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A U.S. election season that produced much hand-wringing across the political spectrum is over, transitioning to a period of rampant speculation before the new administration begins official business in Washington. Amid the many policy directions that could affect substance use and mental health treatment, a much-anticipated discussion of changes to Medicaid will bear watching.
Following decisive Republican victories in the White House and on Capitol Hill, many policy experts have predicted there will be strong momentum for funding cuts in the federal budget. If Social Security and Medicare remain largely off-limits in this discussion, Medicaid is likely to receive heavy scrutiny.
This would be a highly relevant dialogue for behavioral health providers to monitor. Around 1 in 5 individuals in the U.S. receives Medicaid coverage; the percentage is slightly higher among non-elderly adults with a mental illness, according to data reported by the Kaiser Family Foundation. Also, Medicaid expansion that was authorized in the Affordable Care Act and has been adopted by most states has driven improved access to care for individuals with substance use disorders. Many have characterized Medicaid expansion as a key policy vehicle in combating the opioid crisis in recent years.
Clearly there would be many voices seeking to mobilize in the behavioral health field if momentum builds toward a major restructuring of Medicaid. Some significant proposals were advanced in the first Trump administration but could not win congressional approval. It remains to be seen how a new Congress with several first-time members and fairly slim Republican majorities would address these initiatives.
The possibility that the new administration will embrace greater policy flexibility for states could prove beneficial. One could foresee a period of expedited review of Medicaid waiver requests from states, possibly encouraging greater innovation in state programming. This of course could depend on the policy direction pursued at the state level, which is why the behavioral health community’s focus on state-level advocacy will remain critical.
While public support for Social Security and Medicare is unwavering, it’s interesting to note that Medicaid also enjoys significant public backing. A Kaiser Family Foundation staffer wrote this month that two-thirds of U.S. adults report some connection to the Medicaid program, adding that an overall favorable view of Medicaid cuts across political party lines. How might this influence the votes of newly elected members of Congress?
It will remain important, as always, for substance use and mental health treatment organizations to weigh in on these topics at the national, state and local level. At the same time, an important post-election message to deliver should remind everyone who works in the field that the most impactful work that benefits both patients and programs happens in the trenches, every day.
Every person working in this field, regardless of political affiliation, has an opportunity to make a difference in people’s lives, to influence the direction of their organization, and to help demonstrate their organization’s accountability as a careful steward of funds. That mission always rings true.
