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Opioids Archives — Protect Our Care

If Republicans Are Serious About Addressing the Opioid Crisis, Protecting Pre-Existing Conditions and Medicaid is Key

Washington, DC – Today, the House voted on a package of legislation to address the opioid crisis, while at the same time Republicans at all levels have doubled down on their attacks on people with pre-existing conditions, including opioid use disorder, in the courts, through legislation and through regulations that promote junk plans and restrict Medicaid. In response, Leslie Dach, chair of Protect Our Care, issued the following statement:

“It’s past time that Republicans do the things that would truly support the families suffering from this crisis: end its assault on Medicaid, upon which four in 10 Americans with opioid use disorder relies, and back down from its constant attacks on people people with pre-existing conditions.”

 

ADDITIONAL BACKGROUND: How Republican Health Care Sabotage Is Exacerbating The Opioid Crisis

 

BY THE NUMBERS

 

  • More than half of people with an opioid use disorder earn incomes below 200 percent of the federal poverty line.

 

 

 

  • In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide.

 

 

 

  • It is estimated that Medicaid expansion covers four in 10 people with an opioid use disorder.

 

 

 

  • The opioid epidemic is now the most deadly drug overdose crisis in U.S. history. In 2016, roughly 64,000 Americans died of drug overdoses, meaning that more American lives were lost due to drug overdoses in 2016 than were lost in combat during the entirety of the Vietnam War. Two-thirds of 2016 drug overdoses involved opioids.

 

 

  • Medicaid expansion has reduced unmet need for substance use treatment by more than 18 percent. Recent research finds that Medicaid expanding reduced the unmet need for substance use treatment by 18.3 percent.

 

HOW PRESIDENT TRUMP & CONGRESSIONAL REPUBLICANS ARE WORKING TO DISMANTLE MEDICAID

  • President Trump and his Republican allies in Congress have repeatedly tried to slash Medicaid funding, including by imposing per-capita caps. Last year, the House of Representatives passed the American Health Care Act (AHCA), which included a per-capita limit on federal Medicaid spending and would have resulted in huge cuts to Medicaid across states. After failing to pass the AHCA in the Senate, Republicans have relentlessly continued their attacks on Medicaid. In December, the Trump Administration went so far as to propose a budget that called for  $1.4 trillion in cuts to Medicaid.

 

  • The Trump Administration is now encouraging new hurdles for Medicaid enrollees in order to keep their coverage. Experts warn that work requirements are fundamentally bureaucratic hurdles designed to restrict access to health care rather than increase employment. Previous examples show that requiring enrollees verify their employment or work-related activities reduces enrollment among those still eligible for Medicaid.

 

  • President Trump and Congressional Republicans are targeting Medicaid to pay for tax cuts to the wealthy. Last December, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy. How do Republicans plan on paying for it? Speaker Ryan’s answer is clear: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” Republicans’ approach is simple: cut programs like Medicaid that support working families.

 

  • Restricting access to Medicaid threatens lives and impedes states’ ability to respond to the opioid epidemic. Four in ten Americans with an opioid use disorder relies on Medicaid for access to treatment, and in cases of overdose, for life-saving overdose reversal medication. By cutting funding to Medicaid and restricting the eligibility of those who can enroll, the Trump Administration is people’s lives at risk and is depriving states of funding and resources they depend on to fight the opioid epidemic.

BY HELPING PEOPLE ACCESS TREATMENT AND OVERDOSE-REVERSAL MEDICATION, MEDICAID SAVES LIVES

In 2014, Medicaid Paid For 25 Percent Of Spending For Addiction Treatment. “A 2014 study by Truven Health Analytics researchers found that Medicaid paid for about 25 percent — $7.9 billion of $31.3 billion — of projected public and private spending for addiction treatment in 2014. That made it the second-biggest payer of addiction treatment after all local and state government programs.” [Vox, 2/13/18]

By Expanding Access To Naloxone, Medicaid Has Saved Lives. “We estimate that in Massachusetts 868 opioid-related deaths were averted in 2016 (13 per 100,000 population). By contrast in Tennessee, which did not expand its Medicaid program, only 11 opioid-related deaths were averted in 2016 (0.17 per 100,000 population). Both states have been hit particularly hard by the opioid epidemic: Opioid-related deaths in 2015 were 20.9 and 21.5 per 100,000 in Massachusetts and Tennessee, respectively.” [Commonwealth Fund, 7/5/17]

        [Commonwealth Fund, 7/5/17]

MEDICAID EXPANSION HAS INCREASED ACCESS TO TREATMENT

Medicaid Helps Make Buprenorphine And Naloxone, Drugs Used To Treat Opioid Use Disorder, Affordable. “These data are consistent with other evidence that Medicaid expansion is improving access to care for people with opioid use and other substance use disorders. Medicaid makes medications like buprenorphine and naloxone, which are prescribed to combat opioid use disorders, affordable for beneficiaries.“ [Center on Budget and Policy Priorities, 2/28/18]

Medicaid Expansion Has Improved Access To Substance Treatment Services. “Evidence also suggests that Medicaid expansion improved access to substance use treatment services more broadly. After expanding Medicaid, Kentucky experienced a 700 percent increase in Medicaid beneficiaries using substance use treatment services.  Use of treatment services rose nationally as well; one study found that expanding Medicaid reduced the unmet need for substance use treatment by 18.3 percent.” [Center on Budget and Policy Priorities, 2/28/18]

In Ohio, Medicaid Has Helped Those With Substance Use Disorders Access Mental Health Services. “An Ohio study found that 59 percent of people with opioid-use disorders who had gained Medicaid coverage under expansion reported improved access to mental health care. Nationwide, the share of people forgoing mental health care due to cost fell by about one-third as the ACA, including Medicaid expansion, took effect.” [Center on Budget and Policy Priorities, 2/28/18]

