As President Joe Biden, Vice President Kamala Harris, and the 117th Congress took office, they arrived in the midst of multiple crises impacting Americans’ mental health—the pandemic, economic crisis and systemic racism—as well as the aftermath of the Capitol insurrection. Americans are feeling more anxious and overdose deaths reached a record high last year. Federal policymakers have a fresh opportunity in the next six months to make an impact.

Over the next several weeks and on this blog, we will share our #APAAccessAgenda—three policy areas where the Biden administration and the new Congress can move the needle on mental health and addiction so that more people can get the high-quality psychiatric care they need. These areas are:

1. Connecting Patients to Care and Coverage.
2. Addressing Inequities.
3. Investing in Mental Health and Substance Use Disorder Services.

The first step toward these priorities is reversing some harmful actions the previous administration took to roll back health insurance coverage and implement discriminatory policies that likely exacerbated mental health conditions in populations impacted.

Launching APA’s Access Agenda: Reversing Harmful Regulations

The transition to a new presidential administration brings new opportunities to improve access to high-quality care and insurance coverage for people with mental health and substance use disorders. The previous administration implemented executive orders and policies that APA opposed, and the Biden-Harris administration has prioritized addressing.

As President Biden took office, he issued Executive Orders that APA strongly supports and had previously advocated, such as removing the ban on transgender people serving in the military, repealing the order that silenced diversity initiatives, prohibiting discrimination on the basis of gender identity or sexual orientation, and initiating a roll back of Medicaid work requirements. We look forward to the Biden-Harris administration continuing to change or undo policies that either limited access to psychiatric care or were otherwise harmful to peoples’ mental health.

Among the important, urgent steps as of this posting the Biden-Harris administration should take:

• Stop Harmful Actions at the Border: The Trump administration enacted a policy of immigrant family separation at the U.S. Border, a policy in opposition to the terms of the Flores Settlement Agreement, which puts a 20-day limit on immigration detention for children before they are reunited with their families. The Biden administration has ceased family separations at the U.S. Border, but can work to improve conditions in detention centers, and ensure that appropriate health and mental health care is given to children and families at the border.
• Renew Our Welcome to International Physicians: Each year, thousands of international physicians holding J-1 visas come to this country to work and train at U.S. hospitals. A proposed rule to change the duration of the status of J-1 Visa holders issued by the Department of Homeland Security would likely prevent thousands of J-1 physicians from continuing their training programs on July 1 each year, disrupting their pre-assigned clinical physician services at hospitals across the country.
• Renew Our Welcome to Those Under “Public Charge”: Under the previous administration’s rule, immigrants to the United States classified as likely or liable to become a “Public Charge” can be denied visas or permission to enter the country due to their disabilities or lack of economic resources. This rule puts people’s mental and physical health at risk, particularly in light of the economic and health impacts of COVID-19, and it needs to be ended. The Biden administration has initiated a review of public charge that led to immigrants disenrolling from public programs out of fear and confusion.
• Protect the Affordable Care Act So More Americans Can Access Care: Since it was signed into law, the ACA has extended health coverage to 30 million Americans, including 2.8 million Americans with substance use disorders and 1.3 million Americans with serious mental illness who were previously uninsured. The previous administration took actions to weaken it in many areas, a few priorities for the Biden administration are to:
  • Redefine Short-Term, Limited Duration Insurance: These plans were originally intended to be temporary insurance for people between jobs and are not subject to ACA regulations. The Trump administration changed the definition to allow for the plans to remain in effect for up to 12 months with the opportunity for renewal.
  • Strengthen Health Care Networks: Late last year the Trump administration finalized a rule to roll back Obama-era managed care regulations by, among other things, easing network adequacy requirements, which will make it difficult for patients to access needed treatment.

Improving access to care in America is no easy task, but these initial steps will go a long way toward counteracting the policies of the outgoing administration. APA is committed to working with the incoming administration, Congress, HHS, SAMHSA, and other federal entities to improve coverage and access for the millions of Americans who depend on treatment for mental health and substance use disorders.

This post was authored by APA CEO and Medical Director Saul Levin, M.D., M.P.A, FRCP-E