Around 25% of adults in the U.S. report having been diagnosed with a mental health disorder diagnosis or experiencing emotional distress. Individuals with mental health issues are at significantly higher risk for other health problems and complications, including substance abuse.
As it stands, America has some of the worst mental health-related outcomes of higher-income countries, including the highest suicide rate and second-highest drug-related fatality rate. As the COVID-19 pandemic continues to increase the need for services and treatment, 75,000 individuals are expected to die from suicide and substance abuse before the economy recovers fully.
Currently, Medicaid is the largest payer of mental health and substance abuse treatment in the U.S. Through coverage expansions and other requirements, the Affordable Care Act (ACA) made significant changes in Americans’ ability to obtain and afford mental health treatment and services.
Pres. Donald Trump’s Approaches
The Trump administration endeavors to repeal the ACA and this action would undo the coverage and payment protections that expanded Medicaid. It would also remove extended mental health parity requirements to the individual, small group, and Medicaid managed care markets.
Finally, repealing the ACA would mean that mental health services coverage would no longer be considered an “essential health benefit” and could be limited or removed from private health plans. While repealing the ACA appears to prevent patient access to mental health services, Trump promises to “repeal and replace” and what provisions and required coverages the replacement would consist of are unknown.
The Trump administration’s 2021 budget recommends a 24% increase in behavioral health workforce development programs through HRSA (Health Resources and Services Administration) in response to the national shortage of mental health providers.
The Trump administration has also expressed an intention to address suicide among veterans. It created the PREVENTS (President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide) Task Force to focus on suicide prevention for this group, which proposed a funding increase for the Department of Veterans Affairs in 2021.
In response to COVID-19, President Trump released an executive order setting pandemic-related mental health demands as a priority, intending to deter suicide, drug-related fatalities, and poor behavioral health outcomes.
In response to the opioid crisis, in 2017, President Trump declared a national public health emergency and designated several billion dollars in grants to states for drug abuse prevention, treatment, and rehabilitation services and to expand access to medication-assisted treatment for opioid addiction.
Former V.P. Joe Biden’s Approaches
Biden has pledged to protect and build upon the ACA to guarantee coverage expansion and access to mental health services. He has promised to increase efforts to enforce existing mental health equality laws and enhance funding.
To ensure access to professional mental health treatment, Biden has called for investing in training and hiring more clinicians, substance abuse counselors, and peer support advisors while also increasing training for health care professionals, social workers, and educators.
To recognize the unique mental health needs of various communities, Biden has proposed the following:
- Doubling the number of counselors, psychologists, and other mental health providers in schools
- Expanding and strengthening mental health programs for veterans both in and outside the VHA (Veterans Health Administration)
- Strengthening programs focused on reducing suicide among LGBTQ teens
- Increasing access to adequate care for mental health and substance use disorders both during and after incarceration
Biden has released a plan intended to address the opioid epidemic that would increase access to services, reduce unnecessary opioid prescriptions, and hold drug companies accountable for their contributions to the crisis. He also proposed to make medication-assisted treatment available to those who need it.
Biden has also voiced support for exploring incarceration alternatives for persons with mental health conditions. Possible solutions include increased use of drug courts, harm reduction approaches, and treatment diversion programs.
Implications of the Candidates’ Approaches
Consider the following question if you are trying to determine the potential implications of each candidate’s approach to these issues:
If I have a diagnosed mental health disorder and have recently lost my job, will I be able to find a plan that will cover my treatment needs?
A diagnosed mental health disorder is considered a preexisting condition. Under the ACA, marketplace plans cannot refuse a person’s coverage, charge them more, or require them to endure a waiting period due to their condition. Biden has promised to build on the law’s current coverage and protections, while, as noted, President Trump is seeking the ACA’s repeal and replacement.
If the Supreme Court rules against the ACA, protections for preexisting conditions would, by extension, be eliminated as well. Although President Trump has announced that he intends to ensure preexisting conditions stay covered, Congress would need to take legislative action to guarantee that these protections will continue in the ACA’s absence.
How would each candidate likely address the ongoing opioid crisis and ensure prevention and treatment services are available in particularly hard-hit communities?
As noted, in 2017, the Trump administration announced that its strategy to fight the epidemic would include improved addiction prevention, treatment, rehabilitation services, enhanced data, etc.. It earmarked nearly $2 billion in grants to states for these purposes.
Biden has promised to make addiction and drug abuse prevention, treatment, and recovery services available to everyone. To do this, he has proposed a $125 billion federal investment to do this, which, at least in part, would be targeted support for states and localities. Biden also advocates for improved integrated primary care and behavioral health and the pursuit of cost-effective, evidence-based prevention approaches.