MEDICAID GIVES STATES MORE RESOURCES TO ADDRESS THE OPIOID EPIDEMIC

Medicaid Is A Sustainable Source Of Funding Compared To Short-Term Grants. “Now that more people with SUDs are eligible for Medicaid, states can significantly improve treatment for people with SUDs by improving Medicaid-covered services. Medicaid can be a sustainable funding source for providers, as opposed to capped, short-term grant funding.” [Center on Budget and Policy Priorities, 2/28/18]

There Is No Substitute For Comprehensive Health Care In Fighting The Opioid Epidemic. In response to the opioid epidemic, Republicans proposed creating a $45 billion fund. However, as the Center for American Progress analyzes, “The Senate opioid fund is no substitute for comprehensive health coverage.” Why? Because “Even if the entirety of the fund were available to cover low-income individuals being treated for OUD, $45 billion would provide only half of the $91 billion that would be available under the ACA for health coverage alone.” [Center for American Progress, 6/20/17]

Thanks To Medicaid Expansion, The Uninsured Rate For Opioid-Related Hospitalizations Dropped In Expansion States. “In Medicaid expansion states, the uninsured rate for opioid-related hospitalizations plummeted by 79 percent, from 13.4 percent in 2013 (the year before expansion implementation) to 2.9 percent in 2015.  The decline in non-expansion states was a much more modest 5 percent, from 17.3 percent in 2013 to 16.4 percent in 2015.” [Center on Budget and Policy Priorities, 2/28/18]

 

[Center on Budget and Policy Priorities, 2/28/18]

 

PUBLIC HEALTH, LAW ENFORCEMENT EXPERTS AGREE: MEDICAID IS KEY TOOL IN OPIOID FIGHT

A Panel Of Public Health Officials, Policy Experts, And Law Enforcement Officials Found Medicaid Among Most Important Programs In Combating Opioid Epidemic. Investing in Medicaid was the third most cited response when a panel of thirty experts were asked where they would put money to combat the opioid epidemic. [New York Times, 2/14/18]

Jay Unick, University Professor: Medicaid Expansion Is Most Important Intervention To Improve Opioid Epidemic. Medicaid expansion would be “the most important intervention for improving outcomes related to the opiate epidemic…all the other interventions discussed here only work if individuals have access to quality health care.” [New York Times, 2/14/18]

160 National, State, and Local Organizations Warn That Trump’s Medicaid Sabotage Will Hurt Those With Substance Use Disorders in Letter to Secretary Azar: “CMS’s Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis…and will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders.”  [Letter, 2/15/18]

Signatories include: ADAP Advocacy Association (aaa+); Addiction Policy Forum, Advocacy Center of Louisiana; AIDS United, Alameda County Community Food Bank; American Association on Health and Disability; American Association of People with Disabilities; American Association for the Treatment of Opioid Dependence (AATOD); American Civil Liberties Union; American Federation of State; County & Municipal Employees (AFSCME); American Foundation for Suicide Prevention; American Group Psychotherapy Association; American Psychological Association; American Society of Addiction Medicine; Association for Ambulatory Behavioral Healthcare; Bailey House, Inc.; Board for Certification of Nutrition Specialists; Brooklyn Defender Services; CADA of Northwest Louisiana; California Consortium of Addiction Programs & Professionals; California Hepatitis Alliance; Caring Across Generations; Caring Ambassadors Program; CASES; Center for Civil Justice; Center for Employment Opportunities (CEO); Center for Health Law and Policy Innovation; Center for Law and Social Policy (CLASP); Center for Medicare Advocacy; Center for Public Representation; Charlotte Center for Legal Advocacy; CHOW Project; Coalition of Medication Assisted Treatment Providers and Advocates; Colorado Center on Law and Policy; Community Access National Network (CANN); Community Catalyst; Community Health Councils; Community Legal Services of Philadelphia; Community Oriented Correctional Health Services; Community Service Society; Connecticut Legal Services; Consumer Health First; C.O.R.E. Medical Clinic, Inc.; Council on Social Work Education; CURE (Citizens United for Rehabilitation of Errants); DC Coalition Against Domestic Violence; Desert AIDS Project; Disability Rights Arkansas; Disability Rights Wisconsin; Drug Policy Alliance; EAC Network (Empower Assist Care); EverThrive Illinois; Facing Addiction with NCADD; Faces & Voices of Recovery; FedCURE; First Focus; Florida Health Justice Project, Inc.; Food & Friends; The Fortune Society; Forward Justice; Friends of Recovery – New York; Futures Without Violence; God’s Love We Deliver; Greater Hartford Legal Aid; Greenburger Center for Social and Criminal Justice; Harm Reduction Coalition; Health Law Advocates; Hep Free Hawaii; Hepatitis C Support Project/HCV Advocate; Heartland Alliance; HIV Medicine Association; Horizon Health Services; Hunger Free America; ICCA; Illinois Association of Behavioral Health; The Joy Bus; JustLeadershipUSA; Katal Center for Health, Equity, and Justice; The Kennedy Forum; Kentucky Equal Justice Center ; Kitchen Angels ; Justice in Aging ; Justice Consultants, LLC; Lakeshore Foundation; Law Foundation of Silicon Valley; Legal Action Center; The Legal Aid Society; Legal Council for Health Justice; Life Foundation; Live4Lali; Liver Health Connection; Maine Equal Justice Partners; MANNA (Metropolitan Area Neighborhood Nutrition Alliance); Massachusetts Law Reform Institute; McShin Foundation; Mental Health America; Mental Health Association in New York State, Inc. (MHANYS); Michigan Poverty Law Program; Minnesota Recovery Connection; Mississippi Center for Justice; NAACP; The National Alliance to Advance Adolescent Health; National Alliance on Mental Illness; NAMI-NYS; National Alliance of State & Territorial AIDS Directors; National Association of Addiction Treatment Providers; National Association of County Behavioral Health & Developmental Disability Directors; National Association for Rural Mental Health; National Association of Social Workers; National Center for Law and Economic Justice; National Coalition Against Domestic Violence; National Council on Alcoholism and Drug Dependence, Phoenix; National Council for Behavioral Health; National Council of Churches; National Disability Rights Network; National Employment Law Project; National Federation of Families for Children’s Mental Health; National Health Care for the Homeless Council; National Health Law Program; National HIRE Network; National Juvenile Justice Network; National LGBTQ Task Force; National Low Income Housing Coalition; National Organization for Women; The National Viral Hepatitis Roundtable; NC Justice Center; New Haven Legal Assistance Association; New York Association of Alcoholism and Substance Abuse; New York Association of Psychiatric Rehabilitation Services; New York Lawyers for the Public Interest; New York State Council for Community Behavioral Healthcare; Open Hands Legal Services; Osborne Association; Outreach Development Corp.; The Partnership for Drug Free Kids; PICO National Network; The Poverello Center, Inc.; Project Inform; Public Justice Center; Root & Rebound; Ryan White Medical Providers Coalition; Safer Foundation; Sargent Shriver National Center on Poverty Law; School Social Work Association of America; Sea Island Action Network, South Carolina; The Sentencing Project; Shatterproof; Society of General Internal Medicine; Southern Center for Human Rights; Southern Poverty Law Center; Students for Sensible Drug Policy; TASC of the Capital District, Inc.; Tennessee Justice Center; Three Square Food Bank; Transitions Clinic Network; Treatment Action Group; Treatment Alternatives for Safe Communities (TASC) – Illinois; Treatment Communities of America; Virginia Poverty Law Center; Western Center on Law & Poverty

