Trump vs Biden: A Mental Health Policy Face-off 🥊
Less spicy than yesterday's presidential debate.
Hi friends,
We are 33 days from perhaps the most important election in recent US history — did you catch the disaster that was the presidential debate last night?!
🙏 PLEASE VOTE 🙏
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Today, we‘ll be taking a look at the Trump and Biden campaigns and how they plan to address 4 key issues:
Suicide Prevention
The Opioid Epidemic
Provider Shortage
Mental Health Parity
These 4 issues summarize the “biggest problems” that are driving new policies in mental health.
It is important to mention a couple things before I dive in. Firstly, mental health policy is usually not a splashy, front-page type of issue. A lot of the info you see below is based on paragraphs from other policies, proposed budgets, and campaign interviews.
Secondly, we can talk and debate policies but let’s be clear — Trump is an abomination to the American democracy and it’s time to vote his ass out of office 🙃.
Finally, a huge thanks to Nirmita Panchal, Cynthia Cox, Eric Lopez, Rachel Garfield and Rabah Kamal of KFF, who put together the report titled “COVID-19, Mental Health, and the 2020 Election: A Review of Candidate Platforms" that served as the backbone for this article.
Alright, moving on.
What the next president does about mental healthcare matters.
I get it — there are so many things in the world that feel heavy right now. And you're telling me that this is something else that I need to worry about?
Here is the thing: mental healthcare is more important now than ever before. As COVID systematically isolated us from our jobs, our economic stability, and our communities, we are left scrambling to stay afloat. The past 6 months sucked. And because of it, we are facing an unprecedented mental health crisis.
Here’s a graph based on some numbers released by the CDC:
The percentage of adults with reported symptoms of anxiety or depressive disorders has almost quadrupled from Q2 of 2019 to Q2 2020.
Mental health has always been important. But because of the isolation and uncertainty of COVID, a lot more of us have been feeling it intensely.
Issue 1: Suicide Prevention
This is a godawful graph. I don’t need to tell you why this matters.
Both Trump and Biden have listed suicide prevention plans as part of their platform. Both have placed special attention on veterans, who historically are at a higher risk for suicide.
Trump's Plan:
Trump recently released a nationwide plan to end suicide amongst veterans, something that his 2020 presidential campaign highlights. The PREVENTS plan (aka President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide) focuses on creating a Suicide Prevention Campaign, improving suicide prevention research, and partnership building with various groups across the country.
In his proposed 2021 budget for the Veterans Affairs (VA), he has allocated $313 million for suicide prevention programs, a $76 million increase (32%) over 2020.
For regular folks (the non-veterans), he has separately allocated $93 million for suicide prevention activities, via the proposed 2021 Substance Abuse and Mental Health Services Administration (SAMHSA) budget. For more context, SAMHSA is also allocated $1.1 billion in funding for mental health services.
Biden's Plan:
Biden’s suicide prevention plan for veterans is a little more robust and focuses on 1) improving access to mental health resources 2) increase training across all VA programs and 3) increase funding.
His LGBTQ+ policy also touches upon suicide in LGBTQ+ teenagers, with a proposal to double the number of counselors in school, and call for “research to develop more effective teen suicide prevention programs.”
I found nothing concrete on suicide prevention programs for the general public. I did, however, find a lovely Youtube link to his remarks at the National Conference on Mental Health in 2013.
The takeaway:
Both campaigns focused heavily on funding and improving mental health resources for veterans.
Neither campaigns offer guidance in how they plan to address increasing suicide rates in other populations.
Issue 2: The Opioid Epidemic
An estimated 128 people die every day from opioid-related drug overdoses. It’s a chilling number made even more chilling by the knowledge that a lot of these deaths were the result of misinformation and misaligned incentives.
The opioid epidemic was rightly declared a public health emergency in 2017 and has quickly become a hot button issue for political parties.
(If you’re interested in learning more about how this epidemic came to be, check out the New Yorker article, “The Family That Built an Empire of Pain” or Dopesick by Beth Macy)
Trump’s Plan:
His administration declared the crisis as a national public health emergency in 2017 and has renewed that declaration consistently.
His 2021 proposed budget for the Veterans Affairs also provides $504 million for opioid prevention and treatment in vets, a 19% increase from 2020.
However, Trump’s 2021 budget proposes a 2.1% decrease in funding for SAMHSA and calls for a $1 trillion cut to Medicaid and the ACA in the next decade. Medicaid is the largest payer for mental health services and is a major provider of substance use disorder treatments. Cutting Medicaid will severely cut resources to those battling addiction and substance use disorders.
