With Trump taking office, Republicans will control the executive branch and hold majorities in both houses of Congress, meaning they can be expected to make good on the oft-stated objective of cutting federal spending. Historically, mental health has always received only a thin slice of funds allocated for health, and if the health care pie shrinks, that slice can only become thinner.
Also, Trump has vowed to return more of the administration of Medicare and Medicaid to the states through block grants, and the tight budgets of many states often lead to allocating block grant funds in a manner that relieves pressure on the overall fiscal picture rather than increasing health care spending.
For example, increased federal funding may be allocated to replace state dollars presently spent for health purposes so those dollars can be spent on needs in other areas. The result may be little or no actual increase in funds to expand health care.
Indications of limited spending for health care were apparent even before the change of administration with the passage of the much heralded and acclaimed 21st Century Cures Act.
Much of U.S. Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act was folded into the act which easily passed both houses, bringing praise from many mental health organizations, including the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness and the National Eating Disorders Association.
But, the bill was funded at half the recommendation in its original form and much of that funding must be approved in future congressional actions before actually being allocated – with many parts of it to be paid for in block grants.
As for Trump’s intentions concerning mental health care, his transition team has said only that reform of mental health care will be part of the administration’s overall reform of health care. The prime element of health care reform, as Trump and other Republicans see it, is repeal of the Affordable Care Act (Obamacare) and replacing it with health savings accounts while returning regulation of health care insurance to the states.
Exactly what that means for parity of mental health care remains to be seen, but John Caccavale, Ph.D., executive director of the National Alliance of Professional Psychology Providers, foresees problems. In a December column for the organization’s newsletter, Caccavale pointed out that since the Carter administration in the late 1970s spending for mental health has increased under Democrat presidents and decreased under Republicans.
As for returning insurance regulation to the states, Caccavale noted Trump has also proposed allowing companies to sell health insurance across state lines to increase competition and presumably reduce cost. Caccavale said that also likely would cut mental health care.
He explained that it was only through the Affordable Care Act that insurance companies were required to provide mental health care and assure parity with physical health care coverage. He said returning regulation to the states likely will mean that some states will require only minimal or no mental health care coverage, meaning companies locating in those states can market inferior plans nationwide, similar to how many corporations incorporate in Delaware for tax advantages even though the bulk of their business may be in other states.
Although the passage of legislation to repeal Obamacare is a prime element of Trump’s plans for his first 100 days in office, it is not a change that can be realized overnight. In an interview on 60 Minutes, House Speaker Paul Ryan, R-Wisc., said the act will be phased out in a manner to allow health care recipients time to change insurance coverage if necessary.
Asked if everyone would have coverage under the revisions, Ryan said only that all would have “access to affordable health care.” (Emphasis added.)
The one area where Trump has promised greater emphasis on mental health care is the Veterans Administration (VA). He has issued a 10-point plan to improve care, mental and physical, for veterans.
Concerning mental health, the plan promises to: “Increase the number of mental health care professionals and allow veterans to be able to seek mental health care outside the VA.”