Senate Panel Advances Sweeping Opioid Bill to Full Senate

Kerry Dooley Young

April 25, 2018

A Senate panel on Tuesday unanimously approved a wide-ranging package of legislative proposals addressing the nation's opioid crisis, while the House Energy and Commerce Committee is slated to consider on Wednesday more than 60 separate bills addressing painkillers and substance abuse.

Combating addiction and misuse of medicines such as fentanyl and Vicodin (AbbVie) is an area of strong bipartisan interest in Congress, raising the odds that the proposals advanced by these committees might make it eventually into law. The US Senate Committee on Health, Education, Labor and Pensions (HELP) voted 23 to 0 on Tuesday to approve the Opioid Crisis Response Act of 2018 (S.2680).

The package contains varied approaches for combating addiction. It seeks to boost scientific research related to pain, to aid medical and law enforcement efforts to prevent and track misuse of prescription drugs, and to provide assistance for communities already struggling with its consequences. The package contains directions for the National Institutes of Health, the US Food and Drug Administration, US Customs and Border Protection, and the Centers for Disease Control and Prevention.

Senate HELP Chairman Lamar Alexander (R-TN) said it is possible that other committees, such as Judiciary and Homeland Security, may become involved with this legislation. Alexander said he intends to develop a good "framework" for Senate Majority Leader Mitch McConnell (R-KY) to put on the chamber's floor in the months ahead.

"Maybe this is something that the Senate can move on this summer," Alexander said.

McConnell, whose home state has been hit hard by the opioid crisis, has shown great interest in this topic. On Monday, he introduced a bill of his own that would establish a pilot program to help people in recovery from a substance use disorder transition from treatment to independent living and the workforce.  On Tuesday, McConnell spoke on the Senate floor about the package being marked up by HELP. The Senate leader stressed the need for support for those recovering from past abuse of opioids.

"We see firsthand in Kentucky the need for the structure and support that come with a job to help keep former addicts from falling back into the cycle of addiction," McConnell said.

Bipartisan Effort

Senator Patty Murray of Washington, the ranking Democrat on the HELP Committee, also on Tuesday spoke of the need for legislation to address the effects in communities from addiction.

"I'm glad we could work to include support for state efforts to improve plans of safe care for children born to mothers battling addiction," Murray said at the Senate HELP markup meeting on the bill. "I'm also glad we have included provisions to develop a taskforce and grants to help support trauma-informed care programs and increase access to mental health care for children."

Before approving the bill, the Senate HELP committee adopted several amendments by voice votes. It also rejected by roll-call votes amendments offered by Senators Bernie Sanders (I-VT) and Chris Murphy (D-CT).

Sanders sought to amend the HELP package by adding provisions that would have created criminal and civil penalties for drug manufacturers who downplayed the risk of opioids.

"We have not yet held accountable the drug manufacturers for the product they have created and sold when it is quite likely that they knew that the product they were selling was in fact addictive," Sanders said at the markup.

Several Democrats, including Murray, joined the committee's Republican majority in rejecting that Sanders' proposal in a 15 to 8 vote. Murray said she supports the broad goal of Sanders' amendment of holding companies accountable for downplaying the addictive risk of opioids but was concerned about how it might affect legitimate prescribing. She said she intends to work with Sanders to refine the proposal.

Mental Health Parity

There was a more strictly partisan split in the vote rejecting Murphy's amendment, which sought to provide the Labor Department with more tools to enforce mental health parity rules. His amendment would give the Labor Department the authority to levy monetary penalties against health insurers and authority to independently launch investigations of health insurers for violations of mental health parity requirements.

"We all know from talking to our constituents that there is not parity today, that too many families are running into unconscionable obstacles when trying to get their insurance companies to pay for addiction treatment," Murphy said. "Too often insurance companies are paying much higher rates for physical health providers than for mental health providers or putting all sorts of red tape in front of the recovery of benefits for people with addiction."

Murphy noted that Labor Secretary Alexander Acosta has sought these "two new tools" for his department. Acosta spelled out the challenges in enforcing mental health parity law during an exchange with Murphy at an April 17 hearing of a Senate Appropriations subcommittee.

"If you've got an insurance company with 500 insurance plans, we would have to enforce as against each insurance plan," Acosta said, noting that this is "a highly inefficient enforcement mechanism."

"The second point I'd make is the reality that there's always limited resources," Acosta said at the April 17 hearing. "As a general matter, the presence of a civil penalty tends to focus attention more than the absence of a civil penalty."

At the HELP markup, Alexander introduced an April 23 letter from Katherine B. McGuire, an assistant Labor secretary. Alexander said the letter indicated that department doesn't want the additional authorities to be added to the Senate HELP package at this time.

That appeared to surprise Murphy, who said he had not seen the letter yet. He told the HELP panel about his recent exchange with Acosta at appropriations about the need for additional authority for the Labor Department.

"Since then he's changed his mind about having it now," Alexander said.

The panel voted 12 to 11 to reject Murphy's amendment.

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