Advocates Nationwide Highlight Medicaid’s Role In Combating Opioid Crisis

Throughout the second week of Medicaid Awareness Monthadvocates across the country highlighted the significant role Medicaid plays in combating the opioid crisis – most notable being that in 2014 Medicaid paid for one-fourth of addiction treatment nationwide – and spoke out against Republican proposals to weaken and cut Medicaid.

In Ohio, Chillicothe Mayor Luke Feeney, Cheryl Beverly, Operator of Cheryl’s House of Hope, and Michelle McAllister, Coordinator for the Heroine Partnership Project, held a press conference to discuss how changes to the state’s Medicaid program would leave over 150,000 Ohioans that suffer from substance abuse disorders and mental illness without care.

Protect Our Care released an opioid crisis fact sheet, showing how Medicaid provides access to treatment and gives states more resources in combating the epidemic.

In Tennessee, Chip Forrester, a father who lost his son to opioids, held a roundtable discussion about the crisis and how restricting access to Medicaid threatens lives and impedes states’ ability to respond to the epidemic.

The Center on Budget and Policy Priorities released a report analyzing how Better Integration of Medicaid and Federal Grant Funding Would Improve Outcomes for People with Substance Use Disorders.

ACA Medicaid Expansion Reduced Share of Opioid-Related Hospitalizations in Which Patient Was Uninsured

[CBPP]

In Ohio,  Jefferson County Commissioner Thomas Graham and health care leaders in Steubenville held a press conference to talk discuss how Medicaid benefits thousands of Ohioans suffering from substance abuse disorders.

And in Alaska and West Virginia, advocates held a virtual postcard sending party throughout the week to send notes thanking Sen. Lisa Murkowski for supporting Medicaid and encouraging her to continue doing so, culminating in a stand up event outside Sen. Murkowski’s Anchorage office emphasizing the role Medicaid plays in addressing the opioid crisis, and a press conference with faith leaders which focused on the opioid crisis and how West Virginia’s faith community can address substance abuse disorders in the state, respectively.

 

President Trump Ignores Real Opioid Solutions

Washington, D.C. – Today, President Trump spoke in New Hampshire about the opioid crisis. Protect Our Care Campaign Director Brad Woodhouse released the following statement in response:

“Heavy with rhetoric and short on solutions, President Trump’s speech today in New Hampshire was more of the same from a White House more committed to politicizing the opioid crisis than ending it. The Trump Administration has relentlessly attacked and sabotaged Medicaid, proposing to cut funding by hundreds of billions for the program that pays for one-fifth of all substance abuse treatment nationwide, and for two successive years has proposed a 95% cut to the Office of National Drug Control Policy, charged with coordinating the federal response to the nation’s raging opioid crisis.

“If the White House truly cared about combating the opioid epidemic, they would be calling for every state that hadn’t expanded Medicaid to do so. That they’re not tells you all you need to know.”

Medicaid Remains Key In Addressing Opioid Epidemic, Trump’s Repeal and Sabotage Agenda Sets Back Effort to Address the Crisis

As the White House continues to pay lip service regarding the need to address our nation’s growing opioid epidemic, its policy does the opposite — stripping resources from the very programs working to address the crisis.

The Trump Administration has relentlessly attacked and sabotaged Medicaid, which helps people with opioid addiction receive care, paying for one-fifth of all substance abuse treatment nationwide. Beyond slashing funds for Medicaid, Trump has also encouraged states to impose burdensome work requirements, mandating that Medicaid enrollees work a set amount of hours each week and jump through administrative hurdles to prove their employment status. Adding insult to injury, the Trump Administration has proposed a 95% cut to the Office of National Drug Control Policy, which is charged with coordinating the federal response to the nation’s raging opioid crisis – a cut proposed for the second year in a row.

These policies are counterproductive at best, cruel and life-threatening at worst. Medicaid has played a central role in responding to the opioid epidemic, and cutting access will only make it harder for states to address the crisis.

