President Biden Delivers Remarks on Expanding Access to Mental Health Care Transcript

Distinguished guests, the president of the United States, accompanied by the Honorable Senator Debbie Stabenow and Ms. Rachelle Keyes.

Well, first, this is a very exciting day and I want to thank President Biden and thank all of your team for your commitment to putting people first every single day. Thank you. That’s what today’s really all about, and I want to begin with a story.

(01:28)
In 1963, President John F. Kennedy signed the Community Mental Health Act. It was the last act he signed before his death. This act reflected his belief that every person deserved to be treated with dignity and respect, and that people with mental illnesses and addictions should be able to receive high quality services in their community close to home, not just be housed in a hospital or a jail because care wasn’t available. Unfortunately, his vision was not realized for decades until now.

(02:10)
When President Biden signed the Bipartisan Safer Communities Act, he created the largest investment in community behavioral health services ever made in our country. And I want to personally thank President Biden for being with us as a champion every step of the way to get this done. And I’m not talking about grants that start and stock. This is full Medicaid funding for clinics that meet high quality standards. The same model used for federally qualified health centers that do such a wonderful job.

(03:09)
In other words, for the first time, we are transforming our healthcare system to fund healthcare above the neck as well as healthcare below the neck as my friend Patrick Kennedy always says. This transformation began 10 years ago on the 50th anniversary of President Kennedy’s bill signing. When my partner, and I mean true partner, Senator Roy Blunt and I went to the floor of the United States Senate to speak and to introduce our bipartisan Excellence in Mental Health and Addiction Treatment Act. What followed was a 10-year bipartisan journey to show that providing high quality community services including 24-hour psychiatric emergency services was not only the right thing to do for people, but the cost-effective thing to do.

(04:15)
Our 10 demonstration state program has had amazing results from 68% fewer emergency room visits to 60% fewer people sitting in jail. And you know who loves that? Our sheriffs and our police chiefs who want people to get care and not just sit in their jail. A 33% decrease in homelessness, a 74% reduction in hospitalization. Right now we have over 500 community behavioral health clinics across America and more are coming. And the next 10 states to receive full Medicaid funding will be chosen in the next few months.

(04:57)
Let me just say, when someone walks into one of the 34 clinics currently in Michigan, imagine this, they call, they walk in, one-third of the time, they’re seen the same day, the same day. Everyone is seen within 10 days. No more waiting for months and months when you finally get to a point where you want to deal with your addiction, when you finally are at a point where you know you need to deal with your depression or your child desperately needs help. Which brings us to today, we know that funding behavioral healthcare like any other healthcare works and requiring insurance companies to do the same thing works.

(05:48)
I want to thank President Biden again for his vision, his commitment, and his compassion for people every day and for taking another very important step today to strengthen the Mental Health Parity and Addiction Equity Act. Step by step. Step by step we are transforming our healthcare system together.

(06:23)
And now I’d like to introduce someone who understands firsthand the importance of access to behavioral healthcare. Rachelle Keyes is a leader with the National Alliance on Mental Illness. She lives in Stafford, Virginia. She has a daughter, Katrina. Seven years ago at age 15, Katrina suffered a significant mental health crisis and spent time in the hospital. She will share the story. Rachelle wanted to focus on helping her daughter get well. That’s all any of us would want. Instead, she ended up fighting with her insurance company to get coverage. Thank you, Rachelle, for your advocacy and your voice. Please welcome Rachelle Keys.

Thank you so much for having me, and I’m grateful to be able to share my story. My name is Rachelle Keyes. I’m the mom of an exceptional daughter with mental illness. When living with mental illness, it’s hard to know how to help your child. We went to the ER first, then several weeks of 24/7 care in a hospital, followed by months of daily intensive treatment, all covered by insurance. Then we discovered she needed a specialized therapist. I searched for one with expertise my daughter needed who was also in our insurance network. There was no one.