Biden’s Plan:
Biden’s proposal for the opioid crisis is a thing of beauty. I’m no policy connoisseur, but this is easily the most spoken-to mental health issue in his campaign and I appreciate its depth. His plan in summary:
Hold big pharma responsible for their role in the opioid crisis.
Infuse $125 billion in federal investment for prevention, treatment, and recovery services.
Stop over-prescription of opioids and develop less addictive pain medications.
Stop incarceration from drug use alone.
Prevent illicit drugs like fentanyl and heroin from flowing into the States.
The takeaway:
Both campaigns have addressed the opioid epidemic.
Trump proposed a budget that increases funding for opioid treatment for vets but decreases funding for SAMHSA / Medicaid.
Biden proposed a detailed plan which includes funding more treatment services and preventing the crisis from growing.
Issue 3: Provider Shortage
Oprah is wrong ☹️
Over 115 million Americans live in the somberly named “Health Professional Shortage Areas”. In these areas, the ratio of therapists to regular persons is 1 to 30,000. And this problem will only get worse.
(You’re probably thinking — why??? That topic deserves more than a paragraph in a political policy piece. I promise I’ll get to it.)
Trump’s Plan:
I found no mention of this issue anywhere on his website.
Looking at budgets for the Department of Health and Human Services, there was a 24% increase in funding for “Behavioral Health Workforce Development Programs” from 2019-2020. That increase in budget remains in place for 2021.
Biden’s Plan:
Also no direct mention of this issue in his campaign.
His education policy does mention doubling the number of mental health professionals in schools so that children can get the care they need.
Biden also mentions telehealth as a resource for the above-mentioned shortage areas and will expand grant funding to accelerate telehealth usage for mental health and specialty care.
The takeaway:
Both campaigns make little mention of the issue and have no concrete plans to address the shortage of mental health workers.
Issue 4: Mental Health Parity
Ok, I saved the gnarliest for last. Mental health parity is a long-debated, complicated concept that basically says — insurance coverage for your mental health services should be “equal” to the coverage for your medical services.
This is important because historically, most insurance plans did not cover mental health services. And when these services were covered, the plans often had greater restrictions: out-of-pocket costs were relatively higher, limits on length of care were more restrictive, annual/lifetime caps on coverage were separately defined, and authorization requirements for getting care were different. This prevented a lot of folks from seeking mental healthcare since it was less affordable and extremely confusing.
Mental Health Parity in Law — A Timeline:
The Mental Health Parity Act (MHPA) was signed into law in 1996. This was the OG law that codified the concept of mental health parity. But there were many loopholes, and the law did not address treatment limits, coverage limitations, and differences in cost structures.
In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed to cover some of the loopholes. This version banned differences in treatment limits and costs and also applied these conditions to substance use disorders, which the MHPA did not address. The nuance here is: this act only applied if your insurance plan offered mental health coverage, which meant that some plans opted to not offer any coverage at all.
In 2010 the ACA expanded the MHPAEA by deeming mental healthcare as one of the ten “essential health benefits”. As a result, all group health insurances must include coverage for the treatment of mental health and substance use disorders. By including mental healthcare as an essential health benefit, insurers were now mandated to cover mental healthcare.
Trump’s Plan:
There is no mention of mental health parity on his campaign website.
Trump is also looking to repeal the ACA, which removes the law that defines mental health services as an “essential health benefit”. If ACA is repealed, coverage for mental health services is no longer mandated.
Biden’s Plan:
Biden’s healthcare plan states that he will redouble efforts to “ensure enforcement of mental health parity laws”. As VP, Biden had pushed for and implemented improvements to laws, and helped pass the ACA.
We also know that he is planning to protect and build on the ACA, which would keep mental health as an essential health benefit.
The takeaway:
Mental health parity is wrapped into the whole healthcare debate, which makes it dependent on the status of the ACA.
Trump’s campaign does not mention mental health parity and he is actively looking to repeal the ACA.
Biden’s campaign mentions that he’ll focus on enforcement of the existing parity laws, and will continue to build on the ACA.
One Last Note
Mental health policy is not necessarily a front-page, hotly-debated issue. Outside of bi-partisan issues like veterans mental health or the opioid epidemic, both Trump and Biden campaigns barely mention their stances on mental healthcare. So it is hard to see how your choice in president affects your mental healthcare.
Here’s the thing. The answer to a question like “How can we improve your access to mental healthcare?” is incredibly nuanced, and is tightly interwoven with topics like education, taxes and healthcare. And the answer will be determined by how your president thinks about education policies, tax laws, and healthcare coverage. So when you think about your mental healthcare, who your president is matters.
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See ya’ll soon!
Vic
Thanks for sharing your inbox with me! Outside of writing this newsletter, Victoria is also the co-founder of Heard, a mental health company. If a friend forwarded you this and you like what you’re reading, please subscribe!