MEDICAID GIVES STATES MORE RESOURCES TO ADDRESS THE OPIOID EPIDEMIC

Medicaid Is A Sustainable Source Of Funding Compared To Short-Term Grants. “Now that more people with SUDs are eligible for Medicaid, states can significantly improve treatment for people with SUDs by improving Medicaid-covered services. Medicaid can be a sustainable funding source for providers, as opposed to capped, short-term grant funding.” [Center on Budget and Policy Priorities, 2/28/18]

Thanks To Medicaid Expansion, The Uninsured Rate For Opioid-Related Hospitalizations Dropped In Expansion States. “In Medicaid expansion states, the uninsured rate for opioid-related hospitalizations plummeted by 79 percent, from 13.4 percent in 2013 (the year before expansion implementation) to 2.9 percent in 2015.  The decline in non-expansion states was a much more modest 5 percent, from 17.3 percent in 2013 to 16.4 percent in 2015.” [Center on Budget and Policy Priorities, 2/28/18]

[Center on Budget and Policy Priorities, 2/28/18]

MEDICAID EXPANSION HAS INCREASED ACCESS TO TREATMENT

Medicaid Helps Make Buprenorphine And Naloxone, Drugs Used To Treat Opioid Use Disorder, Affordable. “These data are consistent with other evidence that Medicaid expansion is improving access to care for people with opioid use and other substance use disorders. Medicaid makes medications like buprenorphine and naloxone, which are prescribed to combat opioid use disorders, affordable for beneficiaries.“ [Center on Budget and Policy Priorities, 2/28/18]

Medicaid Expansion Has Improved Access To Substance Treatment Services. “Evidence also suggests that Medicaid expansion improved access to substance use treatment services more broadly. After expanding Medicaid, Kentucky experienced a 700 percent increase in Medicaid beneficiaries using substance use treatment services.  Use of treatment services rose nationally as well; one study found that expanding Medicaid reduced the unmet need for substance use treatment by 18.3 percent.” [Center on Budget and Policy Priorities, 2/28/18]

In Ohio, Medicaid Has Helped Those With Substance Use Disorders Access Mental Health Services. “An Ohio study found that 59 percent of people with opioid-use disorders who had gained Medicaid coverage under expansion reported improved access to mental health care. Nationwide, the share of people forgoing mental health care due to cost fell by about one-third as the ACA, including Medicaid expansion, took effect.” [Center on Budget and Policy Priorities, 2/28/18]

THE REPUBLICAN CLAIM THAT MEDICAID CONTRIBUTED TO THE OPIOID EPIDEMIC IS FALSE

PolitiFact: “No evidence to prove Medicaid expansion is fueling the opioid crisis.” [PolitiFact, 10/23/17]

CBPP: States That Have Expanded Medicaid Have Reduced Unmet Need For Substance Abuse Treatment. “Expansion states have reduced the unmet need for the treatment of substance use disorders by 18 percent. All states’ Medicaid programs cover at least one medically assisted treatment medication, and the Medicaid expansion has granted health coverage to an estimated 99,000 people with an opioid use disorder.” [Center on Budget and Policy Priorities, 10/5/17]

Opioid Deaths In Medicaid Expansion States Predates The Affordable Care Act.  “The opioid epidemic started decades before Medicaid expanded … Expansion states did have relatively more drug deaths than non-expansion states in 2015, but the upward trend in deaths in expansion states started in 2010, four years before the Medicaid expansion began. The results are the same if we exclude the six early expansion states. By the simplest criterion for causality, that causes must precede effects, these results cannot be taken as evidence of Medicaid expansion causing these deaths.” [Health Affairs, 8/23/17]

Medicaid Is Part Of The Solution To Curbing Opioid Epidemic. “Medicaid is the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction….The greatest opportunity to address this crisis is in those states that have elected to expand Medicaid, given the greater reach of the program, additional tools available, and the increased availability of federal funds.” [State Health Reform Assistance Network, 7/16]

CDC: “There Is No Evidence Medicaid Leads To Opioid Abuse.” “The Republican argument is flawed because the Medicaid expansion began in 2014, and opioid addiction was declared an epidemic by the Centers for Disease Control and Prevention in 2011. The federal science agency has also said there is no evidence that Medicaid leads to opioid abuse.” [Newsweek, 1/17/18]

Vox: “This Claim Runs Into A Basic Problem: The Concept Of Time.” “But this claim runs into a basic problem: the concept of time. Medicaid didn’t expand under Obamacare until 2014 — well after opioid overdose deaths started rising (in the late 1990s), after the Centers for Disease Control and Prevention in 2011 declared the crisis an epidemic, and as the crisis became more about illicit opioids, such as heroin and fentanyl, rather than conventional opioid painkillers. ‘It’s pretty ridiculous,’ Andrew Kolodny, an opioid policy expert at Brandeis University who’s scheduled to testify at the Senate hearing, told me.” [Vox, 1/17/18]

David Wyman, Georgetown University Law Center: “Just Because A Precedes B Doesn’t Mean That A Causes B. That’s Statistics 101.”  “The witnesses included one anti-Medicaid ideologue, two local prosecutors who testified that they’ve seen a lot of addicts in their work and lots of them seem to be on Medicaid, and two experts who, tactlessly, pointed out that the causes of the opioid epidemic are many and complex, that it started years before Medicaid expansion, and that it involves patients and doctors in Medicare and private insurance as well as the uninsured… Efforts to demonize Medicaid expansion because it was launched as the opioid crisis really took off confuse correlation with causation, David Hyman of the Georgetown University Law Center warned Johnson’s committee. ‘Just because A precedes B doesn’t mean that A causes B,’ he said. ‘That’s statistics 101.’” [Los Angeles Times, 1/17/18]

Katherine Baicker, University Of Chicago Harris School Of Public Policy Dean: “I Don’t Think Anybody Would Suggest Because Overprescribing Of Opioids Poses A Series Health Risk, People Shouldn’t Go See The Doctor.” “If [Republicans] argue against Medicaid based on the idea that it potentially allows more patients to get prescriptions for opioids, they could use that same reasoning to oppose expansion of private health insurance. Expanding health insurance of any variety increases people’s access to health care. Much of that care is beneficial; some may not be, Katherine Baicker, dean of the University of Chicago’s Harris School of Public Policy, told me. ‘I don’t think anybody would suggest because overprescribing of opioids poses a series health risk, people shouldn’t go see the doctor,’ Baicker said.” [Washington Post, 1/17/18]

