During his first State of the Union address, President Biden announced a four-part Unity Agenda focused on areas where members of both parties can come together and make additional progress for the American people: ending cancer as we know it; delivering on the sacred obligation to veterans; tackling the mental health crisis; and beating the opioid and overdose epidemic.
Over the last year, the President was proud to work with Democrats and Republicans to enact major legislation that delivers on all aspects of this four-part agenda. In his State of the Union today, the President will announce a new set of policies to continue to make progress advancing his Unity Agenda and deliver results for families across the country.
Accelerating Progress to End Cancer as We Know It Today
Cancer has touched nearly every American family, and it remains the second leading cause of death in America. To accelerate progress in the fight against cancer, last year, the President and First Lady reignited the Cancer Moonshot with the goal of cutting U.S. cancer death rates by at least half in 25 years and improving the experience of individuals, caregivers, and families living with and surviving cancer. Over the past year, the Cancer Moonshot has announced nearly 30 new federal programs, policies and resources to close the screening gap, tackle environmental exposure, decrease preventable cancers, advance cutting-edge research, support patients and caregivers, and more. More than 60 private companies, non-profits, academic institutions, and patient groups have also answered the President’s call and stepped up with new actions and collaborations. The President will call on Congress to act to end cancer as we know it, and the Cancer Moonshot will drive additional progress this year by:
Bringing America’s cancer research system into the 21st century. As we work to continue the progress we’ve made over the last year, the Administration is urging Congress to reauthorize the National Cancer Act, which 52 years ago set up the National Cancer Institute (NCI) in its current form. The reauthorization will update the nation’s cancer research and care systems to put modern American innovation fully to work to end cancer as we know it. This includes standing up clinical trial networks, creating new data systems that break down silos, and ensuring that knowledge gained through research is available to as many experts as possible, so we can find answers faster and make a difference for patients. Working with Congress, we can also lock in the strong investment in cancer research that passed in 2016 as part of the broadly bipartisan 21st Century Cures Act, which otherwise expires this year.
Providing patient navigation support to every American facing cancer. The Biden-Harris Administration will take steps to ensure that patient navigation services – services that help guide individuals, caregivers, and families through cancer screening, diagnosis, treatment, and survivorship – are covered benefits going forward for as many people facing cancer as possible. These patient navigation services not only improve the experience for those patients and their families, they improve patient outcomes and provide value back to the health care system.
Tackling the biggest single driver of cancer deaths in this country – smoking. The Administration is preparing further action to help people avoid smoking in the first place and support Americans who want to quit. These steps could prevent as much as 30 percent of cancer deaths in this country, saving up to 130,000 American lives, annually. While we have made progress, tobacco products still hook too many young people at an early age and take control away from individual Americans to make the decision not to smoke. The Administration is working to put that control back in the hands of Americans.
During his first State of the Union address, President Biden cited the recent announcement of his plan to supercharge the Cancer Moonshot and called on Congress to fund ARPA-H, the Advanced Research Projects Agency for Health, to drive breakthroughs in cancer, Alzheimer’s, diabetes, and other diseases. Since that time, the President and Congress have stepped up together to provide ARPA-H $2.5 billion in initial investment. The President also signed into law the Inflation Reduction Act, which will lower prescription drug costs for tens of thousands of cancer patients with Medicare coverage. The Bipartisan Infrastructure Law will also help cut cancer deaths by accelerating clean-up at Superfund sites and helping states and communities replace lead pipes and service lines.
Supporting America’s Veterans and Their Families, Caregivers, and Survivors
The President believes there is no more sacred obligation than taking care of our nation’s military service members, veterans, and their families, caregivers, and survivors. On health care, education, and housing, the Administration and Congress have worked together to make progress to connect veterans and their families to needed resources. Over the past year, the Administration expanded benefits for veterans as well as their caregivers and survivors, and delivered more benefits and health care more quickly to more veterans than ever before. In 2022, VA processed an all-time record 1.7 million veteran claims, and delivered $128 billion in earned benefits to 6.1 million veterans and survivors. In the State of the Union, the President will announce his Administration plans to continue that work by:
Reducing veteran suicide. Suicide among veterans is a public health and national security crisis. Since 2010, more than 71,000 veterans have died by suicide – more than the total number of deaths from combat during the Vietnam War and operations in Iraq and Afghanistan combined. Since releasing a comprehensive strategy for reducing military and veteran suicide, both DOD and VA reported declines in suicide deaths, but much more remains to be done. This will include actions to:
- Support states and territories. The Department of Veterans Affairs (VA) is working with the Departments of Health and Human Services (HHS) and Defense (DOD) to partner with 49 states and 5 territories through the Governor’s Challenge. To help facilitate this work, VA will launch a new $10 million program to provide federal resources to states, territories, Tribes and Tribal organizations to develop and implement proposals under the program.
