Biden Highlights Fentanyl, Mental Health Workforce Challenges in SOTU

President Joe Biden’s State of the Union Address Thursday night almost completely left out behavioral health and policies related to the industry.

This is something of a departure for the country’s 46th president. In his first State of the Union in 2022, Biden laid out what he called a unity agenda. It included several behavioral health-related elements. This year, however, the president acknowledged increased fentanyl, the pandemic and historic underinvestment in community mental health as context for other political and policy talking points.

That said, the White House continues to tout its message of improving access to mental health in the broader context of increasing health care consumer rights protection.


“Ensuring robust access to mental health care has been a bipartisan priority for almost 15 years,” the White House said in a fact sheet. “Yet today, too many Americans still struggle to find and afford the care they need.”

The fact sheet highlighted the Biden administration’s work on strengthening mental health parity. In August, it released a proposed rule that was much more prescriptive about how health plans are to assess and prove that their behavioral health benefits are t treated equal to physical health benefits. It would also assess behavioral health provider network adequacy.

The proposed rule has not yet been finalized. Experts previously told Behavioral Health Business that the rule will likely be finalized in the Spring. If finalized, the new rules would apply to health plans on the first day of a new plan year after January 1, 2025.


Increasingly, the White House is antagonistic toward big business and monied interests in health care. The U.S. Federal Trade Commission (FTC), Department of Justice and Department of Health and Human Services (HHS) launched a joint inquiry on March 5 into corporate ownership of health care entities. These and other efforts are meant to drive down prices by increasing competition.

The agencies are “particularly interested in information on transactions in the health care market conducted by private equity funds or other alternative asset managers, health systems, and private payers,” according to a request for information released by the agencies. 

On top of industry and advocacy voices, the agencies want to hear from health care workers and former patients at organizations that go through some kind of deal.

Some agencies have named the behavioral health sector, including the autism therapy industry, as a part of the health care economy, where the Biden administration perceives consolidation by private investors as hurting consumers.

The increased exposure to scrutiny by the federal government may keep the largest of investors out of the behavioral health industry but not deter many mid- and smaller-sized investors.

In the address itself, Biden simply acknowledges the mental health crisis the coronavirus pandemic inflicted on the U.S., the need to address international fentanyl trafficking and his calls for increased investment in law enforcement and “mental health workers.”

The address, however, was full of strong language against big business, especially big pharma. Biden touted his effort to lower drug prices and continue increased access to health insurance, lines that comport with a reelection message for the pending presidential contest in November.

It still drew some praise from behavioral health advocates.

“Addressing the behavioral health care workforce shortage lies at the core of numerous challenges related to behavioral health access, quality, affordability, and coverage,” Patrick Kennedy, a former member of the House of Representatives and sponsor of the Mental Health Parity and Addiction Equity Act of 2008, said in a statement. “I applaud President Biden for drawing attention to the courageous mental health workforce during his address — and for making it a key part of his Administration’s priorities.”

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