Time often helps clarify things. But when it comes to the federal regulatory outlook, time hasn’t helped one bit.
Since the election of Donald Trump to a second term, I’ve been looking for signs that will reveal the new administration’s behavioral health priorities. But that hasn’t shown up. Unlike a typical presidency, the second Trump administration is coming in living up to its outsider cred — without all the whitepapers, agendas, policy reveals, etc.
Assuming Trump continues to be Trump-esque, it’s unlikely that we will see a concise and obvious approach to policy and governing. As we saw during his previous administration, Trump was herky-jerky at best and often beset by legal and administrative missteps that got in the way of the grander vision.
What we have to work with regarding the behavioral health policy outlook for the coming administration is an incomplete and somewhat unreliable collection of statements to the news media by Trump and his initial cabinet picks and policy documents that simply don’t tell much on the topic.
In this week’s BHB+, I trawl through what’s in the public record about the coming Trump administration and cover:
— Trying to put together what the Trump campaign had to say on behavioral health
— The most specific but potentially unreliable policy source we have
— What a key cabinet pick says about behavioral health coming to the role
Trying to see through a muddy situation
Again, health care policy simply didn’t come to the fore in the presidential election, and the Trump campaign hasn’t articulated anything in specificity when it comes to regulating the industry. Still, some of Trump’s comments have illuminated other aspects of the federal government or the health care industry that could impact behavioral health. In short, we are all waiting to see what happens without any specific expectations set by Trump and his campaign.
The Trump campaign website is light on any details about the incoming administration’s plans for health care policy. In a debate with defeated Democratic presidential nominee Kamala Harris, he said he had “concepts of a plan” to replace the Affordable Care Act, also known as Obamacare.
The most specific and only forward-looking health care policy statement from the Trump campaign website is this: “President Trump will always protect Medicare, Social Security, and patients with pre-existing conditions.”
The Republican National Committee platform similarly fails to give specific visions for what the industry can expect.
“Healthcare and prescription drug costs are out of control. Republicans will increase transparency, promote choice and competition, and expand access to new affordable healthcare and prescription drug options,” the platform reads.
So, the official sources for Trump’s policy positions are not helpful. What about the unofficial ones?
The Heritage Foundation, a cornerstone of the conservative think tank apparatus, released the now infamous “Mandate for Leadership 2025: The Conservative Promise” — better known as Project 2025 — to detail what it and several other conservative groups want out of D.C. during the Trump administration. And for all of the many words in the 922-policy book, the behavioral health industry isn’t acknowledged with any specificity.
I say “unofficial” because the policy book is not a product of the Trump campaign, and Trump has gone out of his way to say “we have nothing to do” with it. However, Trump has picked Russell Vought and Tom Homan, co-author of and contributor to the Project 2025 report, respectively, to positions in the cabinet — Vought as director of the White House’s Office of Management and Budget and Homan as “border czar.” Both are alumni from the previous Trump administration.
But what does Project 2025 say?
The Project 2025 policy book is nothing short of a blueprint to rework the federal government as we know it. It seeks to rework the structures of the federal government and, through that effort, reorient American society toward its conservative visions of life and business. On top of that, Project 2025 includes a recruitment campaign to invite like-minded individuals to send their resumes to the so-called “Presidential Personnel Database” for ideologically vetted candidates for federal jobs.
What it does describe as policy objectives related to behavioral health are indirect and tangential. For example, Project 2025 reorients the objective of addressing homelessness toward addressing mental health and addiction and away from establishing housing first.
The most direct address of behavioral health policy is limited to a narrow segment of the population — American veterans. The document details the need and specific approaches to bringing the government in compliance with the VA MISSION Act, passed in 2018.
It calls for actions on the regulation of social media platforms’ treatment of child users. However, the report is ultimately conflicted on whether or not government mandates to address children’s use of social media and social media’s treatment of child users impinge on parental rights. Again, this is a glancingly related issue tied to the industry’s concerns.
One of the most direct mandates to the administration from the report touches on some arcana related to the federal opioid crisis response. The report calls for the Trump administration to bring the Office of National Drug Control Policy under the auspices of either the Departments of Justice or Health and Human Services and for its leader to be a political appointee.
The Project 2025 policy document ties addressing the “fentanyl crisis” to immigration and trade policies, specifically when it comes to Mexico and China: “Disrupting the flow of drugs across our borders and into our communities is of paramount importance, both to save lives and to bolster our public health efforts,” the document reads.
Telehealth is generally seen in a positive light. It proposes reorienting oversight over telehealth to be based where the provider is located rather than the patient to allow for the states to maintain their oversight of medical providers. However, the document doesn’t spell out what interstate telehealth ought to look like; it simply states that constitutes interstate commerce and is regulatable by the federal government.
On all other generally relevant topics, the document says that powers should be pushed to the state level as much as possible, especially regarding medical regulations and Medicaid policy.
However, the document calls for states to be free to institute work requirements, premium collects and narrow Medicaid benefits for work-age adults.
“Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable,” the document reads. “It should also incentivize states to save money and improve the quality of health care.”
It also calls for states to prioritize attacking fraud, waste and abuse within Medicaid and calls for accountability for states that do not ensure proper eligibility of enrollees.
What are appointees saying?
Robert F. Kennedy Jr., Trump’s pick to lead the Department of Health and Human Services, has had some interesting thoughts on addressing addiction and mental health in the U.S.
Earlier in the year, while still running for president, Kennedy proposed that people with behavioral health issues go to “wellness farms,” where they would spend years growing organic crops, all of which would be paid for by cannabis taxes. Theoretically, these would be free to those who are convicted of drug offenses.
At other times, he has called for “tough love,” where law enforcement plays a greater role in pushing people into treatment at the risk of going to jail for their addictions.
“You’re not allowed to do this anymore. We’re going to clean up your neighborhood, we’re going to talk to you three times, and if we can’t talk you into helping yourself, you are going to prison, you’re going to jail, until you choose some other option,” Kennedy said during the premier of his documentary “Recovery America,” according to reporting by STAT.
Kennedy could come into an administration that has some competing directives. On one hand, the more traditional personal-liberty-loving, small-government approach espoused by conservatives calls for the federal government to neuter itself and diminish its own power via deregulation. On the other hand, the populist and more aggressive pro-MAGA remake-the-world-to-our-liking desire of much of the grassroots requires a robust (if not unopposed) executive branch.
Of course, it remains to be seen if Kennedy will make it through the confirmation process.
While time hasn’t clarified what the administration’s approach will be for behavioral health policy, it appears that time will be the only thing that eventually clarifies how this administration is going to impact the industry.
