Energy and Commerce Ranking Member Frank Pallone, Jr. (D-NJ) delivered the following remarks on the House floor today during consideration of H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act:
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 is far from perfect. H.R. 6 does not adequately deal with the magnitude of the crisis that this country is facing, and there are provisions that I did not support at the subcommittee or full committee markups, including provisions that most Democrats voted against.
Nonetheless, I am pleased that Democrats were able to secure positive provisions in the final package we are considering today. Most notable, H.R. 6 includes provisions from a bill introduced by Reps. Tonko and Luján 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 opioid use disorder for five 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, and I commend Reps. Tonko and Luján for their ongoing leadership in this area.
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 opioid use disorders.
This bill also improves coverage for vulnerable populations in Medicaid. It 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 in Medicaid of all forms of Medication-Assisted Treatment for five years. The legislation also mandates comprehensive substance use disorder benefits in the Children’s Health Insurance Program, better known as CHIP.
I’m also pleased that H.R. 3528, the Every Prescription Conveyed Securely Act, authored by Rep. Clark of Massachusetts is included in this bill. E-prescribing is an important tool that will reduce opioid diversion and prescription fraud. Further, the bill gives the Secretary of HHS the authority to expand the use of telehealth services in Medicare for substance use disorder treatment, to help reach more people across the country.
These were all important Democratic provisions and priorities that we worked hard to have included in this final package. I think these will all make a real difference in our fight against the opioid epidemic.
Having said that, I still have concerns with some of the provisions included in this final, negotiated bill, and the process by which we arrived here. For instance, there are two Medicare bills that I opposed through the Committee process and that I do not think will have a meaningful impact on the opioid crisis
H.R. 5804 would increase reimbursement for certain interventional pain injections in the Ambulatory Surgery setting under Medicare. I have seen no evidence that increasing reimbursement for these injections would have a meaningful impact on opioid prescribing. While it is important that Congress find ways to promote non-opioid therapies that will reduce opioid prescribing, this legislation endorses and incentivizes interventions that are over utilized and may not be safe and effective for a majority of patients receiving them.
I also have concerns about H.R. 5809, which would extend a temporary pass-through payment for non-opioid analgesics for post-surgical pain management from three to five years in Medicare. I do question if this bill will have a meaningful impact on the opioid crisis, and it will set a troubling precedent that will likely increase federal spending on drugs.
I am also disappointed that partisan legislation that would direct FDA to issue guidance on how the agency will apply the criteria for Accelerated Approval and Breakthrough Therapy Designation to non-addictive pain and addiction treatments was included in this package. This legislation would set the precedent of having FDA opine on how expedited programs may apply differently for therapeutic areas. It requires the agency to host a public meeting to discuss this and other topics, but provides no resources for the agency to complete these tasks. This is not legislation that FDA asked for or highlighted as a priority in fighting the opioid crisis, and while they may now be comfortable with the changes that have been made to this legislation, I am not comfortable with this policy
Finally, I think it is essential that we keep this opioid package in context of the larger health care debate in Congress. As I have stated before, my Republican colleagues are interested in taking credit today for some policies that help those affected by the crisis, while at the same time actively threatening and sabotaging the very health care coverage that many of these same people rely on in the first place.
The ongoing efforts by House Republicans and the Trump Administration to repeal or sabotage the Affordable Care Act have only harmed those affected by this crisis. Earlier this month, Republicans directly threatened the health care of people with opioid use disorder when the Trump Administration asked a federal court to strike down key patient protections in the Affordable Care Act. If successful, the Administration’s action would eliminate protections that ensure more than 130 million Americans with pre-existing conditions cannot be denied coverage. And guess what is considered a pre-existing condition ---- opioid use disorder.
Republicans also continue with their attempts to gut the Medicaid program - which is our most important weapon in the fight against this opioid epidemic. Both the consumer protections of the ACA and Medicaid have saved countless lives that would have otherwise been destroyed by the opioids crisis.
So, it is nice that we are passing this bipartisan package today, but we should not forget the tremendous harm Republican policies would inflict elsewhere on the same people we seek to help with this opioids package.
I reserve the balance of my time.
