Proposed bill for HEROES Act would give $1.5 billion to SAPT block grant

With the House of Representatives planning to vote last Friday on the fourth COVID‐19 stimulus package, substance use treatment stands a chance of being included — if the Senate, which at press time was still opposing the measure, as was the White House, goes ahead to approve it as well. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, for about $2 trillion, would finally give some money to states, counties and health care. So far, more than $2 trillion has been spent on stimulus funding, with the field trying hard to be included in each bill (see “NASADAD requests $250 million for Phase 4 stimulus,” ADAW April 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32688 ).     

Gavel-to-Gavel Congressional Television Coverage as Political Advertising: The Impact of C-Span on Legislative Sessions

This article examines the effect of television on the length of legislative sessions at the federal level in the United States. Data from the U.S. Congress during the period 1972–96 are employed, during part of which time each house of Congress received significant television coverage by C-SPAN and C-SPAN2. Evidence from a Parks regression suggests that the presence of C-SPAN has increased House sessions by 88–250 hours and the presence of C-SPAN2 has increased Senate sessions by a striking 252–431 hours, other things constant. Additional estimates suggest that House sessions are about two minutes longer per bill introduced under the eye of C-SPAN, and Senate sessions are about four minutes longer per bill introduced in the presence of C-SPAN2. Longer sessions, which represent low-cost forms of advertising for incumbents, are not without costs to taxpayers. We estimate that these costs lie somewhere between $16 million and $392 million in real terms per session of Congress.     

NASADAD pushes block‐grant increase for stimulus 4 bill

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) last week wrote to Sen. Patty Murray (D‐ Washington) and Sen. Roy Blunt (R‐Missouri), the Senate co‐chairs of the Labor, Health and Human Services (HHS), Education, and Related Agencies Appropriations Subcommittee, asking specifically for the $1.5 billion in supplemental funding as provided by the House in the HEROES Act for the Substance Abuse Prevention and Treatment (SAPT) block grant (see “Proposed bill for HEROES Act would give $1.5 billion to SAPT block grant,” ADAW, May 18, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32722 ).     

Senators call for $2 billion in supplemental SAMHSA funding

As the fourth stimulus bill, the HEROES Act, awaits action by the Senate, 19 senators sent a letter last week to Senate and House leadership calling for increased investments in substance use disorder programs during the COVID‐19 pandemic. The letter, from Senators Tammy Baldwin (D‐Wisconsin) and Jeanne Shaheen (D‐New Hampshire), along with 17 other senators (all Democrats), calls for “$2 billion in funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) to administer supplemental grant allocations under the Substance Abuse Prevention and Treatment (SAPT) Block Grant program and the State Opioid Response (SOR) grant program.”     

‘Hogwash’: Addiction Policy Foundation on opioid bill reports

Last week, as the Senate headed toward a vote on the opioid package, the Addiction Policy Forum was weathering an attack in the form of almost identical stories in Congressional Quarterly and Politico that said Democrats were opposed to a provision in the bill that favors the advocacy organization. According to both reports, which came out Sept. 5, Democrats objected to the language that would give $10 million a year for five years to an advocacy organization, language that would apply only to the Addiction Policy Forum. The unnamed Democrat staffers, according to the stories, pinned their criticism on the fact that the Addiction Policy Forum receives pharmaceutical funding, something the organization itself announced last December (see ADAW, Jan. 8) but created a minor ruckus after protesters from Minnesota accused the group of a conflict of interest in a story published in The New York Times (see ADAW, Feb. 19, 2018).     

Sign‐on letter for SAPT increase due March 20

Representatives Paul Tonko (D‐New York) and Brian Fitzpatrick (R‐Pennsylvania) need signatures for their letter to the House Appropriations Committee urging a $500 million increase for the Substance Abuse Prevention and Treatment (SAPT) block grant in fiscal year 2020. “This funding stream serves as the cornerstone of States' substance abuse treatment, prevention, and recovery systems,” states the letter. “SAPT Block Grant funds, which are distributed by formula to all States and Territories, provide lifesaving treatment services to approximately 1.5 million individuals per year. In some States, the SAPT investment accounts for 100 percent of substance use prevention dollars. Unfortunately, SAPT Block Grant funding has not kept up with inflation, resulting in a 24 percent—or $444 million—decrease in actual funding since 2009.” The block grant has been just over $2 billion for decades. The letter requests that legislators fund just over $2.358 million for the SAPT block grant, which is equal to what the House of Representatives approved in the FY2019 Labor‐Health and Human Services Appropriations legislation and a $500 million increase over current funding levels. To sign on to the letter, contact Jeff Morgan in Rep. Tonko's office at jeff.morgan@mail.house.gov or Joseph Knowles in Rep. Fitzpatrick's office at joseph.knowles@mail.house.gov .     

