Election Outlook: How Health Insurance Proposals Could Hurt Behavioral Providers

As the U.S. heads into one of the most divisive elections in its history, a number important issues are on the table. Chiefly among them is health care, with the outcome of the election likely to have serious implications for the behavioral health industry in particular.

Currently, Joe Biden is favored to come out on top. And if he wins the election, that could lead to the creation of a new public health insurance option, which the Democratic nominee has voiced his support for. However, such an option could present problems for behavioral health providers, stakeholders say.

They voiced their thoughts during a panel on election implications at the recent Payer’s Behavioral Health Management and Policy virtual event. The conference was hosted by the Association for Behavioral Health and Wellness (ABHW) and World Congress, a global provider of health care conferences.


“I think moving on a public option is fraught with peril for Democrats because many will just say that’s Medicare for All in slow motion,” Charlie Dent, a senior policy advisor at DLA Piper LLP, said. A Republican, Dent formerly served in the U.S. House of Representatives for seven terms.

While the Public Option that Biden supports is different from Medicare for All, both proposals are meant to provide people with an affordable option for health insurance, especially for those who might not be able to get private insurance otherwise.

The biggest difference between the two proposals, though, is the option for enrollment. Medicare for All would cover all Americans, while the Public Option would offer an optional health insurance plan to those who want it.


Medicare for All — and “Medicare for All in slow motion,” for that matter — could pose a threat to behavioral health providers, namely due to weaknesses in the current Medicare system.

In fact, Andrew Sperling, director of legislative affairs and policy advocacy at the National Alliance for Mental Illness (NAMI), called Medicare the “most discriminatory benefit against behavioral health of any program in the entire U.S. healthcare system.”

“From a NAMI perspective, Medicare for All is potentially very, very harmful,” Sperling said during the panel discussion.

He called out the 190-day lifetime limit on inpatient mental health care and the low participation rate of psychiatrists as especially concerning aspects of the Medicare program. Plus, the program has “essentially no addiction benefit,” Sperling said.

“So [there are] lots of problems with Medicare we would not want to see replicated,” Sperling said. “Most important of all, Medicare is the only major program in the U.S. health care system that does not comply with the Mental Health Parity and Addiction Equity Act.”

Meanwhile, when it comes to the Public Option, Sperling worries there’s not enough information on what such an option would look like and how it would be executed. In fact, he’s seen confusion around the Public Option play out firsthand as a consumer representative for the National Association of Insurance Commissioners (NAIC).

“Would a federal government be able to market a health plan without having to make a submission to the state regulators?” Sperling said. “Would it comply with all the provisions of the Affordable Care Act (ACA)? We don’t know this about the Public Option. There’s a lot of confusion. It’s more a political slogan than it is a concrete firm idea for coverage expansion.”

Meanwhile, if Republicans remain in power, it’s unclear what they’ll do on the health care insurance front as it relates to the ACA or other options, according to Dent.

“Even though we’ve been hearing from the president that he’s going to release a health care plan, it’s like the great white whale,” he said. “We’ve been hearing this now for a long time … so we’re not likely to see any real action there. The bottom line is incremental changes; Medicare for All [is] off the table; [and] watch the public option — it’s more controversial than it appears.”

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