Issue: H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. Question: On Passage.
Result: Passed in House, 396 to 14, 17 not voting. GOP and Democrat Selected Vote.
Freedom First Society: H.R. 6 is a package of more than 50 bills addressing the nation’s “opioid crisis.” Unfortunately, almost all of these bills comfortably ignore the source of the nation’s recent deadly epidemic — drug cartels taking advantage of a porous southern border. Instead, of forcing the federal government to exercise its constitutional responsibility to enforce our borders, Congress with H.R. 6 would throw more and more money at the resulting addiction problem. In large part, H.R. 6 does this through the expansion of unconstitutional federal health care programs, such as Medicare and mandates for state-administered Medicaid. Only one Democrat opposed this “bipartisan” package.
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We have assigned (good vote) to the Nays and (bad vote) to the Yeas. (P = voted present; ? = not voting; blank = not listed on roll call.)
From the Congressional Research Service Bill Summary [Emphasis added]:
This bill makes several changes to state Medicaid programs to address opioid and substance use disorders. Specifically, the bill:
• modifies provisions related to coverage for juvenile inmates and former foster care youth,
• establishes a demonstration project to increase provider treatment capacity for substance use disorders,
• requires the establishment of drug management programs for at-risk beneficiaries,
• establishes drug review and utilization requirements,
• extends the enhanced federal matching rate for expenditures regarding substance use disorder health home services, and
• temporarily requires coverage of medication-assisted treatment.
The bill also alters Medicare requirements to address opioid use. Specifically, the bill:
• exempts substance use disorder telehealth services from specified requirements,
• requires the initial examination for new enrollees to include an opioid use disorder screening,
• modifies provisions regarding electronic prescriptions and post-surgical pain management,
• requires prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries, and
• requires coverage for services provided by certified opioid treatment programs.
The bill also addresses other opioid-related issues. Specifically, the bill:
• establishes and expands programs to support increased detection and monitoring of fentanyl and other synthetic opioids, and
• increases the maximum number of patients that health care practitioners may initially treat with medication-assisted treatment (i.e., under a buprenorphine waiver).
Analysis: According to the Congressional Budget Office (CBO): “On May 9 and May 17, 2018, the House Committee on Energy and Commerce ordered 59 bills to be reported related to the nation’s response to the opioid epidemic.” Unfortunately, Congress is merely posturing to address symptoms of a crisis, e.g., by spending more and more money to treat addiction, while refusing to identify and deal with the real cause of the deadly epidemic.
Researcher/writer Daniel E. Horowitz wrote in “The big opioid myths and lies,” a March 28, 2018 article for conservativereview.com:
“Washington and state governments are clamoring to deal with ‘the opioid crisis.’ But they fail to define what the crisis is, the cause, the trends, why it exploded just a few years ago, and who is at fault…. The reason why they don’t want to discuss the real culprits is obvious: They are open borders and Medicaid, two favored policies of both parties. Worse, some are discussing increasing Medicaid spending as the solution and continue to block every effort to combat drug smuggling, sanctuary cities, and criminal aliens….
“Clearly, if there is a national emergency, it is being caused by illicit drugs. We have a recent heroin/fentanyl problem, mixed with other drugs, not a general opioid crisis – certainly not caused by legitimately prescribed opioids….
“Fentanyl is not being over-prescribed by doctors; it is being smuggled into this country from Mexico and China and is 100 times more potent than morphine. It is practically a hazmat issue and represents the true national emergency.” [Emphasis added.]
In an earlier March 16 report, Horowitz argued:
“We’ve always had drugs flowing into this country. But the supply and dangerous nature of the drugs coming into this country from Mexico (or from China and then distributed by the Mexican cartels) since 2013-2014 are at an epidemic level, dwarfing anything we’ve seen before. It all began with the suspension of immigration enforcement from 2010-2014 and suspension of interior enforcement. Transnational drug cartels worked with gangs and human smugglers to take advantage of Obama’s unprecedented dismantling of our borders in order to launch what should be described as chemical warfare on this country….
“The epidemic we are facing today is not from prescription opioids, at least not more than it has been for an entire generation….
“Almost the entirety of the increased fatalities above the long-term existing trajectory beginning in 2012 were from illicit drugs and mainly from the most dangerous one – heroin. Then, as heroin use began to skyrocket in 2013-2014, we began to see the growth of the cursed synthetic drug – fentanyl – which is 50-100 times stronger than morphine and can kill in small quantities. It’s often laced into heroin. In pretty much every state, fentanyl has skyrocketed to such a level that it has overtaken heroin as the leading drug killer….
