When President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act on March 18, it was a bittersweet moment for all involved. It marked the culmination of two years of persistent advocacy to prioritize physician mental health, but the triumph of passing the bill is impossible to separate from the tragedy of losing Dr. Breen—a sister, a daughter, a friend, and an emergency physician colleague. Still, this law that carries her name is an important step to protect emergency physicians whose emotional health and wellbeing suffered even before this prolonged pandemic, and it helps preserve the memory and legacy of Dr. Breen and other health care physicians who have suffered in silence.

From start to finish, ACEP was deeply involved in the process—helping develop the legislative language, pushing it through the legislative process, hosting hundreds of meetings with legislators during ACEP’s 2021 Leadership & Advocacy Conference (LAC21), persistent grassroots outreach by ACEP members, and collaborative efforts

Corey Feist (2nd L), Co-founder of the Dr. Lorna Breen Heroes Foundation and Chief Executive Officer of the University of Virginia Physicians Group, walks with his family after US President Joe Biden offered him and others a tour of Marine One before he departed the White House in Washington, DC, on March 18, 2022. (Photo by Jim WATSON / AFP) (Photo by JIM WATSON/AFP via Getty Images)

with other health care groups and the Dr. Lorna Breen Heroes’ Foundation—this legislative victory is a testament to our collective voice. Throughout this bill’s journey, your voices were heard.

Now that the bill crossed the finish line, let’s retrace its path to victory.

March 2020

ACEP began working with Rep. Raja Krishnamoorthi (D-IL) on efforts to address stress, anxiety, and burnout among health care workers exacerbated by the COVID-19 pandemic. This initial effort centered around establishing a grant program within the U.S. Department of Health and Human Services (HHS) to increase access to confidential mental health assessment and treatment options for health care workers, as well as funding a comprehensive study on health care worker mental health, including a particular focus on the impacts of the COVID-19 pandemic.

April 2020

When Dr. Breen died by suicide on April 26, 2020, ACEP accelerated the effort to draft legislation aiming to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals.

May 6, 2020

Rep. Krishnamoorthi led a bipartisan letter signed by 90 members of the House of Representatives asking Congress to establish the HHS grant program for health care workers and conduct the study on health care workers mental health and burnout. ACEP and more than 50 other physician and health care associations supported the letter, with ACEP President William Jaquis, MD, FACEP, quoted in the Congressman’s press release on the letter.

June 18, 2020

Reps. Krishnamoorthi, John Katko (R-NY), and Frederica Wilson (D-FL) introduced the ACEP-supported bipartisan Coronavirus Health Care Worker Wellness Act(H.R. 7255) to carry out those aforementioned priorities. Dr. Jaquis was again quoted in the press release.

June 20, 2020

ACEP and other leading medical associations, academics, and psychiatry experts issued a joint statement outlining necessary steps to support the mental health of emergency physicians and other health care professionals on the front lines of the pandemic.

During this time, ACEP also began working with Senator Tim Kaine (D-VA) on the issue. Senator Kaine had taken a particular interest as not only had Dr. Breen’s story resonated on a national level, but her family members were his constituents and she was in Virginia when she died. ACEP worked with the Senator and his staff to help fill out their vision for legislation to provide short-, medium-, and long-term solutions to help address the myriad challenges and hurdles specific to mental health for physicians.

July 29, 2020

The Dr. Lorna Breen Health Care Provider Protection Act (S. 4349) was introduced in  the Senate of the 116^th Congress by Sens. Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), and Bill Cassidy (R-LA). ACEP staff helped secure specific legislative language to ensure health professional organizations (like ACEP) were eligible for grants to promote mental health among the health care professional workforce.

August 22, 2020

The Dr. Lorna Breen Health Care Provider Protection Act (H.R. 8094) was introduced in the House by Reps. Max Rose (D-NY), David McKinley (R-WV), Anthony Brindisi (D-NY), Denver Riggleman (R-VA), Gil Cisneros (D-CA), Morgan Griffith (R-VA), and Fred Upton (R-MI).

Ultimately, the legislation was not considered by the relevant committees, nor was it included in any of the COVID-19 relief packages or any other legislation that passed during the remainder of the 116^th Congress.

