Jan 8, 2020

Medicare for All's missing mental health discussion

Caitlin Owens, author of Vitals

Illustration: Aïda Amer/Axios

America's mental health care system is in dire need of an overhaul, but the any real specifics are largely missing from the 2020 debate about health care.

Why it matters: Suicide and drug overdose rates continue to rise, and the U.S. faces a shortage of mental health providers and a lack of access to treatment.

The big picture: Private insurance is plagued with holes in mental health coverage. Even even though insurers are legally required to cover behavioral health the same way as physical health, they don't.

Yes, but: Medicare to All may not solve the problem, Mental Health America president and CEO Paul Gionfriddo told me.

  • “Medicare would need to be redesigned significantly," he said.
  • Medicare has its own coverage flaws. It would also be crucial to design a system that encourages preventive and early identification services rather than just post-crisis care.

There's also a shortage of mental-health providers. Paying mental health providers more could help address this, but care delivery would also need to be redesigned, Gionfriddo said.

  • Rural areas, for example, would likely still struggle to attract and support these providers because of their remoteness and population size.
  • "The big wild card is how many mental health providers would participate in a Medicare for all program or opt out of insurance entirely," said the Kaiser Family Foundation's Larry Levitt.

For Democrats who support Medicare for All, highlighting how it could help mental health care could have a political upside.

  • “Talking about mental health care needs humanizes the candidates, indicts the shortcomings of private insurance and provides rationale for the need for significant reforms around the current system," Democratic health consultant Chris Jennings said.

The bottom line: "We have a huge problem with health insurance for mental health. A major reform could be an opportunity to improve mental health services, but it could also do harm to them," Gionfriddo said.

Go deeper: Mental health coverage is getting worse

Go deeper

Amid racial unrest, a test at the polls

Photo: Stephen Maturen/Getty Images

Eight states plus D.C. are holding primary elections today following a week of intense protests across the country over the brutal police killing of George Floyd.

Why it matters: It's the first major test for voting since the national outcry. Concerns over civil unrest and the police — as well as the coronavirus and expanded absentee voting — could reduce the number of voters showing up in person but heighten tensions for those who do.

Axios-Ipsos poll: America’s big racial divide on police, virus

Data: Ipsos/Axios survey; Note: ±3.2% margin of error; Chart: Andrew Witherspoon/Axios

A new Axios-Ipsos poll finds that America has a massive racial gulf on each of our twin calamities — trust in police, and fear of the coronavirus.

  • 77% of whites say they trust local police, compared with just 36% of African Americans — one of many measures of a throbbing racial divide in Week 11 of the Axios-Ipsos Coronavirus Index, taken the week George Floyd was killed by a white policeman in Minneapolis.
Updated 46 mins ago - Politics & Policy

Updates: George Floyd protests nationwide

Police officers wearing riot gear push back demonstrators outside of the White House on Monday. Photo: Jose Luis Magana/AFP via Getty Images

Protests over the death of George Floyd and other police-related killings of black people continued for a seventh day across the U.S., with President Trump threatening on Monday to deploy the military if the unrest continues.

The latest: Four police officers were struck by gunfire while standing near a line in St Louis on Monday after a peaceful demonstration, Police Chief John Hayden said early Tuesday. They were all taken to hospital with non-life threatening injuries. He said a small group of people had thrown rocks and fireworks at police officers.