THOSE WHO ARE MOST FAMILIAR WITH THE OPIOID CRISIS AGREE THAT MEDICAID IS CRUCIAL IN FIGHTING IT

A Panel Of Public Health Officials, Policy Experts, And Law Enforcement Officials Found Medicaid Among Most Important Programs In Combating Opioid Epidemic. Investing in Medicaid was the third most cited response when a panel of thirty experts were asked where they would put money to combat the opioid epidemic. [New York Times, 2/14/18]

Jay Unick, University Professor: Medicaid Expansion Is Most Important Intervention To Improve Opioid Epidemic. Medicaid expansion would be “the most important intervention for improving outcomes related to the opiate epidemic…all the other interventions discussed here only work if individuals have access to quality health care.” [New York Times, 2/14/18]

160 National, State, and Local Organizations Warn That Trump’s Medicaid Sabotage Will Hurt Those With Substance Use Disorders in Letter to Secretary Azar: “CMS’s Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis…and will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders.”  [Letter, 2/15/18]

Signatories include: ADAP Advocacy Association (aaa+); Addiction Policy Forum, Advocacy Center of Louisiana; AIDS United, Alameda County Community Food Bank; American Association on Health and Disability; American Association of People with Disabilities; American Association for the Treatment of Opioid Dependence (AATOD); American Civil Liberties Union; American Federation of State; County & Municipal Employees (AFSCME); American Foundation for Suicide Prevention; American Group Psychotherapy Association; American Psychological Association; American Society of Addiction Medicine; Association for Ambulatory Behavioral Healthcare; Bailey House, Inc.; Board for Certification of Nutrition Specialists; Brooklyn Defender Services; CADA of Northwest Louisiana; California Consortium of Addiction Programs & Professionals; California Hepatitis Alliance; Caring Across Generations; Caring Ambassadors Program; CASES; Center for Civil Justice; Center for Employment Opportunities (CEO); Center for Health Law and Policy Innovation; Center for Law and Social Policy (CLASP); Center for Medicare Advocacy; Center for Public Representation; Charlotte Center for Legal Advocacy; CHOW Project; Coalition of Medication Assisted Treatment Providers and Advocates; Colorado Center on Law and Policy; Community Access National Network (CANN); Community Catalyst; Community Health Councils; Community Legal Services of Philadelphia; Community Oriented Correctional Health Services; Community Service Society; Connecticut Legal Services; Consumer Health First; C.O.R.E. Medical Clinic, Inc.; Council on Social Work Education; CURE (Citizens United for Rehabilitation of Errants); DC Coalition Against Domestic Violence; Desert AIDS Project; Disability Rights Arkansas; Disability Rights Wisconsin; Drug Policy Alliance; EAC Network (Empower Assist Care); EverThrive Illinois; Facing Addiction with NCADD; Faces & Voices of Recovery; FedCURE; First Focus; Florida Health Justice Project, Inc.; Food & Friends; The Fortune Society; Forward Justice; Friends of Recovery – New York; Futures Without Violence; God’s Love We Deliver; Greater Hartford Legal Aid; Greenburger Center for Social and Criminal Justice; Harm Reduction Coalition; Health Law Advocates; Hep Free Hawaii; Hepatitis C Support Project/HCV Advocate; Heartland Alliance; HIV Medicine Association; Horizon Health Services; Hunger Free America; ICCA; Illinois Association of Behavioral Health; The Joy Bus; JustLeadershipUSA; Katal Center for Health, Equity, and Justice; The Kennedy Forum; Kentucky Equal Justice Center ; Kitchen Angels ; Justice in Aging ; Justice Consultants, LLC; Lakeshore Foundation; Law Foundation of Silicon Valley; Legal Action Center; The Legal Aid Society; Legal Council for Health Justice; Life Foundation; Live4Lali; Liver Health Connection; Maine Equal Justice Partners; MANNA (Metropolitan Area Neighborhood Nutrition Alliance); Massachusetts Law Reform Institute; McShin Foundation; Mental Health America; Mental Health Association in New York State, Inc. (MHANYS); Michigan Poverty Law Program; Minnesota Recovery Connection; Mississippi Center for Justice; NAACP; The National Alliance to Advance Adolescent Health; National Alliance on Mental Illness; NAMI-NYS; National Alliance of State & Territorial AIDS Directors; National Association of Addiction Treatment Providers; National Association of County Behavioral Health & Developmental Disability Directors; National Association for Rural Mental Health; National Association of Social Workers; National Center for Law and Economic Justice; National Coalition Against Domestic Violence; National Council on Alcoholism and Drug Dependence, Phoenix; National Council for Behavioral Health; National Council of Churches; National Disability Rights Network; National Employment Law Project; National Federation of Families for Children’s Mental Health; National Health Care for the Homeless Council; National Health Law Program; National HIRE Network; National Juvenile Justice Network; National LGBTQ Task Force; National Low Income Housing Coalition; National Organization for Women; The National Viral Hepatitis Roundtable; NC Justice Center; New Haven Legal Assistance Association; New York Association of Alcoholism and Substance Abuse; New York Association of Psychiatric Rehabilitation Services; New York Lawyers for the Public Interest; New York State Council for Community Behavioral Healthcare; Open Hands Legal Services; Osborne Association; Outreach Development Corp.; The Partnership for Drug Free Kids; PICO National Network; The Poverello Center, Inc.; Project Inform; Public Justice Center; Root & Rebound; Ryan White Medical Providers Coalition; Safer Foundation; Sargent Shriver National Center on Poverty Law; School Social Work Association of America; Sea Island Action Network, South Carolina; The Sentencing Project; Shatterproof; Society of General Internal Medicine; Southern Center for Human Rights; Southern Poverty Law Center; Students for Sensible Drug Policy; TASC of the Capital District, Inc.; Tennessee Justice Center; Three Square Food Bank; Transitions Clinic Network; Treatment Action Group; Treatment Alternatives for Safe Communities (TASC) – Illinois; Treatment Communities of America; Virginia Poverty Law Center; Western Center on Law & Poverty