(07:58)
We finally found an out-of-network specialist, but she was expensive. After several visits, knowing how costly it was for us, she did something extraordinary. She offered to join our health plans network. I just needed insurance to agree and accept it. I submitted all the right forms. I was really hopeful. Then the dreaded response, denied. They said there were plenty of in-network providers, it didn’t matter that none of them had the right experience for my kid or that she had a therapist who was helping her and willing to be in-network for her care. I appealed. Denied again. I asked, “What more did I need to do?” They said she needs to see two or three of their in-network providers, and I would have to explain why those therapists weren’t a good fit.

(08:59)
Can you imagine if she had cancer and was twice denied life-saving treatment because she hadn’t tried other treatments that we already know were going to fail? I wouldn’t put my daughter through that and risk losing the progress she had made. We continued paying out of pocket. It was hard. But over five years, this heroic therapist saved my daughter’s life multiple times. My daughter is now thriving and I am so proud of her. She’s amazing. Our story could have turned out tragically, and for many families it does.

(09:50)
Thank you, Mr. President for prioritizing mental health. There is no health without mental health.

Amen.

Insurers must cover mental health care at parity to help families like mine and many of yours I’m sure. And now it’s my honor to introduce a champion of mental health care for all Americans, President Joe Biden.

[inaudible 00:10:30]. Please have a seat. Rachelle, thank you for the introduction and the courage it takes to stand up on national television for all these people and tell your story. But your story’s a story of millions of people all across the country.

(11:06)
One of the things that the pandemic demonstrated is the need for a lot more help. Over a million people dead from COVID, that’s estimated to mean 8 million people left behind who were close to them. How many mornings people get up or show up for dinner and there’s an empty chair? The impact on people’s lives is profound. And you were paying insurance every month. You know, you shouldn’t be your own… Well, you shouldn’t have to do what you had to do, going through one of the hardest things in life.

(11:52)
And by the way, Debbie, Debbie, Debbie, God love you. You’re the best, Debbie. You really are. We wouldn’t be here if it we’re not for Debbie. That’s not an [inaudible 00:12:02]. I’ve served together for a long time in the Senate and I’ve never known you not to be a significant advocate for this very issue. And I want to thank Acting Secretary Su and everyone in the Department of Labor and HHS and Treasury for working in improving insurance coverage for mental health care in America.

(12:30)
And folks, I don’t know what the difference between breaking your arm and having a mental breakdown is. It’s health. There’s no distinction. It’s health. Vivek Murthy, who’s our surgeon general, and I talk about this issue a lot.

(12:48)
In the last two State of the Union addresses, I’ve laid out what I call the Unity Agenda. It’s made up of four big things that we’re going to do together as a nation. One of the things I’m always asked is why Americas have sort of lost faith for a while on being able to do big things. “If you could do anything at all, Joe, what would you do?” I said, “I’d cure cancer.” And they looked at me like, “Why cancer?” Because no one thinks we can. That’s why. And we can, the end of cancer as we know it. Deliver on our sacred obligations to veterans was the second thing I think is critically important. Thirdly was beat the opioid epidemic, which we’re still fighting very hard. And fourth was to tackle mental health crisis, which is why we’re here today.

(13:37)
We can all agree mental healthcare is healthcare. It is healthcare. It’s essential to people’s wellbeing and their ability to lead a full and productive life, to find joy, to find purpose, to take care of themselves and their loved ones. It’s about dignity. Think about this. My dad used to have an expression. “Everyone’s entitled to be treated with dignity.” Imagine being a parent looking at your beautiful child you adore, needing help and know you can’t do a damn thing about it. You don’t have the wherewithal. You can’t talk about stripping a parent of their dignity, their inability to help their child or their husband or their wife or their mother or their father or someone they adore.

(14:20)
But right now, for millions of Americans, mental health care and treatment for substance abuse is out of reach. It’s out of reach. In 2020, less than half, less than half of all adults with mental illness diagnosis received care for it. Less than half. For children, the numbers are even worse. Nearly 70% of our kids who seek care for mental health or addiction cannot get it. 70%. Talk to parents and teachers. Talk to the school nurses and counselors. Talk to young people. They’ll tell you there’s a serious youth mental health crisis happening right now in this country. We must fulfill the promise of true mental health parity for all Americans now. Now.

