Senators Seek More Opioid Funds in Reworked Health Care Bill
Following Senate Republicans’ decision Tuesday to postpone a vote on their health care bill until after the July 4th recess, many lawmakers will push for increased opioid abuse funding in the legislation. The Better Care Reconciliation Act currently provides $2 billion to the cause, which one expert in the treatment field called “ridiculously low.”
“I think there will be a lot of changes,” Sen. Orrin Hatch said of the bill, adding that he was “a little bit surprised” by Senate Minority Leader Mitch McConnell’s decision to postpone action on it. Pressed on specifics, Hatch replied, “That’s beyond my pay grade.”
Opioid abuse, responsible for more than 33,000 U.S. deaths in 2015 alone, has captured the attention of lawmakers on both sides of the aisle, especially those representing areas of the country most affected by the crisis. Ohio’s 3,310 opioid-related deaths in 2015, according to data from the Centers for Disease Control and Prevention, ranked second only to California, whose population is more than triple that of the Buckeye State.
“For months, I have engaged with my colleagues on solutions that I believe are necessary to ensure that we improve our health care system and better combat this opioid epidemic,” said Ohio Sen. Rob Portman in a statement. “Unfortunately, the Senate draft falls short and therefore I cannot support it in its current form.”
Sen. Shelley Moore Capito, whose home state of West Virginia has the highest opioid-related death rate in the country, expressed similar concerns.
“As drafted,” she said in a statement, “this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers.”
Andrew Kolodny, Brandeis University’s director of opioid policy research, reiterated Portman’s sentiment, calling $2 billion “ridiculously low” for a problem borne by every state in America. The American Society of Addiction Medicine recently issued a statement formally calling on the Senate to reject the BCRA, claiming it would “devastate” access to addiction treatment services.
Kolodny added that the money mentioned in the Senate proposal is described vaguely for “mental health and substance use disorders,” casting doubt about how much would actually go toward addressing the epidemic.
“That’s not very specific for the opioid crisis,” he said. “That $2 billion there is not comforting.”
Former Surgeon General Vivek Murthy – who was relieved of his post by President Trump short of his term’s expiration – took the concern a step further in a recent USA Today op-ed. Describing the BCRA as being “on the same harmful path” as the House-approved American Health Care Act, Murthy said the Senate’s proposed fixes are “nowhere near adequate.”
“Senators may earmark some funding specifically for addiction treatment but, realistically, it won't be enough to cover the vast numbers who would lose access to treatment,” Murthy wrote. “Even more important, such an approach ignores a fundamental reality that addiction is rarely an isolated condition.”
The House Bipartisan Heroin Task Force, which includes nearly 90 members, released its legislative agenda Tuesday. In doing so, it emphasized the need for both resources and attention in combating opioid abuse. Rep. Tom MacArthur, co-chair of the group and namesake of the AHCA’s “MacArthur Amendment” – which allows states to seek waivers for some requirements in the bill – described addiction as a disease that should be stripped of stigma in order to be appropriately addressed.
Some senators, however, expressed satisfaction with the current proposal, explaining that it was a stronger alternative than what is provided by the Affordable Care Act. Sen. Tim Scott, who said he “likely” would have voted for the BCRA before it was pulled, argued that the bill moves in the right direction and is an improvement over the House measure.
“I think the fact that we have delineated resources for the opioid crisis is to suggest that we understand there is one and there is something that we at least ought to fund,” he said. “I think it’s a better shot than where we were before. I mean, it’s $2 billion set aside specifically for that issue.”
Sen. Susan Collins, one of the Senate’s moderate Republicans and a key vote in the 50 needed to advance the health care measure, expressed hope that the chamber would work “in a bipartisan fashion” to improve the bill.
One point of general consensus, though, is the need to shift the country’s opioid approach from treatment to prevention.
“Bringing the epidemic under control means that you need to prevent people from getting opioid addicted, and that means [being] much more cautious prescribing so that we don’t directly addict patients,” said Kolodny. Sen. Dean Heller, whose vocal objections to the BCRA soon after it was unveiled presaged the bill’s difficult path ahead, described his personal experience with the problem.
“My mother, right now, has an opioid abuse problem,” he said, explaining the need for education and safer prescribing practices. “She’s had five back surgeries. Because of that … she’s on painkillers that she can’t get off of.”
For many types of acute pain problems, Kolodny said, opioids are either overprescribed or unnecessary, with patients receiving up to 60 pills when two or three would do. The FDA, he explained, has also been exacerbating the problem with a “steady stream” of new opioids, even as the epidemic rages on.
With alternatives such as physical therapy, he said, opioid abuse could be better prevented rather than dealt with afterward, which would save billions of dollars down the road in legal and medical costs. That all starts, however, with an initial investment.
“We need to do a better job as parents, we need to do a better job as community members, and as teachers in elementary, in secondary schools, as well as colleges and universities,” said Hatch. “It used to be that we were concerned with too heavy of drinking -- now we’ve got the opioid problem as well. It just makes you think, ‘Where are we headed?’”