“Thus, we don’t have ‘an opioid crisis;’ we have a heroin and fentanyl crisis….
“From 2013 to 2016, according to the Drug Enforcement Agency (DEA), the level of heroin production in Mexico tripled.”
The following arguments by proponents of H.R. 6 illustrate the refusal of Congress to acknowledge that drug cartels are waging a deadly war against America and why America is vulnerable to the attack. Congress is also willing to camouflage this attack by putting the blame on a myriad of other ostensible causes.
A particularly glaring omission from this discussion is the unwillingness to identify the federal government’s refusal to enforce our southern border as a prime cause of the epidemic. A less obvious omission is the politically supported decline in America’s cultural defenses against drug addiction. These cultural weaknesses have developed in large part from the organized, revolutionary attack on our foundations of religion, morality, the traditional family and purpose.
From the Congressional Record (June 22, 2018) [Emphasis added]:
Rep. Greg Walden (R-Oregon), Chairman of the Energy and Commerce Committee: “These past 2 weeks, this House, the people’s House, has dedicated tremendous amounts of time and energy to send a simple message to millions of Americans impacted by the opioid crisis. And that message is: Help is on the way. Not only are we passing legislation, dozens and dozens of bills that will save lives, but also we want to leave no doubt in the minds of those suffering from addiction that the United States House of Representatives, Republicans and Democrats alike, stand with them together….
“H.R. 6 includes several bills that went through regular order at the Energy and Commerce and Ways and Means Committees, but the bill we will vote on today also includes dozens of other pieces of legislation that have recently passed the House, most unanimously or with very strong bipartisan majorities. You see, at a time when it seems we couldn’t be more divided, it is clear that striking back against addiction is something that transcends politics and brings us together as a community, as a country, and as a Congress.
“Remember, this legislation is not the first action that this Congress has taken to combat the opioid crisis, and I am sure it will not be the last…. The Comprehensive Addiction Recovery Act and the 21st Century Cures Act, both of which were signed into law nearly 2 years ago, and an additional $4 billion in resources for States and communities that was provided in the omnibus appropriations bill just a few months ago, indicate we have been at this for awhile, and we will be at this for a while longer. Taken together, this is one of the most significant congressional efforts against a drug crisis in our Nation’s history….
“The legislation before us will help advance treatment and recovery initiatives, improve prevention and educational efforts, protect our communities, and bolster our efforts to fight deadly synthetic drugs like fentanyl.”
Rep. Frank Pallone, Jr. (D-New Jersey), Ranking Member of the Energy and Commerce Committee: “Mr. Chairman, I rise in support of H.R. 6, the SUPPORT for Patients and Communities Act. This bill makes incremental changes to support those affected by the opioid crisis, but it is far from perfect….
“Nonetheless, I am pleased that Democrats were able to secure positive provisions in the final package that we are considering today. Most notably, H.R. 6 includes provisions from a bill introduced by Representative Tonko and Representative Lujan that would extend access to evidence-based, medication-assisted treatment. Specifically, this section of the bill will allow advanced practice registered nurses, including midwives, to treat patients with buprenorphine for opiate use disorder for 5 years.
“The bill will also allow nurse practitioners and physician assistants to treat patients with buprenorphine permanently, and allow qualified providers to treat up to 100 patients instead of 30 patients in their first year. This is a critical step forward in the expansion of treatment, one of the major challenges that we continue to face in the fight against this epidemic…..
“This bill also expands coverage through Medicare by adding methadone clinics to the Medicare program. Right now, methadone clinics are not Medicare providers. Seniors who want to get treatment from methadone clinics have to pay out of pocket. Adding methadone clinics will address an important coverage gap in the Medicare program and meaningfully expand access to treatment for opiate use disorders. The bill also improves coverage for vulnerable populations in Medicaid, ensures coverage for former foster youth up to the age of 26 nationwide, and supports State efforts to ensure continuity of coverage for people with substance use disorders as they leave incarceration.
“The bill will also provide funding to Medicaid substance use disorder health homes, give States money to expand the treatment capacity of Medicaid providers, and raise reimbursement rates. It also mandates coverage of Medicaid for all forms of medication-assisted treatment for 5 years.”
Rep. Brett Guthrie (R-Kentucky: “Over the past 2 weeks, we have passed more than 50 bills out of the House, including my bill, the Comprehensive Opioid Recovery Centers Act.”
