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Mental Health, SCOTUS Abortion Decision in Spotlight at Senate Budget Hearing

WASHINGTON — Mental health issues, as well as the leaked Supreme Court draft decision that could overturn Roe v. Wade, were on the forefront of senators’ minds Wednesday during a Senate hearing on the fiscal year 2023 budget proposal for the Department of Health and Human Services (HHS).

“The past two years have shone a harsh spotlight on healthcare challenges our communities are facing, like the mental health crisis, which the pandemic has made even more devastating — especially for our kids,” Sen. Patty Murray (D-Wash.), chair of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, said in her opening remarks. “I want to know the administration is doing everything it possibly can to address the mental health crisis.”

Questions About SAMHSA Reshuffle

Sen. Roy Blunt (R-Mo.), the subcommittee’s ranking member, asked HHS Secretary Xavier Becerra — the hearing’s lone witness — about a “fairly substantial” reorganization within the Substance Abuse and Mental Health Services Administration (SAMHSA) that HHS announced after its budget request came out. One part of that effort “established a new Office of Recovery within the Office of the Assistant Secretary [for Mental Health and Substance Use], another created an ‘Office of 988’ which is the suicide helpline number … and a third established a prevention initiative,” Blunt said.

“We have several concerns here,” he continued. “One is there’s nothing in the budget that reflects these agencies being there [and] no direction as to where the money should come from to fund them.” In addition, “I think some of the prevention efforts have a more harm reduction effect than I think Congress would have intended for, or certainly than I would intend for.

“There are even press reports that the administration is thinking about safe injection sites under the guise of prevention, even though I believe those sites are against the law,” Blunt said. “How do you expect us to incorporate this into the budget you’ve already asked for?”

Becerra said the reorganization “does not impact the budget; we’re going to work with the monies that we have. What we’re simply doing is reflecting the president’s priority on behavioral health, and also trying to have a new strategy on drug use.”

More Details About ‘988’ Hotline

Sen. Jerry Moran (R-Kan.) asked exactly what the requested $700 million in funding for the “988” suicide prevention hotline, due to launch in mid-July, was being used for. Becerra replied that the money would help turn a patchwork of state-by-state services into a seamless response so that “today, if you are in D.C., and you’re feeling stress, but then you travel into Maryland or West Virginia, you don’t find that you lose the same access to services that you might have had if you were in one of those different locations. To make that seamless requires a great deal of support, because the states are accustomed to dealing only with the folks in their communities.”

After further questioning, Becerra clarified that the money would be used for professional services rather than the technology. “The technology isn’t that difficult,” he said. “The resources are to make sure there’s actually a health professional who will be available to answer those calls.”

Several senators — all Democrats — expressed concern over the leaked Supreme Court draft decision which, if it became final, would overturn Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide. Sen. Jeanne Shaheen (D-N.H.) called the draft opinion “stunning.”

“This is a statistic that I found incomprehensible: that the United States could become one of only 25 countries in the world that would totally ban abortion,” said Shaheen.

“If this is what the court decides, it would leave up to the states decisions about women’s reproductive freedom,” she said. “That presents challenges in states like New Hampshire where we have seen funding denied to family planning centers on the frontlines of these efforts, even though it’s funding that does not support performing abortions. These family planning centers provide healthcare to thousands of women in New Hampshire.”

Becerra said the Biden administration will “double down on the effort to make sure that the legal rights of all American women to access the care that they’re entitled to continues forward. Yesterday, I had an opportunity to address a number of representatives of many of the health insurance plans in America and made it very clear that we intend to continue to enforce the law. We have heard complaints that some women are not being provided with access to the care that they’re entitled to through their insurance plans. We will continue to do that.”

In addition, “we will continue to support the efforts of family planning efforts that are available in Title X,” said Becerra. “We will also make it clear what the law requires of one who accepts federal funding from Medicare and Medicaid — [that they] provide services to all Americans without discrimination.”

Sen. Tammy Baldwin (D-Wisc.) said that “if the court is going to legislate from the bench and turn back the clock 50 years on Roe v. Wade, then I think the Senate needs to pass the Women’s Health Protection Act,” which would codify Roe into law. “If we need to eliminate the filibuster to get it done, that is what we should do.”

Rules on ‘Junk’ Insurance Plans Coming

Baldwin also asked Becerra about regulation of “junk” insurance plans being sold with skimpy benefits. Becerra said the administration was in the midst of rulemaking on that issue, and noted that the No Surprises Act, which prevents providers from issuing “surprise” out-of-network bills, also protects Americans from having to pay “exorbitant” bills, so between these two efforts “we will hopefully provide Americans with the protections they thought they had.”

Sen. Mike Braun (R-Ind.) asked Becerra about HHS’s condoning of puberty-blocking drugs for use on young transgender patients, pointing out that the drugs are typically used off-label for this purpose. “Would you agree that off-label prescriptions for usages not approved by the FDA are potentially dangerous for patients, especially kids?” he asked.

Becerra responded that “the FDA would raise alarms if they saw that a particular medicine or treatment would be misused.”

“For a drug to be out there and available, it has to be safe and effective,” said Becerra. “When individuals go in for care, their physician is making that decision with them about what type of medicine or treatment they should receive.” In response to further questioning from Braun about HHS support for other gender-affirming care, such as sex-change surgery, Becerra defended the administration’s position.

“I believe that we should help those have that life-affirming care that they need,” he said. “There are many transgender youth who have actually gone in the opposite direction — taking their life. If we can make life better for someone in America, we should, especially if in consultation with their physician, they approve those procedures.”

  • Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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