Stimulus package includes 42 CFR Part 2 provisions

The language in the stimulus package, as of March 26, revises 42 CFR Part 2 (confidentiality of substance use disorder patient records requiring patient consent before release), eliminating the consent provisions – allowing patients to give consent only once: “it shall be permissible for a patient's prior written consent to be given once for all such future uses or disclosures for purposes of treatment, payment, and health care operations, until such time as the patient revokes such consent in writing.”While not full alignment with the Health Insurance Portability and Accountability Act (HIPAA), it is bad news for confidentiality. Many programs probably require consent before admitting patients to treatment. The vague “health care operations” is included as a party that can get information redisclosed. If the House and the President signs off, the new law goes into effect immediately. H. Westley Clark, M.D., J.D., Dean's Executive Professor at Santa Clara University and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration said the pending NPRM on 42 CFR Part 2 from SAMHSA should be suspended, that 42 CFR Part 2 should be formally moved from SAMHSA to the Office of Civil Rights (OCR) of the Department of Health and Human Services since OCR has the function to collect data, monitor breaches, and impose penalties.” In addition, stakeholders should “ask what the new 42 CFR part 2 look like with the proposed changes which include the consent provisions, the breach notification provisions, the penalty provisions and all the other bells and whistles.” The bill was passed unanimously by the Senate March 25, and was scheduled to go to the House of Representatives for a vote March 27, after which President Trump was expected to sign it.     

Parity getting worse,not better: Milliman report

Medical and behavioral (addiction and mental health) care are further apart now than they were two years ago, according to a study published by Milliman Inc. last week. The report, commissioned by the Bowman Family Foundation, shows that the gap for employees and their families between mental/addiction care and medical/surgical care is widening. The report, Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement, is based on actual claim data in 50 states for 37 million employees and their dependents.     

HEALS Act gives SAPT block grant another $1.5 billion

The next COVID‐19 stimulus package has been partially released by the Senate, led by Republicans and prepared in conjunction with the White House. Called the Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act, it specifically targets health care, jobs and supports for children.     

White House budget request decimates substance use prevention

The White House budget request for fiscal year 2021 for the Substance Abuse and Mental Health Services Administration (SAMHSA) proposes to zero out a major prevention program — the Strategic Prevention Framework State Incentive Grant — Partnerships for Success program. This is a cut of $109 million. It recommends using the prevention set‐aside (20%) from the Substance Abuse Prevention and Treatment (SAPT) block grant instead. But it doesn't give any more money to the block grant.     

The economic toll of intimate partner violence against women in the United States

This study provides estimates of the economic cost of intimate partner violence perpetrated against women in the US, including expenditures for medical care and mental health services, and lost productivity from injury and premature death. The analysis uses national survey data, including the National Violence Against Women Survey and the Medical Expenditure Panel Survey, to estimate costs for 1995. Intimate partner violence against women cost $5.8 billion dollars (95% confidence interval: $3.9 to $7.7 billion) in 1995, including $320 million ($136 to $503 million) for rapes, $4.2 billion ($2.4 to $6.1 billion) for physical assault, $342 million ($235 to $449 million) for stalking, and $893 million ($840 to $946 million) for murders. Updated to 2003 dollars, costs would total over $8.3 billion. Intimate partner violence is costly in the US. The potential savings from efforts to reduce this violence are substantial. More comprehensive data are needed to refine cost estimates and monitor costs over time.     

SAMHSA to write new application for new SOR with stimulants included

The addition of stimulants as an allowable use for State Opioid Response (SOR) grants will require a new application, which the Substance Abuse and Mental Health Services Administration (SAMHSA) is working on, ADAW has learned. The change was in the FY 2020 appropriations bill passed last month by Congress (see ADAW, Dec. 23, 2019; “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ), along with funding for other SAMHSA programs, including the Substance Abuse Prevention and Treatment block grant (SAPT BG). After the bill passed before Christmas, Washington went away for the holidays.     

Questions and answers on health insurance benefit issues

This Issue Brief addresses eight topics in the areas of health insurance and health care costs. Using a question and answer format, the discussion draws largely on EBRI research and the EBRI Databook on Employee Benefits, third edition. In 1993, U.S. expenditures on health care were $884.2 billion, and they are projected to reach $2,173.7 billion by 2005, increasing at a projected average annual rate of 7.8 percent. Health care spending accounted for 13.9 percent of Gross Domestic Product (GDP) in 1993 and is projected to reach 17.9 percent of GDP by 2005. Among the factors contributing to the increase in health care costs are the growth in the number of individuals with traditional reimbursement health insurance coverage, the rapid expansion of technology and treatment options, and demographic factors such as the aging of the population. In 1993, employers, both public and private, spent $235.6 billion on group health insurance, accounting for 6.2 percent of total compensation. Group health insurance is the fastest growing component of total compensation, increasing at an average annual rate of 13.7 percent from 1960 to 1993. An increasing number of employees are required to make a cash contribution to their health insurance plan premium. In 1993, 61 percent of full-time employees in medium and large private establishments who participated in an employee only health insurance plan were required to make a contribution to the premium, up from 27 percent in 1979. In 1993, 185.3 million persons under age 65 had health insurance coverage, while 40.9 million people--or about 18.1 percent of the nonelderly population--received neither private health insurance nor publicly financed health coverage. Of those individuals who had health insurance coverage, 60.8 percent, or 137.4 million persons, received their health insurance through an employment-based plan. In 1993, 15.2 percent of the nonelderly population without health insurance coverage were noncitizens. In six states noncitizens represented a higher proportion of the total uninsured population than individuals in the nation as a whole. An increasing number of employers are self-funding their health insurance plans. In 1994, 74 percent of employers with 500 or more employees self-funded their health insurance plans, up from 63 percent in 1993. An estimated 22 million full-time employees in private industry and state and local governments participated in a self-funded employment-based health insurance plan.(ABSTRACT TRUNCATED AT 400 WORDS)     

