While November 8 might seem like a long way away, the presidential hopefuls are probably wishing for more time on the campaign trail. Most Americans believe it’s going to be an especially heated debate season with high emotion among supporters on both sides. Former Senator and Secretary of State Hillary Clinton, who’s running on the Democratic ticket, and billionaire business owner Donald Trump, who’s running on the Republican ticket, are sharply divided on a number of issues, including several that behavioral health leaders are watching.
In this election, the Affordable Care Act (ACA), policies to address the opioid crisis and general attitudes toward behavioral health concerns are top of mind for industry professionals. Experts in the field stop short of endorsing either candidate, but many are open about what they’re watching in the months ahead and how to evaluate what the next administration might look like.
Carol McDaid, principal of Capitol Decisions, says in the coming weeks, industry leaders should watch the debates on television and listen for relevant keywords in the campaign rhetoric.
“What is an adequate response in some of their remarks to the opioid epidemic, and do they use the words ‘treatment and recovery?’ Those are bellwether words to be on the look out for,” McDaid says. “The analysis of speeches afterwards are worth looking at to see if key issues that our field has been working on come up.”
Many believe Clinton’s experience in politics and healthcare reform will be her strong point. However, the main drivers behind unfavorable ratings for Clinton speak to larger campaign narratives that define her as “untrustworthy,” according to a survey by Morning Consult. Her challenge might be to win over those who question her authenticity.
In January, Clinton announced her proposal to tackle the addiction crisis in the United States, a policy that would cost an estimated $10 billion over 10 years. Some $7.5 billion would be dedicated to state/federal partnership models that offer incentives for states to work on five goals identified in the proposal, such as increasing access to naloxone and expanding the addiction-treatment workforce. In a matching program, $4 would be provided by the federal government for every $1 each state provides for the effort. Another $2.5 billion would be added to substance-use disorder block grants. It isn’t clear where the $10 billion will come from.
“It springs back to her days as first lady where she was one of the architects of healthcare reform at that time,” says Mark Dunn, policy advocacy representative for the National Association of Addiction Treatment Providers (NAATP). “This is not new to her. As someone who supports the continuation of ACA and all it does for addiction treatment, I think her approach is at least more thorough and comprehensive and probably embraces our broader member perspective.”
Clinton staffers did reach out to addiction professionals in advance of structuring the plan, and her campaign has indicated the opioid crisis is part of her agenda.
“Clearly Clinton has a leg up on this one because we’ve seen her in action, and she has produced a detailed policy stance on addiction,” says Linda Rosenberg, president and CEO of the National Council for Behavioral Health. “Our staff here have talked to her advisors on mental health and addiction, and she is focused on details, not just statements.”
McDaid says it’s been a pivotal year for addiction policy considering the number of bipartisan bills passing though Congress.
In terms of other healthcare topics, Clinton says on her official campaign site that she will continue to defend the Affordable Care Act against Republican efforts to repeal it, with a focus on addressing costs—something most observers believe ACA failed to accomplish. The growing cost of prescription drugs is an issue she has publicly vowed to work on, noting that three-quarters of Americans believe prescription drug costs are unreasonable.
As of this writing, Clinton did not appear to have a formal position on the use of marijuana recreationally or for medical purposes—something clinical leaders might be watching.
She has proposed allowing individuals as young as age 55 to sign up for Medicare, and the creation of a “public option” health plan that aims to be more affordable for consumers. It would not be the single-payer model that candidate Bernie Sanders had touted but more like a competitor to commercial insurance plans.
The cost of Clinton’s proposed Medicare measure is uncertain.
In July, the Clinton campaign also announced a new healthcare proposal to expand funding for federally qualified health centers by $40 billion over the next 10 years and to make the support mandatory—not subject to appropriations.
Rosenberg says Clinton has put forth more than just rhetoric on a number of healthcare issues, including proposals for policies that could increase treatment capacity or redesign reimbursement models.
“Those are all things people in healthcare are interested in, and she certainly has opinions and positions,” Rosenberg says.