ASHINGTON — The Trump administration declared the opioid crisis a public health emergency two weeks ago. Six days later, a White House-appointed panel proposed a national drug court system, a dramatic increase in addiction treatment beds, and what President Trump called “really tough, really big, really great advertising” to warn of the perils of drug use.
Neither the White House nor Congress has suggested how to pay for those measures.
With fewer than two dozen days left on the 2017 legislative calendar, a contentious tax cut pending, and the specter of a government shutdown looming in December, Congress is unlikely to create a major new stream of funding before the new year. Key House leaders are not formally discussing a major bill to accompany the president’s emergency declaration, even as they discuss other priorities for a year-end spending package.
And there’s no pressure coming from the White House: While the administration has pointed to vague, Senate-inspired plans to dedicate $45 billion over a decade to the crisis, it has not spelled out where that money would come from or exactly how it would be spent. Nor has the administration put in an explicit request to Congress.
“Somebody’s got to tell me what that is and how you get to a number,” said Rep. Greg Walden (R-Ore.), who chairs the House Committee on Energy and Commerce, adding that his committee has not spent time determining what an appropriate number might be.
Last year, through the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act, Congress authorized roughly $1.2 billion in spending to combat the opioid crisis. But public health experts, stressing that epidemic could cost the U.S. a half million lives over the next decade, have called for far more spending. Many lawmakers agree.
“I just know we need a lot more money,” said Rep. Frank Pallone (D-N.J.), the ranking member on the energy and commerce committee.
While that sentiment, in varying degrees, is common, opinions on whether it’s realistic vary widely. Rep. Tom Cole (R-Okla.), who chairs the House’s health appropriations subcommittee, suggested that funding for the opioid crisis isn’t at the top of his priority list, at least within existing spending caps.
“At the end of the day,” Cole told STAT, “I need to know: How much money am I going to have to spend overall? Is this a ‘Rob Peter to pay Paul’ exercise, or is there enough there to keep things that are priorities — like increased funding at [National Institutes of Health], making [the Centers for Disease Control and Prevention] whole, things I’d like to do — and also have extra money for what we all agree, on a bipartisan basis, is a very serious problem?”
It’s not just the pricey asks — like a pending bill to repeal a ban on Medicaid reimbursement for inpatient treatment facilities with more than 16 beds — that Congress has yet to consider.
The GOP leadership in the House has long intended to hold an “opioids week” this year to draw attention to the crisis. Now, members say even that seems to be off the table — among other reasons, because GOP leadership in the House seems to have run out of time.
“I don’t think it’ll happen,” said Rep. Tom MacArthur (R-N.J.), the co-chair of the Bipartisan Heroin Task Force.
MacArthur said he hopes House leadership schedules such a week for next spring instead — similar to the manner in which Congress passed the Comprehensive Addiction and Recovery Act.
Members of Congress from both parties, along with public health advocates, have acknowledged that the White House’s emergency declaration will mean little without funding to back it up. Rep. Michael Burgess (R-Texas), who chairs the Energy and Commerce health subcommittee, said some funding could be approved within a year-end spending bill, but that his panel had not yet discussed the issue in detail.
The Public Health Emergency Fund, MacArthur pointed out, is “basically broke” — worth just $57,000, according to the Department of Health and Human Services.
Even if it does not act to replenish that fund, MacArthur said, Congress could choose to move on a number of bills at various stages of legislation as part of a year-end spending package.
“I think both options are on the table,” he said. “I don’t see us replenishing the health fund this year, necessarily. But there are discrete bills that are under consideration that we could fund year-end.”
One of the few active legislative efforts is one that centers on existing programs authorized via last year’s legislation.
“We will be doing a review of the funding that went out via CARA and 21st Century Cures to see how that’s working,” Walden said, adding that lawmakers know they are facing a “huge issue.”
Beyond the proposal to eliminate the 16-bed cap, known as the IMD exclusion, the Bipartisan Heroin Task Force’s agenda includes legislation to help ensure physician access to patient addiction history, a $150 million grant program to help communities obtain the overdose antidote naloxone, bills strengthening trafficking enforcement, and a program that would establish Medicaid-funded pediatric care centers for infants born with neonatal abstinence syndrome.
Democrats in the Senate, for their part, have run with the Republican idea of a $45 billion fund for prevention and recovery initiatives over the course of the next decade, first introduced by Republicans during one of their unsuccessful attempts to repeal the Affordable Care Act.
And while a number of Republicans — including Shelley Moore Capito (W.Va.), Rob Portman (Ohio), and Dan Sullivan (Alaska) — later told STAT they would have at least considered supporting such a proposal, Sen. Ed Markey (D-Mass.) said in an interview that despite its conservative inspiration, the bill was deliberately introduced on a partisan basis.
In the meantime, congressional committees overseeing health funding and policy have continued to hold hearings at which members of Congress have questioned funding streams and whether existing efforts are sufficient for the communities they represent.
NIH Director Francis Collins, in particular, has stressed a need for research funding to allow the agency to more intensely study non-addictive alternatives to opioid painkillers and additional options for medication-assisted treatment for addiction.
While the Trump administration continues to point to the opioid crisis as a top priority, the White House and Republicans in Congress have also supported budget outlines that cuts $1.1 trillion in planned Medicaid spending over the course of the next decade. Medicaid, Democrats have been quick to point out, is the nation’s largest payer for addiction treatment services.
The executive branch, meanwhile, still has a pair of key vacancies atop the Department of Health and Human Services and the Office of National Drug Control Policy, leaving the federal government without a flag-bearer on efforts to fund many of the policy changes proposed by Congress and the White House’s commission.