Behavioral Health Changes Under Biden Could Hinge on Senate Outcome

With multiple major media organizations calling the race, former Vice President Joe Biden appears to have won the presidential election over President Donald Trump.

Of note: As of late Friday afternoon, Trump had not formally conceded the race, ballots across the U.S. are still to be counted, and it will be weeks before the result is made official. Barring a dramatic turn of events, though, Biden is set to take office as the nation’s 46th president on Jan. 20, 2021. What will his election mean for mental health and addiction treatment providers?

That, industry leaders say, could largely depend on Senate races that are still very much up in the air. Elections for both Georgia Senate seats are headed to run-off votes in January, with Democratic challengers Jon Ossoff and Raphael Warnock facing Republican incumbent Sens. David Perdue and Kelly Loeffler, respectively. Democrats would have to win both run-offs to effectively flip the Senate by creating a 50-50 split, with the vice president casting the deciding vote on ties.

If Republicans maintain control of the Senate, changes implemented by a Biden administration could be largely relegated to the margins, says Chuck Ingoglia, president and CEO of the National Council for Behavioral Health.

“There might be some opportunities to do some things around the edges, but the prospects for significant legislative activities go down,” Ingoglia tells BHE. “Certainly, the administration can look at ways to shore up the Affordable Care Act, whether that’s in terms of ensuring that all plans meet ACA requirements, that there’s more robust advertising for open enrollment, those kinds of things.

“If we did have unified Democratic control, I think the prospects for more significant legislating go up considerably. Sen. Lindsey Graham, who is likely going to be the chair of the budget committee if Republicans maintain control of the Senate, is already talking about reducing the federal deficit. I think that will likely be a theme from the Republican Senate.”

Should Democrats take control of the Senate, to go along with the existing majority they have in the House, however, Andrew Kessler, JD, principal of the behavioral health consulting firm Slingshot Solutions, says he would like to see the new administration puts a heavy emphasis on pursuing new initiatives.

“What I’m hoping for more than anything else is innovation,” Kessler says. “Not just the last four years, but for many years, we have in terms of policy been doing the same thing over and over. Naloxone is great. Treatment is great. Medication-assisted treatment is great. But we really need to start going well beyond policy that just does the real basics of treatment and start looking at why we have this problem at a societal level.”

Specifically, Kessler says attention should be drawn toward taking a deeper dive into addressing adverse childhood experiences and trauma that often lead individuals to be more susceptible to substance use disorders, as well as taking more concrete steps to further develop a whole-health approach.

“I think it comes down to a huge investment in prevention and, on the other side of treatment, recovery,” Kessler says. “Treatment is a necessary, but small part of the equation. It’s the other two sides—prevention and recovery—that need to be just as strong. I think this administration is going to understand that. No more of the convenient narrative of ‘I had a drug problem, but then I got buprenorphine, and now I’m better.’ No more of that.”

Kessler credited the Trump administration for the establishment of its President’s Commission on Combating Drug Addiction and the Opioid Crisis, specifically the document it published in November 2017, an extensive report that brought together policy recommendations for addressing the nation’s substance use disorder crisis from all corners of the industry and put them into one place.

Now, Kessler says, a Biden administration could use the report as a blueprint to start putting many of the recommendations into action.

“I would have no problem dusting that off and saying, ‘Hey, maybe we’ve got something to work from here,’ ” Kessler says. “But you’ve got to actually do something with it and not just say, ‘Look, we made this document. Done. Check,’ which I kind of feel like this White House did. They didn’t utilize it. Maybe this next White House can build on that because there are some good recommendations in there.”

COVID-19 remains a factor

For the foreseeable future, any progress in addressing substance use disorders made by the Biden administration and Congress will have to be made under the looming specter of the COVID-19 pandemic.

Ingoglia notes that Senate Majority Leader Mitch McConnell has indicated he would like to see a fourth coronavirus relief package passed within the next two months, and the House and Senate have introduced bills with increasing amounts of money earmarked for mental health and substance use support. The most recent version passed by the House has dedicated $850 million for such services.

Kessler adds that the administration will have to weigh the needs of several areas of the public health system that are feeling the pinch created by the pandemic.

“We’re not alone,” Kessler says. “The behavioral health field hasn’t cornered the market on ‘we have it worse during the pandemic.’ We know that COVID-19 can be damaging to the heart and lungs, so cardiologists and pulmonologists have it tough. We know it can do bad things to circulation. They’re finding new things every day.”