Last week, as it was consumed with the drama of confirming Judge Brett Kavanaugh to the U.S. Supreme Court — a saga widely regarded as one of the most bitter and depressing to unfold in the capital in years — the U.S. Senate overwhelmingly passed legislation to counter the opioid public health crisis.
That backdrop underscored why the bill’s passage — by a margin of 98 to 1 — was so enthusiastically welcomed by lawmakers. Senate Majority Leader Mitch McConnell said that the legislation represents years of collaborative work from 70 senators across five Senate committees, the upshot of his sentiment clear: even at its darkest hour, the Senate can work together to get important things done.
That Congress’ bipartisan achievement was legislation to address opioids only makes that point more resonant: there’s probably no cause that commands more support from the public than the fight to stop an epidemic that has claimed the lives of hundreds of thousands of people and has ravaged communities in every part of the country. Opinion polls consistently show that the vast majority of Americans, regardless of political background, believe the government needs to do more to fight the opioid epidemic.
The recent legislation, which was promptly signed into law by President Donald Trump, aims to satisfy that demand and give public health officials more tools to deal with the crisis. The bill’s top-line provisions focus on making it harder for dangerous opioids to enter the U.S. via Mexico and Canada, establishing more avenues for people to seek help with addiction, and bolstering alternative treatments for pain relief.
Help on the way?
The legislation, titled the Opioid Crisis Response Act of 2018 in the Senate, is best understood as a collection of dozens of individual bills related to the epidemic.
The most significant provisions, experts say, are ones that reauthorize $500 million in annual funding to combat the crisis, create a grant program to support community addiction treatment centers, and aim to stop the trend of opioid overprescribing that fueled the crisis by making changes to Medicare and Medicaid and enacting tougher penalties on drug distributors that prescribe too many pills.
When the bill passed the chamber, DFL Sen. Amy Klobuchar joined most of her colleagues in sending out a release that outlined her contributions — in her case, three bills that were included as part of the package. One of them, the Synthetics Trafficking and Overdose Prevention (STOP) Act, is intended to make it harder for fentanyl — a powerful and deadly synthetic opioid — to enter the U.S. by requiring greater disclosure of information about packages sent to the U.S. through the postal system.
The Washington Post reported that this provision, which Klobuchar sponsored along with Sen. Rob Portman, an Ohio Republican, was getting perhaps the most attention of any part of the bill, given the recent scrutiny on fentanyl, which is estimated to be 50 times more potent than heroin and is accounting for a greater share of overdose deaths than ever before.
Two other Klobuchar bills made it into the final package — one to crack down on synthetic drugs and another to stop abuses among providers of recovery treatment — and each was co-authored with prominent Republican senators, Sen. Lindsey Graham of South Carolina and Sen. Marco Rubio of Florida.
“Signing this bill will help more families access the treatment and recovery services they need and put in place proven strategies to prevent addiction in the first place,” Klobuchar said in a statement on the legislation.
Minnesota’s junior senator, Sen. Tina Smith, has only been in Congress since January, but was able to tout a contribution of her own to the opioid bill. A “news flash” sent out by her campaign highlighted a provision included in the legislation, authored by Smith and Sen. Lisa Murkowski of Alaska, to improve resources for mental health in schools, particularly those in rural areas.
It wasn’t just senators who rushed to announce their contributions to the opioid bill: members of the U.S. House — which passed its version of the legislation in September — did so, too. The House bill included legislation from 3rd District GOP Rep. Erik Paulsen to better educate Medicare beneficiaries about non-opioid alternatives to pain relief.
“To Minnesota families and communities on the front lines of the opioid crisis: more help is on the way,” Paulsen said in a statement following the House’s 393-8 vote on the bill.
Bringing home the bacon
Public health officials agreed that Congress’ opioid bill means that some help is on the way for the estimated 2.1 million people with an opioid use disorder, according to the Centers for Disease Control, but probably not enough to really counter a historic crisis.
Dr. Leana Wen, the health commissioner of Baltimore, one of the major cities hardest-hit by the epidemic, told Vox that the bill “is simply tinkering around the edges.” She argued that increased federal funding would be needed to combat the problem — far more than the maximum $8 billion over five years authorized by the legislation.
Keith Humphreys, a professor of public health at Stanford University, suggested to Vox that the final legislative product indicates Republicans and Democrats remain far from an agreement on appropriating the tens of billions of dollars that most experts believe is necessary to end the crisis. “Lacking that, Congress did the next-best thing — which is to find agreement on as many second-tier issues as they could,” he said.
The bill’s backers are preferring to focus, naturally, on its strengths, something that could be a powerful tool heading into a critical midterm election in which the mood of voters is defined by negativity and divisiveness.
According to a recent CBS News poll, eight in 10 Americans believe the federal government should be doing more to address the opioid crisis, with Republicans, Democrats, and independents agreeing at roughly equal rates. A 2016 poll from the Kaiser Family Foundation found that 44 percent of Americans blamed the government for the spiraling problem. (Sixty percent blamed pharmaceutical companies.)
Liz Hamel, director of public opinion with the Kaiser Family Foundation, said that the opioid crisis is rare in today’s landscape of political issues. “As opposed to a lot of issues that are really divisive, this is one where, among the public, we see people across the political spectrum saying this is important and the government should be doing something to address it,” she told MinnPost.
The legislation, she says, is “something that both Republicans and Democrats can take home to their districts as a political win for having passed something and taken some action.”
That’s a significant element of the opioid bill, said Robert Blendon, a professor of public health and politics at Harvard University — at least for the run-up to the November 6 elections. He argued that, while the opioid crisis alone isn’t a defining issue of the election, the bill’s passage gives Republicans a useful boost.
“Republicans have a problem — that voters don’t believe they did anything big, at least that they feel good about,” Blendon told MinnPost. “This is a big issue, it’s a bipartisan issue, and from a Republican perspective, all they want to say is, we did something — see, we are leading in Congress.”
Blendon said that it gives Democrats an opportunity of their own to argue that they would take the additional steps, like boosting funding to address the problem, if they were in charge in D.C.
Progressive groups like the pro-Obamacare advocacy outfit Protect Our Care are arguing that Republicans aren’t serious about taking the measures needed to counter the opioid epidemic. Protect Our Care singled out Paulsen and 2nd District Rep. Jason Lewis on the issue, saying their votes in favor of the GOP’s American Health Care Act would have slashed Medicaid, the federal government’s health program for low-income individuals. The Kaiser Family Foundation estimates four out of 10 Americans with an opioid use disorder is covered by Medicaid. (Lewis has said he favors reforming Medicaid to preserve it for those who need its services most.)
Dimming further prospects for progress, in the eyes of some, is that makers of prescription painkillers also continue to exercise significant influence in D.C., through campaign contributions and lobbying. Purdue Pharma — the company that makes OxyContin, a drug whose destructive potential federal prosecutors allege Purdue has known for some time — has given money to the campaigns of several Democratic and Republican lawmakers, including Paulsen, who received a $1,000 check from Purdue this election cycle.
Still, the optics of Congress overwhelmingly taking at least some action is good for pretty much everyone involved, Blendon said, given the unanimity surrounding the opioid crisis.
“We’re in a moment in time where there are deep divisions on almost every issue,” he said. “We just don’t have other bipartisan issues where, regardless of who you are, you just agree the government has to do more about it… This is just an issue that people will be united on.”