(15:07)
Now I might note parenthetically, if we do, it saves the country billions of dollars, the idea that it saves. Here’s what it means. Almost 15 years ago, the Bipartisan of Mental Health Parity and Addiction Equity Act became law. You call for health insurance companies to cover mental health care and treatment for substance abuse at the same levels of physical healthcare. Because just like when you break a bone or you have a heart attack, when you’re having a mental health crisis, you should be able to get help, medical help, professional help. During the Obama-Biden administration, we worked hard to put this law into effect. And the result by some important measures, there is greater parity, not nearly a greater parity today than in the past.

(16:07)
Look, there’s lower copays for mental healthcare, getting rid of some arbitrary limits on the number of times you can see your therapist each year. Plus, for the first time ever, the Affordable Care Act made mental health care in essential service, which means many health plans must cover it. These were important steps, but they weren’t enough. We’re still not where we need to be. We’re still not there. Insurers still make it far too difficult to get mental health care. Their networks of providers are badly inadequate with far fewer psychiatrists, therapists, and other mental health professionals compared to all other medical specialties.

(16:49)
Now as a result, even with private insurance, patients are often forced to seek out-of-network care at significantly higher cost if they can find it. Seeing a therapist can cost 200 bucks a visit or more. That’s $800 a month if you have a session every week, which is often what patients need. Many families, significant number of families cannot afford that. And by the way, think about parent. Think about just how difficult it is to begin with to say, “I need help.” You break your arm, you have no trouble going to emergency. “I need help.” You’re having a mental crisis. It’s hard. It’s hard to say, “I need help. I need help. My child needs help.” And this is happening to millions of people.

(17:40)
People with insurance are twice as likely to have to go out of network for mental healthcare compared to physical healthcare. And that gap has only gotten wider. As a result, folks with depression, anxiety, post-traumatic stress, bipolar disorders, eating disorders, addiction and other illnesses often go without care. Period. And you know how that ends many times. They try to power through and hope they can manage on their own or they pay whatever it takes, spending down their savings, racking up credit card bills, or taking out second or third mortgages to get the care for themselves or their children. Folks, it shouldn’t be this way. It doesn’t need to be this way.

(18:24)
I’ve heard from mental health professionals across the country describing a system that’s falling short. One therapist wrote me, who primarily treats teenagers including some or having suicidal thoughts, and he said when his patients need to be hospitalized to save their lives, insurance companies often deny the claims, often deny the claims. Another clinical psychologist wrote me and described getting calls from desperate people who’ve called 20 different therapists looking for help but can’t find it. This therapist says, and I quote, “I try to create time that I don’t have to see more patients.”

(19:00)
“I’m often the only person,” he went on to say, “who is able to call them back. They never even get calls most of the time.” And I personally received letters from family members whose loved ones are suffering from mental illness, who describe how difficult it can be to help. One woman wrote me and went on to say about her mother, retired teacher who has a bipolar disorder. Her daughter wrote, “Too often, insurance companies dictate the standard of care when it actually needs to be care providers and family members who have more to say.” She went on to say, “Please advocate hard for the most vulnerable among us.” Well, that’s exactly what my administration is trying to do.

(19:44)
Today, my administration is announcing new steps to dramatically expand access to mental healthcare in America. Our plans would require health insurance plans to identify the gaps in the mental health care that they provide. For example, they need to measure how many mental health providers are in their network, how much they are paying these providers, how difficult it’s for someone to join their network, how often doctors have to get the so-called prior authorization before they can treat a patient. Some of you have dealt with this more than once. You get referrals to see mental health specialists, but when you make the appointment they say, “I can’t see you until your doctor submits the paperwork and get special permission from the insurance company.” Give me a break. It’s ridiculous. It really is. It’s ridiculous to prevent people from getting the care they need.