As GOP Preaches Opioid Solutions, Medicaid Remains Key

Today, the Center on Budget and Policy Priorities released an analysis showing that states which expanded Medicaid saw higher rates of insurance coverage for people with opioid-use disorders. As the House Energy and Commerce Committee holds hearings and President Trump hosts a summit to address the opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“This analysis makes clear what we have been saying for months: Medicaid is a lifeline for those battling the scourge of opioid addiction, and Republican plans to gut the Medicaid program would have disastrous ramifications for the millions of Americans courageously doing so,” said Woodhouse. “This report undercuts false GOP claims and shows that Medicaid expansion increased access to substance abuse treatment, period. If they truly care about combating the opioid crisis, President Trump and GOP Members of Congress should end their partisan war on health care and immediately call for the expansion of Medicaid in states which have not done so.”

Trump’s Opioid Mess Keeps Getting Worse

New Report: Congressional Republicans Fed Up With Inaction

After new POLITICO reporting reveals mounting frustration among even Congressional Republicans about the Trump Administration’s failure to confront the national opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“When Republican Members of Congress are willing to go on record about your Administration’s continuing failure to confront a massive public health crisis, you have a problem. President Trump needs to wake up to reality and get serious about this out-of-control crisis instead of continuing his harmful efforts to gut the agency charged with fighting it and to sabotage Medicaid, which funds one-fifth of all substance abuse treatment nationwide.”

Kellyanne Conway’s ‘opioid cabinet’ sidelines drug czar’s experts

POLITICO // BRIANNA EHLEY and SARAH KARLIN-SMITH // 02/06/2018

President Donald Trump’s war on opioids is beginning to look more like a war on his drug policy office.

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a “just say no” campaign.

Trump is expected to propose massive cuts this month to the “drug czar” office, just as he attempted in last year’s budget before backing off. He hasn’t named a permanent director for the office, and the chief of staff was sacked in December. For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.

“It’s fair to say the ONDCP has pretty much been systematically excluded from key decisions about opioids and the strategy moving forward,” said a former Trump administration staffer, using shorthand for the Office of National Drug Control Policy, which has steered federal drug policy since the Reagan years.

The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings, according to his close associates. His schedule, obtained under a Freedom of Information Act request, included no mention of the meetings. Two political appointees from Baum’s office, neither of whom are drug policy experts, attend on the office’s behalf, alongside officials from across the federal government, from HHS to Defense. A White House spokesperson declined to disclose who attends the meetings, and Baum did not respond to a request for comment, although the White House later forwarded an email in which Baum stressed the office’s central role in developing national drug strategy.

The upheaval in the drug policy office illustrates the Trump administration’s inconsistency in creating a real vision on the opioids crisis. Trump declared a public health emergency at a televised White House event and talked frequently about the devastating human toll of overdoses and addiction. But critics say he hasn’t followed through with a consistent, comprehensive response.

He has endorsed anti-drug messaging and tougher law enforcement. But he ignored many of the recommendations from former New Jersey Gov. Chris Christie’s presidential commission about public health approaches to addiction, access to treatment, and education for doctors who prescribe opioids. And he hasn’t maintained a public focus. In Ohio just this week, it was first lady Melania Trump who attended an opioid event at a children’s hospital. The president toured a manufacturing plant and gave a speech on tax cuts.

Much of the White House messaging bolsters the president’s call for a border wall, depicting the opioid epidemic as an imported crisis, not one that is largely home-grown and complex, fueled by both legal but addictive painkillers and lethal street drugs like heroin and fentanyl.

“I don’t know what the agency is doing. I really don’t,” said Regina LaBelle, who was the drug office’s chief of staff in the Obama administration. “They aren’t at the level of visibility you’d think they’d be at by now.”

Conway touts her opioids effort as policy-driven, telling POLITICO recently that her circle of advisers help “formalize and centralize strategy, coordinate policy, scheduling and public awareness” across government agencies.

That’s exactly what the drug czar has traditionally done.

Conway’s role has also caused confusion on the Hill. For instance, the Senate HELP Committee’s staff has been in touch with both Conway and the White House domestic policy officials, according to chairman Lamar Alexander’s office. But lawmakers who have been leaders on opioid policy and who are accustomed to working with the drug czar office, haven’t seen outreach from Conway or her cabinet.

“I haven’t talked to Kellyanne at all and I’m from the worst state for this,” said Sen. Shelley Moore Capito, a Republican from West Virginia, which has the country’s highest overdose death rate. “I’m uncertain of her role.” The office of Sen. Rob Portman (R-Ohio,) another leader on opioid policy, echoed that – although Portman’s wife, Jane, and Conway were both at the event with Melania Trump this week.

Some drug abuse experts and Hill allies find a silver lining, noting that Conway’s high-rank brings White House muscle and attention.

“If I want technical advice, I’m going to work with Baum,” said Rep. Tom MacArthur (R-NJ), a co-chair of the Bipartisan Heroin Task Force. “If I want to get a message to the president, Kellyanne is somebody that I know I can talk to.”

“It’s a really good sign that one of the president’s top advisers has been assigned to such an important topic,” said Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum.

Baum’s email called the drug office the “lead Federal entity in charge of crafting, publishing and overseeing the implementation of President Trump’s National Drug Control Strategy,” which multiple agencies review. He called Conway’s opioids cabinet an “interagency coordinating apparatus for public-facing opioids-related initiatives” and said that it was not overseeing national policy. But several administration officials did say her cabinet was indeed focused on a variety of policies.

