Friday, April 27, 2018

The Health 202: Congress is moving on opioids legislation -- but is it enough?

The following article appeared in the Washington Post on April 26th

Emerging partisan fights and political considerations are threatening to derail legislation addressing the opioid epidemic, even as both chambers of Congress try to move quickly on the crisis in an election year.
Rep. Greg Walden

House and Senate panels have passed separate bundles of bills aimed at countering opioid abuse — the Senate Health, Education, Labor and Pensions Committee moved its package on Tuesday, and yesterday evening the House Energy and Commerce Health Subcommittee approved 56 measures. There was lots of fanfare from both sides of the aisle, as lawmakers patted themselves on the back for advancing a bipartisan response to what President Trump has dubbed a public health crisis.

“The epidemic of opioids needs a prompt, bipartisan and effective response, and we gave that today in the Senate Health Committee,” said Chairman Lamar Alexander (R-Tenn.).

But the legislative pathway forward is far from clear.

For one thing, there’s little money to work with, meaning limited opportunity to dramatically expand treatment opportunities for Americans struggling with opioid addiction. Congress provided $4 billion in new opioid-directed funding in the sweeping spending bill it passed last month, but the money was allocated mainly through grants to states and Indian tribes and distributed among federal agencies to strengthen ongoing efforts to address the problem.

And now Democrats are rethinking whether they even want to hand Republicans a win on the hot-button issue, as they face the prospect of taking back the House and gaining more leverage in 2019. If they seize the House majority, Democrats could influence more of the agenda and try to force the hand of Republicans to address opioid abuse through Medicaid.

In a hearing this month, top Energy and Commerce Committee Democrat Frank Pallone (N.J.) said that the whole process felt “more like an opioids media blitz than a thoughtful discussion of our national crisis.” Yesterday the congressman appeared even more critical of his GOP colleagues, accusing them of rushing through the process without deliberating which kinds of policies and programs might work best.

“Taking the wrong action because we are not spending the appropriate amount of time to get these policies right could have the very serious consequence of making things far worse,” Pallone said at yesterday’s hearing.

Energy and Commerce Democrats refused to support a handful of bills the health subcommittee had been trying to advance, including a measure from Rep. Markwayne Mullin (R-Okla.) to revise medical privacy law so doctors can access patients' previous treatment for drug abuse and addiction. The change is widely supported by medical and industry groups, including the American Hospital Association, the American Psychiatric Association and America's Health Insurance Plans. The measure wasn't among the bills passed.

The dozens of bills passed in both the House and Senate committees make small — but significant — changes to the ways federal agencies regulate, oversee and enforce rules on opioid painkillers, and to how states and localities try to mitigate abuse as well as to how Medicaid handles patients struggling with addiction.

For example, language in the Senate package would clarify the Food and Drug Administration's authority to require that companies package certain opioids in smaller dosages and give the National Institutes of Health more flexibility in researching nonaddictive painkillers that could be alternatives to opioid painkillers.

Lawmakers say that these tweaks to public policy could, overall and over time, help tamp down high rates of abuse and overdose. But here’s a broader question to consider: What would Congress need to do to close the treatment gap?

Federal data show a huge number of Americans who need substance abuse treatment don’t get it. Just 11 percent of the people who required such treatment in 2016 actually got it, according to the latest National Survey on Drug Use and Health.

As The Health 202 wrote in March, the most efficient way to tackle opioid abuse is probably through the Medicaid program, since it covers four in 10 non-elderly adults with opioid addiction. But lobbyists say Republicans are reticent to make any big changes to the program for low-income people because it has become so politicized in recent years.

At this point, the House looks more likely than the Senate to pass opioid legislation, as Senate Majority Leader Mitch McConnell (R-Ky.) has not appeared eager to move on any kind of health-care legislation. Energy and Commerce Committee Chairman Greg Walden (R-Ore.) has set a goal of getting a package to the floor by Memorial Day — but it’s still unclear whether things will stay bipartisan until then or devolve into across-the-aisle bickering.

“We’re tinkering around the edges — we’re not tackling this public health crisis,” Rep. Kathy Castor (D-Fla.) complained yesterday.

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