DEMOCRATIC POLITICS AND THE LONG MARCH ON GLOBAL WARMING: Comments on McCright and Dunlap

The political impasse over global warming legislation stems from obstacles in the mass media arena, public awareness, electoral politics as well as governmental policy. Advocates of global warming policy have to be simultaneously successful in all four major public arenas to prevail. This article provides an overview of the obstacles in each public arena in the United States highlighting the broader context in which McCright and Dunlap's analysis of polarized public opinion operates. Global warming advocates have had their greatest success in the media arena but are checked by the rise of a conservative counter‐campaign as well as media reporting norms, which have contributed to polarized public opinion and limited salience of the issue. Global warming never ranks in the top issue list to which electoral candidates attend, giving it little priority in national electoral contests. Although the House of Representatives passed the Waxman‐Markey Bill in 2009, the bill died in the Senate and will not resurface until the Democratic margin is again large enough to overcome opposition vetoes. At the same time, major legislation has often incubated on the margins of these public arenas for significant time until a political crisis removes the normal obstacles to such major “watershed” legislation. For global warming, the long march through American public arenas appears to have begun.     

President's proposed budget would slash treatment and prevention funding

We had a feeling of déjà vu when the White House sent its proposed budget to Congress last week. Similar to past years, the Office of National Drug Control Policy (ONDCP) would be decimated, moving the $100 million Drug‐Free Communities program to the Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health Services Administration (SAMHSA). There's no additional money in the Substance Abuse Prevention and Treatment (SAPT) block grant and cuts to the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, CSAP and SAMHSA's Center for Substance Abuse Treatment.     

The "albatross" of immigration reform: temporary worker policy in the United States

The author examines the history of U.S. labor and immigration policies, paying particular attention to the evolution of the temporary worker policy. Complications in the immigration reform process caused by efforts to admit more temporary workers are discussed. The position of the Reagan administration, Senate and House consideration of immigration and temporary worker bills, and the political controversies surrounding this issue are reviewed. The author points out that it was not until the major temporary worker proposals were finally removed from the Simpson-Rodino Act that passage of legislation was achieved, and he anticipates that efforts will eventually be made to revive temporary worker policy and thereby rekindle the debate     

Senate passes opioid bills; Confidentiality,Medicare for OTPs,and IMDs conflict with House version

In June, the House of Representatives passed H.R. 6, its comprehensive opioid package, as well as H.R. 6082 (see ADAW, July 2). The Senate finally passed its version of H.R. 6 on Sept. 17. Two glaring differences need to be worked out in conference between the two chambers.     

The Crisis in Retiree Health Benefits

Over 7 million retirees currently are covered by employer-sponsored health benefits plans in which the employer contributes all or a portion of the premium cost. Almost one-third of these retirees are under age 65 and therefore lack Medicare coverage. The annual cost to employers for this coverage is now $9 billion and is expected to be $22 billion in 20 years. However, inflation in health care costs, recent court decisions, the aging of America, and a major proposed accounting rule change by the Financial Accounting Standards Board have combined to produce a "crisis in retiree health benefits" in the business sector. As a result, employers are rapidly redesigning retiree benefit plans to shift future health care cost increases to their retirees. Until now, the aging network has been largely oblivious to this transformation in financing. Yet, this "crisis" begs for public/private sector dialogue and partnership, and the White House Conference on Aging could be a major forum for this dialogue.     

The Heterogeneous Effect of the Passage of the Occupational Safety and Health Act on Stock Returns

I analyze how stock prices reacted to the passage of the Occupational Safety and Health Act (OSHA) of 1970. Previous studies focus on accounting measures or actual OSHA violations, and my work complements the literature by examining how shareholders expected OSHA to affect firm profitability. Returns fell around the OSH bill’s release to the House floor and its eventual passage, and average market value dropped by $1.5 million over the 3 days surrounding House Rules Committee release. Durable manufacturing and mining industries were hardest hit in OSH passage, losing $2.6 million and $5.7 million in average market value, respectively. I also find that larger firms with poorer working conditions sustained more negative returns, and market power, not union density, explains variation in expected profitability. Furthermore, future penalties appear unrelated to shareholder expectations about compliance costs.

Text of opioid bill released by House Ways and Means Committee: 42 CFR Part 2 is spared

Last week, the long‐awaited opioid package was released by the House of Representatives Ways and Means Committee. Notably, 42 CFR Part 2, which the House version had slated for elimination but the Senate had not addressed, is spared. The confidentiality regulation, which requires substance use treatment providers to obtain consent from patients before releasing their information, would have been replaced with the Health Insurance Portability and Accountability Act (HIPAA), which would have included their information in their record.