So far, there are more questions than answers about how a President Trump will work to address addiction and improve mental health services. We take a look at some of the hints that the president-elect has given about direction and some of the key policies at stake.
Many of the president elect’s public statements indicate that he sees the opioid epidemic as more of a criminal justice problem than a public health problem. If he continues to take this stance, it will put him at odds with research that has consistently shown that it is more effective to treat addiction as a chronic health condition than as a crime.
Trump promised during campaign rallies to reduce the inflow of opioids by closing the border with Mexico. However, the majority of opioids abused in the U.S. are prescription opioids. It does not appear that President-elect Trump has made any statements on how he might address this problem.
He did make a statement at one town hall in Ohio in August in which he said, “It’s very hard to get out of the addiction of heroin. We’re going to work with them, we’re going to spend the money, we’re going to get that habit broken.” The President-elect has not provided any details about how he envisions spending treatment money.
President-elect Trump’s website features a page called “Healthcare Reform To Make America Great Again,” which focuses primarily on repealing the Affordable Care Act (ACA), or Obamacare. It mentions certain features that might be present in a replacement plan, such as tax-free Health Savings Accounts, and the ability to purchase insurance across state lines, but does not spell out a comprehensive alternative plan.
Since being elected, Trump has suggested that he will keep popular parts of the ACA such as guaranteed coverage for pre-existing conditions, and letting young people stay on their parents’ insurance. Since the law is complicated and has been cobbled together with compromises between Congress, insurance companies, and consumer advocates, it is unclear whether it will be possible to scrap unpopular parts of the law while keeping well-liked parts.
There is one paragraph on the Healthcare Reform page that addresses mental health:
“Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.”
It is unclear which reforms he is referencing, so we look forward to greater detail on this.
The only other place on the President-elect’s website that addresses mental health is in a section about protecting Second Amendment rights. On this page, the policy position reads:
“Fix our broken mental health system. All of the tragic mass murders that occurred in the past several years have something in common – there were red flags that were ignored. We can’t allow that to continue. We must expand treatment programs, and reform the laws to make it easier to take preventive action to save innocent lives. Most people with mental health problems are not violent, but just need help, and these reforms will help everyone.”
While the passage notes that most people suffering from mental illness are not violent, including mental health funding in this context draws a link that the mental health field has strived to dispel, as the vast majority of mental health needs have nothing to do with violence against others. It is unclear what these reforms would be or how they would be funded.
Given Republican control of both houses and the executive branch, it seems highly likely that some or all of the ACA will be repealed. Some people consider this a welcome change, while others are concerned about what it might mean for their insurance coverage and costs. Whether certain provisions survive may impact the availability of mental health and substance abuse services and the extent to which insurers will cover these services.
The Essential Health Benefit, or EHB, requirements of the ACA govern the minimum coverage provided by private insurance plans. It defines ten mandated components, which include ambulatory services, emergency, hospitalization, maternity/newborn care, pediatric care, prescription drugs, preventive/wellness, rehabilitative/habilitative and mental health, and substance abuse care. By including mental health and substance abuse care in the EHB, the ACA, insurance plans that may not otherwise have included this coverage now are required to include it.
The Mental Health Parity Act, passed in 1996, required insurance companies to provide equal coverage for mental health concerns as for physical health concerns. This law only applied to plans offered through large employers. In 2008, Congress enacted the Mental Health Parity and Addictions Equity Act (MHPAEA), which expanded the coverage of the act to apply to plans to small group plans and those purchased privately.
These laws work in tandem, along with other provisions of the ACA, to provide mental health and substance abuse coverage to millions more Americans than were previously covered. If the ACA is repealed as promised by the next administration, it is unclear what the fate of these provisions will be.
Reduced insurance coverage of mental health and substance abuse services could result in big shifts in the treatment field, as treatment programs that previously were able to bill insurance for their services face a much smaller population that can afford to pay out of pocket.
If you value mental health and addiction services and would like to see greater coverage by insurance companies and/or more support and funding for these services from the government, let your elected representatives know! Hearing stories of those who utilize these services makes the issues real for these public officials.
This page can help you find contact information for your representatives.
As the serenity prayer reminds us, “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”