March 4, 2021

The Dr. Lorna Breen Health Care Provider Protection Act (S. 610) was reintroduced in the Senate of the 117^th Congress by Sens. Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), Bill Cassidy (R-LA), and others.

March 8, 2021

The Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667) was reintroduced in the House by Reps. Susan Wild (D-PA), David McKinley (R-WV), Raja Krishnamoorthi (D-IL), Fred Upton (R-MI), Judy Chu (D-CA), Morgan Griffith (R-VA), Haley Stevens (D-MI), John Katko (R-NY), and others.

March 11, 2021

In a very unique development, the American Rescue Plan Act of 2021 (P.L. 117-2), a $1.9 trillion COVID-19 relief package passed by Congress through the “budget reconciliation” process, appropriated $140 million for clinician mental health grants and education campaign funding under the Breen bill framework.

Why was this unusual? Congress typically passes authorizing legislation and then appropriates funding afterward. In this case, funding came first, but ACEP continued working to get the authorizing legislation passed that would provide additional guidance and clarity on how the funds should be distributed. Plus, the bill included a study regarding health care professional mental health, burnout, and barriers in seeking appropriate care—provisions that were not eligible to be included under the budget reconciliation rules.

May 25, 2021

The Senate Health, Education, Labor, and Pension (HELP) Committee passed a committee markup by a unanimous voice vote. Sen. Kaine specifically thanked ACEP for our efforts during the committee hearing.

July 16, 2021

The Health Resources & Services Administration (HRSA) opened the grant application process for health care worker mental health programs via the funding provided by the American Rescue Plan Act.

July 25-28, 2021

ACEP hosted LAC21, bringing members together in-person for the first time since the beginning of the pandemic. Generating support for both the House and Senate versions of the Breen bill (H.R. 1667 and S. 610) was a primary focus of our meetings with legislators. ACEP members conducted 287 meetings with legislators and staff from 44 states, giving firsthand perspectives on physician mental health concerns. These testimonials are so important; they remind legislators and staffers that this issue is not just political—it’s a real problem that affects real people. And just days later …

August 6, 2021

The full Senate approves S. 610 under unanimous consent! This was a huge step, generating a lot of momentum for the legislation.

ACEP then turned its focus to pushing for the House to take up S. 610. This is where it got tricky—(in most cases) the exact same bill needs to be approved by both the House and the Senate. Because the Senate bill underwent some carefully-negotiated, but relatively minor changes before its unanimous approval, ACEP encouraged the House to consider the Senate version to ease its pathway toward enactment. However, the House Committee on Energy and Commerce had their own considerations they wanted to address and chose to consider the House version of the bill, H.R. 1667, instead. Unfortunately, this meant that even if passed by the House with minor changes, H.R. 1667 would still need to go back to the Senate for approval.

November 4, 2021

The House Committee on Energy and Commerce held a legislative markup of nine health care bills, including the House version of the Lorna Breen Act (H.R. 1667). The Committee made some slight changes to the legislation to help align it with the Senate bill and incorporated some minor technical changes.

December 7, 2021

As the end of the year approached, Congress was faced with a number of significant, time-sensitive priorities all colliding at the same time, including the need to avert a nearly 10 percent cut to Medicare payments. Needing a legislative vehicle to help clear some wonky procedural hurdles, the House used the Senate-passed S. 610 bill, amending it by stripping out the entirety of the text of the Lorna Breen Act and replacing it with the Medicare fix (and some other provisions). They renamed the legislation the Protecting Medicare and American Farmers from Sequester Cuts Act, approved it, and sent it back over to the Senate for approval. Thankfully, the House bill was still in play.

December 9, 2021

The full House of Representatives passed H.R. 1667 in a bipartisan 392-36 vote. As a result of the changes made by the House to H.R. 1667, the Senate was then required to vote on the House-passed bill one final time.

February 17, 2021

The Senate approved H.R. 1667 by unanimous consent, clearing the measure to be sent to the President for his signature.

March 18, 2021

President Biden signed H.R. 1667 into law.

What Now?

ACEP continues to work on the issue of mental health for patients and for health care workers alike on both the legislative and regulatory fronts. We are working with Senator Kaine on what he envisions as “Breen 2.0” to address some of the other lingering challenges affecting health care workers and how they seek and access mental health care treatment, and we continue working with various congressional committees that have recently turned their focus to the nation’s mental health crisis as well.

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