With nearly 2.6 million Americans addicted to prescription opioid painkillers or heroin, the Trump administration declared a public health emergency on Thursday, unlocking roughly two cents per person in new funding for the effort.
Trump’s official declaration, initially promised on August 10, allows the executive branch to dip into the Public Health Emergency Fund. This fund holds only $57,000, as The Intercept reported in August. No other funding was immediately made available by the declaration.
Other methods of declaring an emergency could have opened up significantly more funding. A national emergency similar to what gets declared during a natural disaster would have uncorked funds from the Federal Emergency Management Agency, though that request would have had to compete with money for relief in Texas, Florida, and Puerto Rico. And a public health emergency under the Stafford Act would also unlock the Disaster Relief Fund.
But Trump’s order only encompasses the Public Health Services Act, and its $57,000 of available emergency cash. That will get you about 12 doses of the auto-injector Evzio, which delivers the overdose-reversing drug naloxone for around $4,500 per pop.
The administration argued in a fact sheet that the declaration allows the Department of Health and Human Services to shift money within its HIV/AIDS programs to get people eligible for those programs substance abuse treatment. (This, of course, reduces available funding for HIV treatment, unless the coffers are replenished). The Department of Labor could also issue “dislocated worker grants” to help anyone who lost their job due to opioids, but that’s “subject to available funding,” and the Trump administration has proposed a 40 percent cut in such dislocated worker grants.
Finally, the White House touted over $1 billion that has been allocated for drug addiction and the opioid crisis during Trump’s tenure, but that was largely already in the queue, mostly through the 21st Century Cures Act that passed at the end of 2016, before Trump became president.
In his speech, Trump did announce one costly initiative alongside the declaration – an ad campaign, similar to Nancy Reagan’s “Just Say No” public service announcements in the 1980s. Those did introduce America to how a brain on drugs is similar to a fried egg, but did next to nothing to combat drug use.
State and public health officials were said to be disappointed by the paucity of money. The President’s Commission on Combating Drug Addiction and the Opioid Crisis, in its interim recommendations in July, recognized this, saying that declaring a public health emergency would “force Congress to focus on funding.”
Indeed, just yesterday, Sen. Bob Casey, a Democrat from Pennsylvania, and 13 Democrats introduced the Combating the Opioid Epidemic Act, which would deliver $45 billion over 10 years to prevention, early detection, and treatment of opioid abuse. Senate Republicans put exactly this amount, $45 billion, into their Obamacare repeal bill as a sweetener for wayward members. Ultimately that bill never passed. Even the White House has said that they would push Congress to replenish the Public Health Emergency Fund to enable more grants to fight opioid abuse.
So Trump’s declaration guarantees that opioid funding will become another major agenda item for the end-of-the-year omnibus bill, said at various times to include: appropriations to avoid a government shutdown, a raise in the debt ceiling, authorization to fund the cost-sharing reduction payments for insurers in the Affordable Care Act, a deal on the Deferred Action for Childhood Arrivals program, reauthorization of the now-expired Children’s Health Insurance Program and enhanced funding for community health centers, a re-up for the National Flood Insurance Program which expires in December, and continued disaster relief funding for areas affected by hurricanes and wildfires.
In short, it turns that December decision into a giant cliff, imperiling virtually everything in the deal because of the number of moving parts. And because ultimately you can’t move the needle much on the opioid crisis without more funding, it raises the stakes significantly for what happens over the holidays, at a time when Congress is laser-focused on tax reform.
Other parts of the public health emergency declaration could make a small difference. The White House said they would use it to expand access to telemedicine, including remote prescribing of treatment medications. There’s also deregulation in the order, as it enables HHS to “overcome bureaucratic delays and inefficiencies” and hire more temporary specialists to deal with the crisis. That deregulation could loosen restrictions that currently block Medicaid from funding drug treatment in a facility with more than 16 beds.
In addition, Food and Drug Administration Commissioner Scott Gottlieb’s endorsement before Congress of medication-assisted treatment puts a powerful proponent on the side of a critical solution. Gottlieb’s persistence on the opioid crisis ultimately may prove more substantial than anything in the emergency declaration.
If Gottlieb’s push toward a medication-based approach to recovery is married with an expansion of telemedicine that expands access to buprenorphine, a dent could be made in the epidemic.
The declaration did not commit the federal government to negotiating down the price of naloxone, the anti-overdose treatment which has skyrocketed in cost and pressured local budgets. Several members of Congress have pressed for that in recent weeks.
The president’s opioid commission is expected to deliver a final report with recommendations and findings November 1, after a month’s delay. The president said today he “eagerly awaits” the report.
The public health emergency declaration will have to be renewed every 90 days to keep in effect.