- Increase lethal means safety: In the coming year, VA will deploy new resources to improve suicide risk identification and increase lethal means safety counseling and safe storage. VA will offer additional training for the 1.3 million community providers and expand KeepItSecure, the landmark lethal means safety campaign, with new resources and materials for providers, caregivers, family members of veterans, and gun shop owners to encourage safe storage of firearms and lethal medications.
- Expand outreach to justice involved veterans. Veterans who become involved in the criminal justice system may be at high risk of suicide. Through Veteran Treatment Courts and other justice outreach engagements, VA is able to provide veterans access to benefits and services that can be life-changing, and VA will accelerate hiring of veteran justice outreach professionals to expand these programs.
- Expand Access to Legal Support Services. VA will build upon and expand its current 28 Medical-Legal Partnerships. Family caregivers participating in VA’s Program of Comprehensive Assistance will also be able to receive Financial and Legal Assistance later this year. VA will also award up to 75 grants under its new Legal Services for Homeless Veterans and Veterans at Risk for Homeless (LSV-H) program to provide legal services to veterans who are homeless or at risk of homelessness.
Expanding access to peer support, including mental health services. Military service increases the risk of mental health problems and other adjustment challenges for veterans. Veteran Peer Specialists are a critical asset within VA’s workforce, working across various programs to connect their fellow veterans to services, participate as members of health care teams, and provide individual and group-based peer support. Last year, VA pledged to hire an additional 280 peer specialists and is on track to meet this goal by the end of 2023. VA will increase the number of peer specialists working across VA medical centers by 350 over the next 7 years.
Ensuring access to affordable, stable housing for low-income veterans. Every veteran should have a roof over their head. The President’s upcoming budget will triple the number of extremely low-income veterans who can access the assistance they need to afford rent over the years ahead, paving the path to an entitlement for those who have served our country. The number of veterans experiencing homelessness declined by 11% between 2020 and 2022 and the United States permanently housed more than 40,000 veterans in 2022 alone.
Delivering high-quality job training for veterans and their spouses. Roughly 200,000 service members transition from the military to civilian life each year. In the coming year, DOL’s Veteran Employment and Training Service (DOL-VETS) will implement its Employment Navigator Partnership Pilot, which has already provided one-on-one career assistance to 6,500 transitioning service members and military spouses. And, the Department of Defense will use the Military Spouse Career Accelerator Pilot program, a 12-week paid fellowship program, to expand employment opportunities for eligible military spouses.
In last year’s State of the Union, the President called for Congress to pass comprehensive legislation to address military toxic exposures. In August 2022, President Biden signed the bipartisan PACT Act into law, the most significant expansion of benefits and services for toxic exposed veterans in more than 30 years. Over the last year, the Administration also took critical action to help reduce veteran suicide, including transitioning the Veterans Crisis Line to “988, press 1.” The Administration also expanded access to reproductive health services for women veterans, supported more than 2.3 million children living with wounded, ill, or injured service members through the First Lady’s Joining Forces Initiative, and implemented key measures to protect veterans from predatory for-profit colleges.
