Trump, Biden Differ on Approach to MH Policies

At press time, Donald Trump’s plans to address mental health issues in a second term were unclear. His campaign website largely outlines what he has completed in his first term, including allowing short-term health plans to be extended up to 12 months, repealing the individual mandate of the Affordable Care Act (ACA), and declaring the opioid crisis a public health emergency.

The website notes that in 2019, Trump signed an executive order calling on his administration to develop a comprehensive strategy to end suicide among veterans and establishing a task force to do so. His administration also expedited the release of emergency grants to states to improve access to treatment for substance use disorder (SUD) and other mental illnesses during the COVID-19 pandemic.

He also signed the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act, which expands access to treatment for people with SUD and other mental illnesses.

Shortly before the Republican National Convention last month, Trump’s campaign team posted his second-term agenda on his website, which outlines 10 goals but does not provide details on how he would achieve them. The agenda does not list any specific policy goals related to mental health, but a news release notes that he will outline additional policies as he continues on the campaign trail.

Under health care, the agenda lists seven goals, including cutting prescription drug prices and putting patients and doctors back in charge of the health care system. The goal of eradicating COVID-19 is also listed as a second-term priority, and bullet points include developing a vaccine by the end of 2020 and returning to normal in 2021.

“Mental health has remained a priority for President Trump, both throughout his Administration and the coronavirus pandemic,” said Courtney Parella, the Trump campaign’s deputy national press secretary, in an email. “President Trump has expanded critical telehealth technology to reach Americans in every corner of the nation, and because of his Administration’s continued focus on this issue, Americans have never had more access to mental health resources than they do today.”

In a comprehensive comparison of Trump and Biden’s campaign platforms, the Kaiser Family Foundation (KFF) noted that Trump’s 2021 budget includes an increase in funding for suicide prevention programs in the Substance Abuse and Mental Health Services Administration (SAMHSA).

With regard to mental health parity, KFF also noted that the Trump administration joined the case now before the Supreme Court that would invalidate the ACA, “an outcome that would substantially limit the scope of parity rules and eliminate the essential health benefit requirement,” according to the analysis. KFF also pointed out that Trump’s 2021 proposed budget would decrease total funding for SAMHSA, though the budget also includes a small increase in grants to address opioid use disorder.

Joe Biden’s campaign website states that, as vice president, he was a champion of efforts to implement the federal mental health parity law, improve access to mental health care, and eliminate the stigma of mental illness.

The website adds, “As President, he will redouble these efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.” The website notes that enforcement of the Mental Health Parity and Addiction Equity Act has been insufficient. “As President, he will finish the job by appointing officials who will hold insurers accountable, enforcing our parity laws to the fullest extent,” the website states. “He will also direct federal agencies to issue guidance making clear how state officials and the public can file a complaint when their insurers—or Medicaid—are not living up to their parity obligations.”

Biden says he will protect and build on the ACA and create a public health insurance option for Americans, similar to Medicare. Additionally, he would “redouble efforts to ensure insurance companies stop discriminating against people with behavioral health conditions and instead provide the coverage for treatment of mental illness and substance use disorders that patients and families need,” according to his website.

Biden further promises to double funding for community health centers and expand the supply of health care professionals through efforts such as expanding the National Health Service Corps.

In a series of questions Biden was asked by the Mental Health for US initiative, Biden responded that his first step to tackle the opioid crisis and reduce SUDs in general is to build on the ACA as well as the 21st Century Cures Act. The law provides $1 billion in grants to states for substance use disorder prevention, treatment, and recovery efforts. The campaign website expands on his plan, noting that he would “dramatically scale up the resources available, with an unprecedented investment of $125 billion over ten years.”

Biden proposes to ensure that his new public option, as well as public insurers such as Medicare and Medicaid, integrates SUD care into standard health care practice. His website also notes that Biden will call on Congress to invest $50 million to accelerate research into the causes and prevention of gun violence at the Centers for Disease Control and Prevention and the National Institutes of Health.

In terms of the COVID-19 pandemic, Biden would ensure that health care workers and first responders have access to prevention and early intervention mental health services, including emotional health support and psychological first aid. He would also expand “immediate access to telemental health services by requiring all carriers—not just Medicare—to pay for telemental health services,” according to the campaign website. ■