Rep. Anna Eshoo (D-Calif.): “There isn’t any question that our country is in the midst of a destructive opioid epidemic that claims 142 lives every day. This is a national crisis, and it is our duty as Members of Congress to do everything in our power to stem the tide of addiction and the devastation that this epidemic is causing. It is claiming more lives than were lost in the Vietnam war. They are staggering figures.”
Rep. David McKinley (R-West Virginia): “Mr. Chairman, I rise in support of H.R. 6. Over the past 2 weeks, America has witnessed something impressive. Both parties have come together, once again, to take action on one of the more challenging issues of our time: the opioid epidemic.”
Rep. Scott Peters (D-Calif.): “The opioid crisis has ravaged our Nation. It twice has been declared a national public health emergency under Federal law. More than 100 people will die from an overdose just today. That is why this bipartisan effort to address it is so important. There is certainly work to be done, but I am happy that legislation that I worked on with my colleague, Dr. Bucshon, is included in this bill, and it aims to stop addiction where it frequently begins: after surgery. Millions of Americans are prescribed opioids following routine surgeries because they are cheap and accessible, and nearly 70 percent of those pills go unused. Our bill reverses the perverse incentive that put so many cheap pills in people’s hands in the first place.”
Rep. Katherine Clark (D-Mass.): “Mr. Chairman, I thank the ranking member for yielding and for all his work on this issue and continuing to underscore the need to actually fund access to healthcare so that we can curb this horrible epidemic in a meaningful way.
[Freedom First Society: This is how Congress proposes to deal with the crisis: “Let’s not prevent car accidents. We’ll just fix up the victims as best we can and finance their treatment with money created by the Federal Reserve System out of thin air to cover whatever deficits we run.”]
Rep. Clark continues: “One of the many factors that contributes to the opioid crisis is the sheer volume of opioids in circulation. According to the CDC, over 214 million prescriptions were written for opioids in 2016, and we can see that in our own Federal programs. A 2016 study showed that one in three Medicare part D recipients received opioids. That is almost 80 million prescriptions for a cost of $4.1 billion. The sheer volume makes it hard to prevent abuse, addiction, waste, and fraud…. “That is why I, along with my colleague, Markwayne Mullin, have introduced the Every Prescription Conveyed Securely Act. This bill will require that every prescription written for a Medicare part D beneficiary be prescribed electronically by 2021. We know this technology will save lives by making it harder to forge prescriptions, easier for doctors to know if a patient is doctor shopping, and be able to prevent fraud and save the government money.”
Rep. Larry Bucshon(R-Indiana): “Mr. Chairman, I rise today in support of H.R. 6, the SUPPORT for Patients and Communities Act. This bill will help our struggling communities combat the opioid epidemic ravaging our Nation by focusing on providing care to those in need while addressing prevention of opioid misuse and abuse. I am proud that two pieces of legislation that I introduced are included in H.R. 6 as sections 202 and 203. Section 202, which I worked closely with Representative Peters on to introduce, would incentivize development of nonopioid pain alternatives for postsurgical pain.”
Rep. Paul Tonko (D-New York): “The SUPPORT for Patients and Communities Act incorporates legislation that I introduced along with my good friend and colleague, Representative Ben Ray Lujan of New Mexico, which will provide a meaningful expansion to addiction treatment across our country, especially in rural areas, and for vulnerable populations like pregnant and postpartum women and the 13,000 babies born on average each year with neonatal abstinence syndrome. Our legislation includes three main policy changes to expand access to treatment.”
Rep. Kevin McCarthy (R-Calif.), House Majority Leader: “Mr. Chairman, I rise today to urge the passage of H.R. 6 which contains more than 50 opioid-related bills which we have considered in the past 2 weeks. We have in this body the opportunity nearly every day to approve legislation of great consequence to millions of people. But rarely do the consequences feel so immediate and so vital as they do for the opioids package we are considering. That is because this legislation has to do with the deadliest drug crisis in our Nation’s history. The grim truth is this: More Americans have died from drug overdoses since the turn of the century than died in the Civil War. Yes, you heard that right. In less than two decades, more than 630,000 people have died because of drugs. Half of those deaths had to do with opioids. This death toll is the ‘American carnage’ that President Trump referred to in his inaugural address…..
“Mr. Chair, if we hope to defeat the deadliest drug crisis in history, we will need the biggest response in history. Rest assured that the response is already underway, led by this administration and this Congress. We are wrapping up voting on more than 50 bills to help millions of Americans affected by the opioid crisis. We are about to vote on a package that contains almost all of those bills, H.R. 6.