Whatever Conway’s ties to the president, her career has been in polling and politics, not public health, substance abuse, or law enforcement.

Some of her “cabinet” participants do have a broad, general health policy background. But they don’t match the experience and expertise of the drug office’s professional staff. In her circle is Lance Leggitt, the deputy director of the White House’s Domestic Policy Council who was also chief of staff to former HHS Secretary Tom Price. Another top Price aide, Nina Schaefer, recently returned to the Heritage Foundation. The conservative think tank then touted her as having managed “the development of the HHS response to the opioid abuse crisis,” but when POLITICO recently tried to contact her, she said through a spokesperson she was not an expert on the topic.

Among the people working on the public education campaign that Trump promised is Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy, multiple administration sources told POLITICO. Nor has Conway spent her career in the anti-opioid trenches.

“Kellyanne Conway is not an expert in this field,” said Andrew Kessler, the founder of Slingshot Solutions, a consulting group that’s worked on substance abuse with many federal agencies.“She may be a political operative and a good political operative,” he added. “But look. When you appoint a secretary of Labor, you want someone with a labor background. When you appoint a secretary of Defense, you want someone with a defense background. The opioid epidemic needs leadership that ‘speaks’ the language of drug policy.”

The set-up befuddles other experts who’ve worked on substance abuse for prior administrations. Fresh ideas are fine, they say. But the drug office has a purpose.

“The whole reason we created ONDCP in 1988 was to be a coordinating force with power in the government and to bring together 20 agencies, many reluctant to be involved in drug control,” said Bob Weiner, who served in that office in both the George W. Bush and Clinton White Houses. “This is exactly when the agency should get maximum support from the White House,” he added.

An ONDCP spokesperson told POLITICO the office “works closely with other federal agencies and White House offices, including Kellyanne Conway’s office, to combat the opioid crisis” but declined to say whether the office’s career experts have attended any of her “opioids cabinet” sessions. The drug office is still crafting the annual drug control strategy, outside the Conway group, administration officials said.

A senior White House official confirmed that officials considered kicking off the media campaign with a big splash during the Super Bowl, but that fell through. Beyond that, many experts on drug policy and substance abuse say messaging alone won’t solve the problem anyway. People with addiction need treatment, and many people get addicted in the first place to painkillers their doctors have prescribed. An ad campaign won’t solve that.

One big test for the drug office will come when Trump releases his budget Monday, which is expected to slash the office’s budget, turning much of its work over to HHS and the Department of Justice. Both departments are developing their own opioid approaches; in past administrations, the drug czar would have coordinated. Lawmakers are already sounding the alarms over the budget plan.

A bipartisan group of senators last week wrote a letter to White House budget director Mick Mulvaney, urging him to reconsider and maintain the office’s programs that “prevent and fight against the scourge of drug abuse.”

Pushback to a similar proposal last year led the Trump administration to reverse the decision and maintain the office’s budget. Lawmakers hope that there will be a similar outcome this time — along with a smarter utilization of the drug policy office.

“What we haven’t seen is the kind of coordination of critical programs that ONDCP has traditionally done,” said Sen. Maggie Hassan, a Democrat from New Hampshire, another state with one of the highest overdose death rates in the country.

Trump officials say it was the Obama administration that began undermining the drug policy office, demoting the director from the Cabinet, shrinking the staff and stressing the health aspects more than a law enforcement-focused “war on drugs.” They say the emergency requires a new approach.

Bob Dupont, who served as the second White House drug czar under President Gerald Ford, before the formal drug policy office was created, and still informally advises the Justice Department on drug policy, believes the White House will eventually realize it needs the expertise that ONDCP has to offer.

The West Wing doesn’t “have the staff or capability” to carry out drug policy work like ONDCP does, Dupont told POLITICO. “I don’t think swashbuckling your approach is going to last very long.”

 

Fact Check: Trump’s Massive Failure to Address the Opioid Crisis

Officer Ryan Holets is a true role model, one of the many dedicated Americans who work hard every day to fight our nation’s raging opioid crisis. Sadly, President Trump is not among them. For those Americans who had hoped that Trump might address this raging epidemic with the urgency it deserves, tonight’s hollow words echo last year’s broken promises. In reality, Trump has done nothing to facilitate treatment for Americans struggling with addiction, and his attacks on critical federal health care and opioid response programs threaten to make the situation worse:

  • The window-dressing public health emergency declaration the President touted in tonight’s speech freed up a fund worth only $57,000, falling pathetically short of the billions that experts say are desperately needed to combat the crisis.
  • The House repeal bill that President Trump supported would make the opioid crisis worse by eliminating parity requirements for mental health and addiction coverage, and through drastic Medicaid cuts that put states on the hook for the huge cost of dealing with the epidemic.
  • The Trump Administration has relentlessly attacked and sabotaged Medicaid, which helps people with opioid addiction receive care, paying for one-fifth of all substance abuse treatment nationwide.
  • This month, the Trump Administration proposed a 95% cut to the Office of National Drug Control Policy, which is charged with coordinating the federal response to the nation’s raging opioid crisis – for the second year in a row.

When you add it all up, the Trump Administration is not only offering a pathetic response to the nation’s most urgent public health crisis, it is actively sabotaging communities that are fighting to turn the tide on this deadly epidemic.

A Year Later: President Trump’s Broken Health Care Promises

Enough Is Enough Graphic

Last year, in his first address to a joint session of Congress, President Donald Trump made several promises to the American people about what type of health care plan he would support. Tonight, as he makes his first official State of the Union address, we know he and his Republican allies in Congress broke those promises.

PRESIDENT TRUMP BROKE HIS PROMISE ON LOWERING HEALTH COSTS

WHAT TRUMP SAID: “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going do.”

