March 20, 2023
The Honorable Bernie Sanders
Committee on Health, Education, Labor, and Pensions
428 Dirksen Senate Office Building
Washington, DC 20510
The Honorable Bill Cassidy, M.D.
Committee on Health, Education, Labor, and Pensions
455 Dirksen Senate Office Building
Washington, DC 20510
Dear Chairman Sanders and Ranking Member Cassidy:
On behalf of the CEO Members of the Business Roundtable who collectively lead companies with more than 20 million employees, we thank you for the opportunity to comment on your request for information on the health care workforce shortage.
With nearly half of covered Americans enrolled in a health plan through their employer, Business Roundtable members lead companies that are some of the largest payers and providers of care and coverage in the country. As sponsors of this health coverage, our members believe that employees should have access to high quality, comprehensive care. Critical to that effort is a robust network of primary care providers and specialists that can meet the needs of their employees and their families.
Increasingly, Business Roundtable member companies are hearing from their employees that they and their family members are struggling to access mental health and substance use disorder services. This problem is particularly acute for teenage children whose mental health is especially vulnerable. Most mental health and substance use disorders are identified in the United States by primary care providers. Health policy experts agree that the primary care system in the United States is underfunded and is facing increasingly problematic provider shortages. Some of the workforce issues are due to the fact that primary care providers are generally paid less than specialty providers, incentivizing new providers to enter specialty fields at the expense of primary care. These financial disincentives may also create financial barriers to providing care in rural and historically underserved areas, worsening existing health disparities.
When it comes to treatment, mental health and substance use disorder services are sometimes provided by primary care providers, while other times, patients are referred to a specialist. Access to mental health specialists has long been an issue. Over half of U.S. counties have no psychiatrists, and even in areas that have mental health providers, there are often not enough to meet the needs of the community — especially if patients must travel long distances to reach available providers. Telemedicine flexibilities granted to employer sponsored insurance during the Covid-19 pandemic have been a welcomed tool for bridging the access to care gap. The Kaiser Family Foundation’s 2021 Employee Health Benefits Survey found that many employers made changes to their mental health coverage during the pandemic to expand access to services and create new employee assistance programs to better serve employees struggling with mental health needs. Most of this involved some form of care provided by telemedicine and 96% of employers are now projected to offer telemedicine-based mental health services by the end of 2023.
The combination of mental health workforce shortages with increased demand for mental health services has created a need for greater investment in the supply of qualified providers at all levels (paraprofessional, masters and doctorate-prepared mental health workers). The United States must not only build a larger, more diverse health care workforce but also execute on strategies that reduce burnout for the current workforce. One way this burnout can be addressed is by expanding the use of and breakdown barriers to the adoption of team-managed, evidence-based, care delivery models that better integrate mental health and substance use disorder services into primary care. These types of models reduce the amount of time providers must spend on tasks that others can perform and allow more patients to be seen.
The United States is facing a mental health and substance use disorder crisis unlike anything we have ever experienced before, and employers are on the front lines of trying to provide access to the necessary care. It is critical that we address the underlying workforce issues compounding this crisis. To that end, Business Roundtable recommends the following policy actions by Congress:
- Extend current telehealth flexibilities that allow employers that are offering high-deductible health plans (HDHPs) paired with health savings accounts (HSAs) to cover telehealth services without a deductible or prior to the deductible.
- Offer increased incentives for primary care physicians, mental health specialists, nurses, physician assistants and counselors to receive training in behavioral health care, including for children and adolescents.
- Expand the use and breakdown barriers to the adoption of evidence-based integrated care models that integrate mental health and substance use disorder services into primary care.
- Support legislation designed to expand scholarship and loan repayment programs for individuals from diverse and underserved communities who are interested in employment in the medical fields. Increased access to education and training opportunities will help grow the talent pool in health care, address workforce shortages and bolster workforce diversity.
- Streamline the process and expand eligibility for federal financial aid to apply to students pursuing graduate certificate and/or industry-recognized certification programs in medical fields, such as physician assistants, nurse practitioners and counselors.
- Modernize our immigration system to recruit and retain top talent, especially in primary care and medical specialties experiencing shortages and in underserved geographical areas.
- Increase access to telehealth care by helping to coordinate state requirements for providers to practice across state lines.
- With guardrails to ensure quality and safety, permanently allow behavioral health providers to practice across state lines and behavioral health providers with a medical license and accreditation to practice virtually.
- Remove unnecessary barriers that prevent providers from utilizing innovative treatment programs and technologies for substance use disorders, including medication assisted treatment programs.
- Add pharmacists and other high-demand health care occupations to the U.S. Department of Labor’s “Schedule A” list of occupations experiencing a shortage in the U.S. labor market.
Thank you for the opportunity to participate in this critical, bipartisan effort to improve our health care workforce and address the increasingly problematic shortages. Business Roundtable members stand ready to work with members of the HELP Committee to advance policies that improve access to care, especially for mental health and substance use disorder services, for our employees and their families.
Sincerely,
Corey Astill
Vice President, Health and Retirement
Business Roundtable