Future of Mental Health Parity Landscape Up in the Air Based on Trump Administration Actions: Ali Khawar

Ali Khawar, former principal deputy assistant secretary with the Employee Benefits Security Administration, US Department of Labor, expressed his worry that the actions of the Trump administration through the first few months of their term will make parity in coverage for mental health and substance use treatment more difficult to acquire in the future.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

How do you envision the future of this space given this decision and other decisions from the Trump administration?

In his first term, President [Donald] Trump, there's a series of quotes that you could pull that indicate a level of support from the administration for mental health parity, for ensuring you know robust treatment and societal care for individuals with mental health and addiction conditions. Certainly, the opioid issue he's been quite vocal in this administration as well about the need to address it. Mostly, I'm not going to pretend I know everything that he said, but mostly my sense is, with a focus on the fentanyl supply, which is 1 piece of an issue.

I think at the moment, I'm struggling to view the Trump administration as maintaining credibility on these issues, because when you combine the budget cuts, the personnel cuts, and the policy decisions, they are kind of walking away from these issues. I think it's unfortunate. I hope that's not what the future holds, but it's going to be really difficult to see how they actually can move the ball down the field. It doesn't have to be the way the Biden administration did it. But what is their strategy? I'm not seeing or hearing in any of the public pronouncements what the affirmative public—or not necessarily even public, but what the affirmative plan is to address these problems.

As I said earlier, the problems haven't gone away. It's not like the second President Trump got sworn in for his second term, mental health conditions ceased to exist in the United States, or the opioid epidemic ended, or any number of things like that. If that's the universe, we know that there is a very real problem, and we know that it's not being addressed. Compliance didn't skyrocket the second the President got sworn in either. You don't have compliance. You have a real problem. How are you going to address that? What is your plan? If you want to walk away from the rule, you want to cut funding for research, you want to cut funding for supports that exist in communities. You want to cut all these things, and you want to walk away from other things. What are you replacing it with?

Maybe there's a plan. I don't know. What I do know is there's not a public plan, and it makes it hard to see, 1, how they can maintain credibility on these issues, but, 2, how things are going to get better for the individuals with these conditions, and also for the parents, the siblings, the spouses, the children, whoever it is that is laying awake at night and worrying and stressed about their loved one who has this condition, who needs the treatment, who is fighting with an insurance company, and who used to be able to have the federal government in their corner. It doesn't seem like the federal government is in the corner of patients anymore.

How are we actually going to make mental health parity a reality? It's not a bumper sticker, it is the law. A big motivation for the work that we were doing in the Biden administration is that that was not the reality for patients, and it needs to be; that's what they deserve. I want to be optimistic about what the future holds, but there are, unfortunately, a lot of decisions that have been made so far that are very, very troubling.