federal government over five years, Misty writes. The savings would mostly result from people dropping out of Medicaid or not qualifying in the first place because of the new rules.

OPIOID OPTICS

--The opioid epidemic is paralyzing the workforce. Even with six million open jobs across the country, rampant drug abuse has “incapacitated thousands of working-age people whom employers would otherwise be eager to hire,” CNN’s Lydia DePillis writes. In its annual economic report, Trump’s Council of Economic Advisers wrote “curbing the opioid crisis is of critical importance for ensuring a stable or growing employment rate among prime-age workers.”

Research published in September from Princeton economist Alan Krueger found the rise in painkiller prescriptions  from 1999 to 2015 led to a 20 percent drop in men’s workforce participation and 25 percent decline in women’s participation.  As a result, "some employers that typically screen drug users out through testing are starting to become less picky," Lydia writes. But "such tolerance is not an option for all employers. Jobs that involve working with children typically bar people with criminal records," she adds. "Construction companies, too, are less likely to take the risk of hiring someone who might come to work high and make a fatal mistake while on a ladder or using heavy equipment."

TRUMP TEMPERATURE

--Trump's administration is taking a step toward tightening work requirements in the food stamp program, with a focus on high-unemployment areas that have been exempted from those rules since the recession, The Post's Caitlin Dewey reports. Today, the Agriculture Department will begin soliciting public comment on work requirements, the first step toward changing those rules.

"Under existing rules, able-bodied adults without dependents can receive benefits for only three months, unless they work at least 80 hours a month or participate in a qualified job-training or volunteer program," Caitlin writes. "But those rules do not currently apply in Alaska, California, Louisiana, Nevada, New Mexico and parts of 28 other states, where jobs are less widely available."

“This is a population that we believe we can move to self-sufficiency, with the right focus,” USDA administrator Brandon Lipps said in a conference call with reporters Thursday.

--A few more good reads from The Post and beyond:

INDUSTRY RX
One reason for the evictions, legal advocates say, is that the residents’ better-paying Medicare coverage is ending and will be replaced by Medicaid.
New York Times
STATE SCAN
D.C. Politics
The United Medical Center board chairwoman was defiant following a ruling from the city’s top ethics official that the panel violated the law by excluding the public from its discussion.
Peter Jamison
Virginia Politics
Virginia’s House and Senate on Thursday approved starkly different state budget plans, one flush enough for teacher raises, expanded health care and more financial aid for college students, the other filled with painful cuts. The difference boiled down to Medicaid expansion.
Laura Vozzella and Gregory S. Schneider
Tourists catching a flight out of Sin City can now dump their leftover legal marijuana in metal containers set up at the airport. The 10 green bins dubbed “amnesty boxes” prevent federal transportation agents from finding pot on passengers during security screenings. The drug is legal in Nevada but still banned by the U.S. government.
AP
REPRODUCTIVE WARS
Bishop Thomas John Paprocki of the Diocese of Springfield, Ill., has barred Sen. Dick Durbin from receiving Holy Communion for his recent vote against a bill that would have banned late-term abortions.
Washington Examiner
DAYBOOK

Coming Up

  • The Joint House and Senate Veterans' Affairs Committees hold a hearing on the legislative presentation of the Disabled American Veterans on March 1.
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