Tackling the Mental Health Crisis
Forty percent of American adults report symptoms of anxiety and depression, and the percent of children and adolescents with anxiety and depression has risen nearly thirty percent. Last year, President Biden called for additional actions to advance his Mental Health Strategy across its three objectives: support Americans by creating healthy environments; strengthening system capacity, and connecting more Americans to care. Over the last year, the Administration invested critical resources to provide mental health and substance use supports to Americans, including by expanding Certified Community Behavioral Health Clinics, investing unprecedented resources in the 988 suicide prevention hotline, and taking steps to help address the harms of social media on youth. In the State of the Union, the President will say that we will continue that work by:
Creating healthy environments. Decades of research show that coordinating prevention and recovery support across settings can pay long-term dividends. The Biden-Harris Administration will:
- Protect kids online. There is compelling and growing evidence that social media and other tech platforms can be harmful to mental health, wellbeing and development. Children, adolescents, and teens are especially vulnerable to such harm. More than one-third of American teens say they use a major social media platform “almost constantly” and that they spend “too much time on social media.” Far too often, the platforms do not enforce their own terms of service with respect to minors who use their products and services. Children are also subject to the platforms’ excessive data collection vacuum, which they use to deliver sensational and harmful content and troves of paid advertising. Children also suffer from bullying, harassment, abuse, and even sexual exploitation by other users online. And platforms use manipulative design techniques embedded in their products to promote addictive and compulsive use by young people in the name of “user engagement” – all to generate more revenue. The Administration will build on the Surgeon-General’s Youth Mental Health Advisory, the Department of Health and Human Services’ new Center of Excellence on Social Media and Mental Wellness, and the recent passage of the Children and Media Research Advancement Act. Platforms and other interactive digital service providers should be required to prioritize the privacy and wellbeing of young people above profit and revenue in their product design, including safety by design standards and practices for online platforms, products, and services. The President is calling for bipartisan support to ban targeted advertising online for children and young people and enact strong protections for their privacy, health and safety online.
- Strengthen data privacy and platform transparency for all Americans: Big Tech companies collect huge amounts of data on the things we buy, the websites we visit, and the places we go. There should be clear and strict limits on the ability to collect, use, transfer, and maintain our personal data, especially for sensitive data such as geolocation and health information, and the burden must fall on companies – not consumers – to minimize how much information they collect. We must also demand transparency about the algorithms companies use that far too often discriminate against Americans and sow division. The President has called for imposing much stronger transparency requirements on Big Tech platforms and is calling for bipartisan support to impose strong limits on targeted advertising and the personal data that companies collect on all Americans.
- Support the mental health of the health workforce. Even before the pandemic, health workers were experiencing high levels of burnout, anxiety, and depression. Studies have shown that burnout have reached crisis levels, affecting up to 54 percent of nurses and physicians. This year, the Centers for Disease Control and Prevention will launch a new campaign to provide a hub of mental health and resiliency resources to health care organizations in better supporting their workforce
- Promote youth resilience. While rates of anxiety, depression, and self-harm among youth have been on the rise over the past several years, there are also remarkable stories of hope and resilience. To help foster innovation in promoting resilience, HHS will launch a new Children and Youth Resilience Prize Challenge, awarding a total of $750,000 in a new pilot program.
Connecting more Americans to care. On average, it takes 11 years after the onset of mental health symptoms for someone to seek treatment. We can do better. To mitigate these challenges, the Administration is working to make care more affordable and accessible across all types of health insurance, integrating mental health services into settings that are more familiar, such as schools, and expanding access to telehealth. To continue this progress, the Biden Administration will:
- Improve school-based mental health. The Department of Education (ED) will announce more than $280 million in grants to increase the number of mental health care professionals in high-need districts and strengthen the school-based mental health profession pipeline. HHS and ED intend to issue guidance and propose a rule, respectively, to remove red tape for schools, making it easier for them to provide health care to students and more easily bill Medicaid funding for these critical services.
- Strengthen parity. This spring, the Administration will propose new rules to ensure that insurance plans are not imposing inequitable barriers to care and mental health providers are being paid by health plans on par with other health care professionals.
- Enhance crisis services. The Administration launched 988, the National Suicide & Crisis Lifeline, in 2022, making it easier for individuals experiencing a behavioral health crisis to receive timely care. In the coming year, HHS will improve the capacity of the 988 Lifeline by investing in an expansion of the crisis care workforce; scaling mobile crisis intervention services; and developing additional guidance on best practices in crisis response.
- Expand access to telehealth. HHS will triple resources dedicated to promoting interstate license reciprocity for delivery of mental health services across state lines. VA will launch a new nationwide network of behavioral health clinicians to ensure timely access to evidence-based mental health services to veterans enrolled in VA health care. And, DoD will continue to expand the BRAVE program, a virtual behavioral health center providing services 24/7 to service members and their families located on federal installations across the globe.