(20:44)
Now, insurance companies, now insurance are going to have to measure how often they require prior authorization and how often they deny those requests. Right now, many health plans don’t collect data. Under my administration’s new plan, they would be required to collect that data. None of the existing law when facts reveal that mental healthcare is not being treated on par with physical healthcare, they’d be required by law to fix it. Fix it. Fix it. Fix it.

(21:19)
Here’s something else we’re announcing today. When the Mental Health Parity Act was passed 15 years ago, there was a loophole. Health plans that are offered to state and local government employees did not have to comply with the Mental Health Parity Act. More than 200 health plans nationwide were left out. Now we’re making it clear, they have to follow the law as well. They must follow the law as well. This builds on the work we’ve done over the past two years. We’ve expanded certified community behavioral health clinics. And I want to thank Debbie again, who for years worked to get this program up and running. She made sure it was funded in the Bipartisan Safer Communities Act, which I was proud to sign the law. The largest investment in mental health ever, ever, ever, ever. Thank you, Debbie.

(22:24)
These clinics provide a range of service including crisis support available 24 hours a day and seven days a week. And they serve anyone who needs care regardless of the ability to pay. They’re now 500 of these clinics in 46 states. We’ve added more than 140 during my administration. And we’re going to keep increasing the number because you need more than the 500. We’ve also launched a nationwide crisis hotline, 988. Let me say that again. The Crisis hotline is 988, where you can connect with the trained crisis counselor 24 hours a day, seven days a week. Over 5 million people have called that hotline since I launched it a year ago. 5 million. And we say we don’t have a problem?

(23:06)
We’ve invested $1 billion to help schools hire, train, and train 14,000 new mental health counselors in schools across the country.

(23:22)
And we’re taking steps to address the harm of social media is doing to our young people, and it is doing harm. We’ve got to hold these platforms accountable for the national experiment they’re conducting on our children for profit. Later this week, senators will debate legislation to protect kids’ privacy online, which I’ve been calling for for two years. It matters. Pass it. Pass it. Pass it. Pass it. Pass it. I really mean it. Think about it. You ever get a chance to look at what your kids are looking at online?

(23:57)
Folks, the actions we’re announcing today represent a real step forward to help millions of people get mental healthcare they need, and the insurance should be provided. It should be provided. But there’s still so much more to do. Improving our mental health system means addressing the three Cs, coverage, care, and causes. Today we took a big step in coverage. Now we need to keep expanding care. For example, by increasing access to telemedicine, expanding our mental health workforce, doctors, therapists, and counselors. Expanding it. We need to address prevention and the root cause of the pain and trauma that a lot of people are feeling like loneliness and isolation. Social media and online bullying, gun violence. And we’re still feeling the profound loss of the pandemic. As I mentioned, over 100 people dead. That’s 100 empty chairs around the kitchen table. Every single loss, there are so many people left behind and broken-hearted.

(25:06)
Folks, this mental health crisis is something we need to face together as a country. We have a moral obligation, in my view, to be there for each other, to reach out, reach to our neighbors and grief and stress and trauma and despair, reach out to them to offer help or just a listening ear, to have the courage to ask for help when we need it and it’s hard, because we know that even when it feels as dark as it can get, we aren’t alone. It’s important for people to realize they’re not alone. That’s what I want for everyone in America, not to feel isolated and alone, to know their country has their back and their president has their back.

(25:51)
Let me close with this. Many people have to seek mental health care at some point in their lives. Whether you’re in a red state, a blue state, it doesn’t matter. Mental health care can be life changing and even lifesaving. For all those brave enough and strong enough to seek help, and I mean that, brave enough and strong enough to seek help, we have to do better. Together I know we will. We just have to remember who we are for God’s sake. We’re the United States of America. There’s nothing beyond our capacity. Nothing. Nothing beyond our capacity when we do it together. So God bless you all and may God protect our troops. Thank you so very much.