President Trump threw the public for a loop again on Thursday when he announced his administration was moving to declare the opioid crisis a national emergency, just two days after administration officials said they weren’t going to take such a step.
Emergency declarations can carry both symbolic weight and serious policy consequences. Here are four things STAT will be keeping an eye on.
When will the declaration be issued, and what will it say?
First, it’s unclear when the declaration will be formally issued. Trump has a habit of announcing policies via tweets or, as he did Thursday, in response to a question from reporters. But enacting policies requires bureaucratic follow-up, and in statements issued after Trump’s remarks, neither the White House nor Health and Human Services Secretary Tom Price indicated just when an emergency would go into effect.
Trump said Thursday his administration was working on the paperwork to make the declaration official; what that says will be key. There are several laws that allow the president or the health and human services secretary to issue a declaration, and they each outline different pathways for assistance and appoint different officials to lead the initiatives. HHS and the Federal Emergency Management Agency could play roles, depending on which law is invoked.
Under the laws, the president also needs to spell out which authorities his administration is going to leverage during the emergency period, including whether there are certain rules — like Medicaid and Medicare regulations — that will be relaxed as part of the response.
How do you measure success?
Trump’s announcement came in response to an “urgent” recommendation from his commission on combatting the opioid epidemic to declare a national emergency. But in interviews over the past two weeks, experts on emergency and disaster declarations have all admitted this is uncharted territory — they’re not entirely sure how an emergency announcement will apply to a crisis like the opioid epidemic.
In the past, declarations have been issued to respond to a natural disaster when state and local resources get overwhelmed, or to stop the spread of an infectious disease. In those cases, it is clear when the emergencies end: when the affected region is cleaned up to a certain point, or when the outbreak of a disease ebbs. The emergencies generally last a few months, at most.
The opioid epidemic, however, is not expected to dissipate for years. Does that mean the emergency declaration will be in effect for years, or will the White House say from the start how officials will know when to end it?
Some advocates have even expressed concern that the Trump administration could use its emergency powers to push for a law enforcement crackdown on people who use drugs, instead of following through on the commission’s recommendations, such as expanding access to treatment and incentivizing the use of medication-assisted treatment. Trump has made clear that he sees the criminal justice system — whether through increased police enforcement or harsh sentences — as a critical tool in tackling the crisis.
Will this inspire other action?
Both the commission and outside experts have argued that, even absent additional measures, a national emergency is in itself a public awareness campaign and rallying cry. (Some experts have also questioned whether the public really needs any further reminder that the opioid epidemic is a historic crisis, given how profoundly it has affected much of the country.)
Advocates have also said that a declaration is just that — bluntly, some official-sounding words on a piece of paper — unless it is accompanied by further action. They hope the announcement could inspire Congress and federal agencies to bolster their responses, even if it’s with authorities they already have.
Through laws like the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, Congress has appropriated new resources and started new programs to fight the opioid epidemic. But the resources available are a tiny fraction of what it would actually cost to provide enough treatment to completely meet demand, experts have said. Lawmakers of both parties have generally been supportive of Trump’s announcement, so perhaps it will encourage them to take additional action on their own.
Another example: As one of its top recommendations, Trump’s opioid commission identified changing Medicaid rules so that the program would pay for care at facilities with more than 16 beds. (The fact that such a bed limit exists dates back decades to when health officials didn’t want federal Medicaid dollars going to state psychiatric hospitals.) But reworking Medicaid law to get rid of the limit would require congressional action. To get around that, federal health officials have been offering “waivers” to states for several years to expand payments to facilities with more than 16 beds, and at least four states have received them. Will the emergency declaration motivate more states to apply for waivers, or motivate Congress to change the law itself?
The first lady factor
First lady Melania Trump attended the opioid briefing with administration officials Tuesday, and the crisis is reportedly going to be part of her policy platform. It’s worth watching how she plays a role in the response, and the approach she takes.
She will reportedly be working on the issue with White House counselor Kellyanne Conway, who has traveled with Price on an opioid “listening tour” and has been seen as sensitive to some of the key, if often underestimated, factors driving the crisis, such as the stigma that still remains against addiction.
Opioids are destroying our youth/people. Mtg w @Potus & @SecPriceMD today to give my support to #STOPDRUGADDICTION pic.twitter.com/aAjNNnu98n
— Melania Trump (@FLOTUS) August 8, 2017