“Among others, it contains a bill by Congressman Mike Bishop that will reduce the flow of Chinese fentanyl into our country by giving law enforcement new tools to detect suspicious packages in the mail.”
[Freedom First Society: Efforts to “reduce the flow of Chinese fentanyl into our country” are on target.]
Rep. Tony Cardenas (D-Calif.): “Mr. Chair, I rise today to say how glad I am that my bill, the At-Risk Youth Medicaid Protection Act, has been included in today’s opioid package. According to a June 2017 MACPAC report, the opioid epidemic disproportionately affects Medicaid beneficiaries. Therefore, State Medicaid programs are taking the lead in identifying and tailoring strategies to prevent and treat opioid use disorder.”
Mr. Leonard Lance (R-New Jersey): “Mr. Chair, I rise today in support of this bipartisan package, H.R. 6. The Energy and Commerce Committee, under the leadership of Chairman Walden, has again delivered for the American people on the pressing public health challenges facing the Nation. From combating childhood cancer, to improving mental health care, to fighting the scourge of drug addiction, the Energy and Commerce Committee produces results. The menace of drug abuse and addiction has manifested itself in opiates. Every corner of this country has known the heartache of losing a life from this terrible problem. Congress has acted before with passage of the Comprehensive Addiction and Recovery Act, but CARA needs reinforcement. H.R. 6 delivers more resources, treatment, and mitigation tools to fight opiate addiction. Included in this package is the Eliminating Opioid-Related Infectious Diseases Act, legislation I have authored with my colleague on the Energy and Commerce Committee, Congressman Joseph P. Kennedy III.”
Rep. Kevin Brady (R-Texas): “All too often, we hear stories of loved ones exposed to opioids, and then quickly addicted, from routine surgeries that may not have required opioid treatment in the first place. This can be prevented. That is why I rise today in support of H.R. 6, known as the SUPPORT for Patients and Communities Act. This bill, which incorporates legislation recently approved by the Ways and Means Committee, addresses this crisis by putting in place many commonsense measures to reduce the unnecessary prescription of opioids and also to help those who have become addicted.”
Rep. Richard Neal (D-Mass.): “H.R. 6 also expands coverage of medication-assisted treatments and allows nurse practitioners and physician assistants to prescribe or dispense certain opioid treatment drugs. The measure also provides consistent Medicaid coverage for at-risk youth and expands Medicaid coverage for foster youth until the age of 26. These bills are pieces of a large, complex puzzle. We need to find realistic solutions with long-term outcomes. Part of this approach is to protect and strengthen Medicaid and the Affordable Care Act.”
Rep. Peter Roskam (R-Illinois): “So here is what we are trying to do: We are saying that we need to resist pharmacy shopping. We need to resist doctor shopping. And we need to make sure that people can be identified who have a predisposition towards this addiction. So what this bill does —what part of this bill does — is it says: Medicare part D programs don’t just have the option of requiring a lock-in program, we are now locking in on lock-in. We are saying: You have got to do this. Unambiguously, it is a mandate, it is a good mandate, and it is something that has been a long time coming.”
Rep. George Holding (R- North Carolina): “Mr. Chairman, I would like to highlight the importance of medication-assisted treatment in combating the opioid epidemic…. Medicare beneficiaries have among the highest and fastest rate of opioid use disorder, yet they do not currently have coverage for the most effective treatment. The SUPPORT Act, which will be before the House today, would change that. This bill provides for a fully coordinated, bundled-care model that will help patients through medication-assisted treatment, which combines the use of medication with counseling, group therapy, and drug testing.”
Rep. Jackie Walorski (R-Indiana): “Mr. Chair, I rise today in support for the SUPPORT for Patients and Communities Act. It includes my bill, the Dr. Todd Graham Pain Management, Treatment, and Recovery Act, that passed the House earlier this week.”
An Even Greater Danger
Unfortunately, America is the victim of a much bigger and ultimately more serious epidemic — one totally ignored by Congress — the perversion of Congress to become a tool for building total government. The result can be seen in the continued growth of unconstitutional government programs and spending. The negative impact on middle class opportunity must be incredible. One can only imagine what Americans could have accomplished since World War II if they were free from burdensome regulation and destructive incentives!
But the perversion doesn’t stop there. As with open borders, the destruction is planned and championed by Establishment elites. Time and again, Congress has created the poison and the bigger government antidote in the same laboratory.
Rebuilding a Congress accountable to an informed electorate, a Congress that respects the limits of the Constitution will require organized action from responsible, concerned citizens. Please consider the program of Freedom First Society.