Strengthening system capacity. Severe shortages in the behavioral health workforce are at the center of the mental health crisis. In addition to implementing legislation passed by Congress that creates 350 new slots to help train the next generation of mental health professionals, the Administration will:
- Recruit diverse candidates to the mental health profession: HHS will increase funding to recruit future mental health professionals from Historically Black Colleges and Universities and to expand the Minority Fellowship Program.
- Prioritize research: The Office of Science and Technology Policy and Domestic Policy Council released the White House Report on Mental Health Research Priorities, which identifies key areas where additional scientific research is needed to address our national mental health crisis. These priorities will ensure coordination across the federal agencies and private sector partners that support or perform mental health research.
Last year, after the President called for addressing the nation’s mental health crisis in the State of the Union, the Administration made important progress on expanding access to mental health services and treatment for substance use. President Biden signed into law the Bipartisan Safer Communities Act, which makes unprecedented investment in youth mental health and supports school-based health services. The Administration also oversaw the successful transition to 988, the National Suicide & Crisis Lifeline, investing over $500 million to strengthen 988 infrastructure and grow local crisis-center capacity – a twenty-fold increase over the prior administration. The Biden Administration also developed new resources to support the mental health and resilience of frontline workers, expanded Medicare coverage to include additional mental health and substance use disorder services, and encouraged states to better address youth mental health for those with Medicaid coverage.
Beating the Opioid and Overdose Epidemic by Accelerating the Crackdown on Fentanyl Trafficking and Public Health Efforts to Save Lives
Last year, President Biden announced his plan to beat the opioid epidemic as part of his Unity Agenda, because opioid use and trafficking affect families in red communities and blue communities and every community in between. Under President Biden’s leadership, overdose deaths and poisonings have decreased for five months in a row – but these deaths remain unacceptably high and are primarily caused by fentanyl. In the State of the Union, the President will announce key actions the Administration to tackle this issue head on, including by:
Disrupting the trafficking, distribution, and sale of fentanyl. In just the last year Customs and Border Protection (CBP) has seized a historic 260,000 pounds of illicit drugs primarily at ports of entry on our border, including nearly 15,000 pounds of fentanyl. The Drug Enforcement Administration and the White House Office of National Drug Control Policy’s (ONDCP) High-Intensity Drug Trafficking Areas (HIDTA) program were involved in the seizure of more than 26,000 pounds of fentanyl in FY22—including 50.6 million fentanyl-laced counterfeit prescription pills—along with over 6,500 pounds of heroin, 335,000 pounds of methamphetamine, and 370,000 pounds of cocaine. The HIDTA seizures denied $9 billion to drug traffickers, cutting into their profits. Further, through President Biden’s Executive Order on Imposing Sanctions on Foreign Persons Involved in the Global Illicit Drug Trade, the Department of the Treasury has imposed sanctions against dozens of individuals and entities involved in the illicit drug trade. To aggressively expand on this historic effort, the President will announce in the State of Union that his administration will:
- Stop more fentanyl from getting into the U.S. at the Southwest Border Ports of Entry. By providing 123 new large-scale scanners at Land Points of Entry along the Southwest Border by Fiscal Year 2026, Customs and Border Protection (CBP) will increase its inspection capacity from what has historically been around two percent of passenger vehicles and about 17 percent of cargo vehicles to 40 percent of passenger vehicles and 70 percent of cargo vehicles. These investments will crack down on a major avenue of fentanyl trafficking, securing our border and keeping dangerous drugs from reaching our country.
- Stop more packages from being shipped into the United States with fentanyl and the materials used to make it. Drug traffickers use small, hard-to-track packages to ship opioids and other illicit materials into and within the United States, hidden among the millions of packages sent daily via commercial package delivery companies. That’s why CBP is working with these companies to have them voluntarily provide data that help law enforcement identify, inspect and intercept suspicious packages. Through these combined public-private efforts, CBP has increased seizures in commercial package delivery services’ warehouses from 42,000 pounds of illicit substances to more than 63,000 pounds in just the past two years. This year, CBP will expand these voluntary data sharing partnerships to capture more information – and, in turn, seize more packages.
- Lead a sustained diplomatic push that will address fentanyl and its supply chain abroad. The Administration will work with international partners to disrupt the global fentanyl production and supply chain, and call on others to join our efforts. We will focus on seizing chemical ingredients and fentanyl before it can reach our communities, and hold accountable the producers, traffickers, and facilitators of these deadly drugs. Many of these ingredients and materials originate outside our borders, and we will call on global partners to work with us and do more to disrupt the criminal elements within their countries who sell chemicals and tools for the production of counterfeit pills around the world.
