What Can We Expect From New Congress on Mental Health Care?

Time will tell how the disturbing, violent attack on the U.S. Capitol that began the new year affects Congress, our institutions of government, and our divided citizenry. Not even during the Civil War did Americans attack and desecrate our temple of democracy. The last time our nation saw a violent invasion of our Capitol was when the British set fire to it in 1814. As we collectively grapple with this saddening and sobering event, our elected leaders must now find a path forward and do the hard work of governing a divided nation with large portions of our citizenry seemingly living in alternate universes.

The January 6 attack occurred a few short hours after the Democrats took two Georgia Senate seats, giving them control of the Senate, House, and presidency for the next two years by the narrowest of margins. Until then, it appeared that incrementalism would rule the day and that legislating on health care would remain extremely difficult. Now, however, some more legislative options appear possible.

Democratic control of Congress and the presidency means more likelihood of action to improve the Affordable Care Act (ACA), confront climate change, and deal with racial justice reform and policing. An additional COVID-19 relief package is also likely to see early action in the new Congress. But the razor-thin margins of Democratic control—a 50-50 split in the Senate and only about five votes in the House—will create complexities and limits around legislative options.

For example, some of the ACA-related and other measures with little chance of breaching the 60 votes necessary to overcome a Senate filibuster can be passed using budget reconciliation. Reconciliation allows the majority party in the Senate to pass legislation with only 51 votes and avoid a filibuster. However, it is a tricky process that limits legislative options to items with revenue implications. In other words, while a unified Democratic caucus can certainly send some significant legislation to President Biden’s desk using budget reconciliation, there will be limits to what legislation can pass without bipartisan support.

Another important dynamic relates to control of Congress for the second half of President Biden’s term, which rests on a knife’s edge. House members from marginal districts and senators up for reelection will have a very different political calculus from their colleagues in more partisan districts, and it will only take one Democratic senator or a small handful of members of the House to stop much legislation in its tracks. And most legislation will still require 60 votes to get through the Senate, with neither party having more than 50.

So, where does this leave mental health? The conclusion of the 116th Congress demonstrated that even in polarized times with toxic politics, progress is still possible. If we can keep the legislative engine running long enough, it is possible to steer it out of the ditch and down the freeway from Capitol Hill to the White House. But doing so requires constant effort, bipartisan support, and the engagement of APA members and allies.

Before the last Congress began, APA began working with bipartisan champions on Capitol Hill on priority legislation to promote compliance with the mental health parity law. Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.) and Reps. Katie Porter (D-Calif.) and Gus Bilirakis (R-Fla.) introduced the Mental Health Parity Compliance Act, and APA members and our allies advocated for it on Capitol Hill. After working for two years to move it in both houses of Congress, gaining bipartisan support on all relevant committees and enlisting additional champions like Reps. Joe Kennedy (D-Mass.) and Fred Upton (R-Mich.), we succeeded in adding the bill to the omnibus legislative package Congress passed at the end of last December. Now, federally regulated ERISA plans and insurance plans in all 50 states must conduct the analyses to prove they are complying with the parity law or risk consequences.

APA also worked with Reps. Cheri Bustos (D-Ill.) and Susan Wild (D-Pa.) and Sens. Joe Manchin (D-W.V.) and Cory Gardner (R-Colo.) to secure $35 million of new funds for states to build out their systems of crisis call centers, mobile crisis units, and stabilization facilities. With support from Rep. Rosa DeLauro (D-Conn.) and Sen. Roy Blunt (R-Mo.), those funds will facilitate the on-the-ground response needed to accompany the new 988 suicide hotline when it becomes operational. They will also help reduce unnecessary and, too frequently, deadly interactions between law enforcement and those experiencing a mental health crisis.

The legislative stakes remain high for psychiatry and people with mental and substance use disorders, including the need to ensure permanent access to telehealth, promote collaborative care, and address the racial disparities that have been laid bare by COVID-19. Continuing challenges due to COVID-19 and the continuing suicide and opioid crises require a robust response from Congress and the new Biden administration. Sadly, the toxins invading our body politic make addressing these needs more difficult than should be the case. But APA has friends on both sides of the aisle who recognize the need for action. The more engaged our APA members are on a bipartisan basis, the more chance we will have of getting the job done. ■