WHAT TRUMP DID: The health repeal plan House Republicans passed last year, and President Trump supported, ripped coverage away from 24 million people and raised premiums 20 percent. It imposed an age tax on older Americans by allowing insurers to charge people over 50 five times more.

PRESIDENT TRUMP BROKE HIS PROMISE ON PROTECTING PEOPLE WITH PRE-EXISTING CONDITIONS

WHAT TRUMP SAID:We should ensure that Americans with preexisting conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges.”

WHAT TRUMP DID: The health repeal plan that House Republicans passed, and President Trump supported, raised costs on people with pre-existing conditions by allowing states to let insurers charge them more. This surcharge could be in the six figures: up to $4,270 for asthma, $17,060 for pregnancy, $26,180 for rheumatoid arthritis and $140,510 for metastatic cancer. The Trump Administration has also proposed rules that, if finalized, will allow health insurers to skirt protections for pre-existing conditions.

PRESIDENT TRUMP BROKE HIS PROMISE ON MEDICAID

WHAT TRUMP SAID: “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”

WHAT TRUMP DID: The health repeal bill House Republicans passed, and President Trump supported, ended Medicaid as we know it, slashing it to the tune of $839 billion, or 25 percent, and converting it into a “per capita cap”, thus ending guaranteed coverage for everyone who qualifies, chiefly seniors, children and people with disabilities. It also ended Medicaid expansion. As a result, 14 million people were estimated to lose their coverage under the plan.

PRESIDENT TRUMP BROKE HIS PROMISE ON WOMEN’S HEALTH

WHAT TRUMP SAID:My administration wants to work with members of both parties to … invest in women’s health…”

WHAT TRUMP DID: The Trump Administration and its Republican allies in Congress waged a war on women’s health last year, including efforts to defund Planned Parenthood; taking direct aim at birth control by rolling back the copay-free coverage requirement in the Affordable Care Act; proposing drastic cuts to Medicaid; putting anti-choice judges on the federal bench; and raising costs on women by making them pay more for maternity care.

PRESIDENT TRUMP BROKE HIS PROMISE ON OPIOIDS

WHAT TRUMP SAID:We will expand treatment for those who have become so badly addicted.”

WHAT TRUMP DID: The House repeal plan Republicans passed, and President Trump supported, would make the opioid crisis worse. The repeal bill eliminated the parity requirement that mental health and addiction services be covered under the Medicaid expansion, and the plan put states on the hook for the full cost of dealing with the crisis by proposing drastic Medicaid cuts.

PRESIDENT TRUMP BROKE HIS PROMISE ON PRESCRIPTION DRUGS

WHAT TRUMP SAID: “[We should] work to bring down the artificially high price of drugs, and bring them down immediately.”

WHAT TRUMP DID: Bringing down prescription drug prices has not been a priority for the Trump Administration this past year. Just yesterday, President Trump installed a former Big Pharma executive, Alex Azar, as the new secretary of Health and Human Services.

Republicans Must Finally Confront Trump’s Disastrous Handling of Opioid Crisis

Inaction + Funding Cuts = Sabotage

Washington, DC – After former Congressman Patrick Kennedy, a member of President Trump’s Opioid Commission, said this Administration’s “efforts to address the epidemic are tantamount to reshuffling chairs on the Titanic,” and other leading advocates spoke out against the Administration’s nonresponse, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“With members of Trump’s own commission decrying the President’s non-response to the raging opioid epidemic, Republicans must finally face up to this Administration’s failure to confront the nation’s most urgent health care crisis. Despite his campaign-trail promises, Trump has done worse than nothing: his attacks on the Affordable Care Act, Medicaid, and the Office of National Drug Control Policy are actively sabotaging Americans’ access to addiction treatment. Enough is enough: Congressional Republicans need to end their partisan war on health care, stand up against President Trump’s sabotage, and put their money where their mouths are on the opioid epidemic – or else admit that they are making this crisis worse.”

Opioid commission member: Our work is a ‘sham’

CNN // Wayne Drash and Nadia Kounang // January 23, 2018

The Republican-led Congress has turned the work of the president’s opioid commission into a “charade” and a “sham,” a member of the panel told CNN. “Everyone is willing to tolerate the intolerable — and not do anything about it,” said former Democratic Rep. Patrick Kennedy, who was one of six members appointed to the bipartisan commission in March. “I’m as cynical as I’ve ever been about this stuff.”

Trump has had a year to confront the opioid epidemic. He’s done almost nothing.

Vox // German Lopez //  Jan 23, 2018, 8:00am

If you listen to President Donald Trump’s words about the opioid epidemic, he seems to understand it’s an emergency. He declared it as one late in 2017. And he has repeatedly promised, as president and on the campaign trail, that he will do something about it — that he would “spend the money,” and that “the number of drug users and the addicted will start to tumble downward over a period of years.” If you look at Trump’s actions, well, it’s a very different story. There has been no move by Trump’s administration to actually spend more money on the opioid crisis. Key positions in the administration remain unfilled, even without nominees in the case of the White House’s drug czar office and the Drug Enforcement Administration (DEA). And although Trump’s emergency declaration was renewed last week, it has led to essentially no action since it was first signed — no significant new resources, no major new initiatives.

Trump Administration Breaks Its Promise Again on Opioid Crisis

Following today’s news that the Trump Administration will propose a 95% cut to the Office of National Drug Control Policy charged with coordinating the federal response to the nation’s raging opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“For Americans fighting the opioid crisis who had hoped that President Trump might finally address this raging epidemic with the urgency it deserves, today’s proposed ONDCP cuts are yet another blow. This Administration has done nothing to facilitate treatment for Americans struggling with addiction, and its attacks on Medicaid and the ONDCP stand to make the situation worse. By trying to gut the office charged with coordinating the federal opioid response, the Trump Administration is not only continuing its pathetic response to the nation’s most urgent public health crisis: it is now actively sabotaging the communities that are fighting so hard to turn the tide on this deadly epidemic.”