- Work with Congress to make permanent tough penalties on suppliers of fentanyl. The federal government regulates illicitly produced fentanyl analogues and related substances as Schedule I drugs, meaning they are subject to strict regulations and criminal penalties. But traffickers have found a loophole: they can easily alter the chemical structure of fentanyl—creating “fentanyl related substances” (FRS)—to evade regulation and enhance the drug’s impact. The DEA and Congress temporarily closed this loophole by making all FRS Schedule I. The Administration looks forward to working with Congress on its comprehensive proposal to permanently schedule all illicitly produced FRS into Schedule I. Traffickers of these deadly substances must face the penalties they deserve, no matter how they adjust their drugs.
Expanding access to evidence-based prevention, harm reduction, treatment, and recovery. Over the last year, the Biden-Harris Administration took unprecedented steps to expand access to naloxone and other harm reduction interventions, such as permitting the use of $50 million for local public health departments to purchase naloxone, releasing guidance to make it easier for programs to obtain and distribute naloxone to at-risk populations, and prioritizing the review of over-the-counter naloxone applications. The Administration has also fundamentally changed addiction treatment across the country by working with Congress to remove barriers that prevented medical professionals from prescribing treatment for opioid use disorder and pursuing rulemaking to make permanent the COVID-19 era flexibilities that allowed for telehealth prescribing of buprenorphine and take-home methadone doses. To further connect people to life-saving help, the Biden-Harris Administration will:
- Deliver more life-saving naloxone to communities hit hard by fentanyl. In late spring, HHS will take new steps to encourage and aide states in their efforts to use existing funding to purchase naloxone and distribute it in their communities. The Substance Abuse and Mental Health Services Administration (SAMHSA) will provide enhanced technical assistance to states who have existing State Opioid Response funds, and will host peer learning forums, national policy academies, and convenings with organizations distributing naloxone beginning this spring.
- Ensure every jail and prison across the nation can provide treatment for substance use disorder. Providing treatment while individuals are in jails and prisons, and continuing their treatment in their communities, has been proven to decrease overdose deaths, reduce crime, and increase employment during reentry. By this summer, the Federal Bureau of Prisons will ensure that each of their 122 facilities are equipped and trained to provide in-house medication-assisted treatment (MAT). Further, since more than 90 percent of individuals who are incarcerated are in state and local jails and prisons, the Centers for Medicare and Medicaid Services will provide guidance this spring allowing states to use Medicaid funds to provide health care services—including treatment for people with substance use disorder—to individuals in those facilities prior to their release.
- Build on historic progress to drastically expand access to medications for opioid use disorder. The Biden-Harris Administration will further expand access to treatment by working with medical professionals to make prescribing proven treatments, including buprenorphine for opioid use disorder, part of routine health care delivery and ensure that manufacturers, wholesalers, and pharmacies are making medications available to everyone with a prescription.
- Launch a national campaign to educate young people on the dangers of fentanyl, and how naloxone saves lives. The Ad Council’s Real Deal on Fentanyl campaign has raised awareness about the dangers of fentanyl among youth. ONDCP and the Ad Council will build on this work by launching a naloxone education component of the campaign, which will reach the young people who are the fastest-growing age group to experience opioid overdose and poisoning by engaging popular social media platforms, college athletes and campus-based organizations. The campaign will also develop media to be shared on college campuses, in bars, public transportation stations, and retail locations to educate young people about the dangers of fentanyl and highlight naloxone resources.
During his first State of the Union address, President Biden called on Congress to get rid of outdated rules that stop doctors from prescribing treatments and provide law enforcement with the tools necessary to stop the flow of illicit drugs like fentanyl. In his State of the Union today, President Biden will highlight a bipartisan effort that delivered on his promise by passing the MAT Act, which removed the X-waiver as a barrier for health care providers prescribing life-saving medications for opioid use disorder at a time when fewer than 1 out of Americans can access the treatment they need. President Biden also signed into law the Consolidated Appropriations Act that included a two-year extension to classify fentanyl-related substances as Schedule I substances under the Controlled Substances Act, ensuring law enforcement has the tools they need to respond to the manufacture and trafficking of illicitly manufactured synthetic opioids driving the overdose epidemic.