[Congressional Record Volume 164, Number 97 (Tuesday, June 12, 2018)]
[House]
[Pages H5045-H5047]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SUBSTANCE USE DISORDER WORKFORCE LOAN REPAYMENT ACT OF 2018
Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5102) to amend the Public Health Service Act to authorize a
loan repayment program for substance use disorder treatment employees,
and for other purposes.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5102
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Substance Use Disorder
Workforce Loan Repayment Act of 2018''.
SEC. 2. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER
TREATMENT EMPLOYEES.
Title VII of the Public Health Service Act is amended--
(1) by redesignating part F as part G; and
(2) by inserting after part E (42 U.S.C. 294n et seq.) the
following:
``PART F--SUBSTANCE USE DISORDER TREATMENT EMPLOYEES
``SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER
TREATMENT EMPLOYEES.
``(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall carry out a program under which--
``(1) the Secretary enters into agreements with individuals
to make payments in accordance with subsection (b) on the
principal of and interest on any eligible loan; and
``(2) the individuals each agree to complete a period of
service in a substance use disorder treatment job, as
described in subsection (d).
``(b) Payments.--For each year of obligated service by an
individual pursuant to an agreement under subsection (a), the
Secretary shall make a payment to such individual as follows:
``(1) Service in a shortage area.--The Secretary shall
pay--
``(A) for each year of obligated service by an individual
pursuant to an agreement under subsection (a), \1/6\ of the
principal of and interest on each eligible loan of the
individual which is outstanding on the date the individual
began service pursuant to the agreement; and
``(B) for completion of the sixth and final year of such
service, the remainder of such principal and interest.
``(2) Maximum amount.--The total amount of payments under
this section to any individual shall not exceed $250,000.
``(c) Eligible Loans.--The loans eligible for repayment
under this section are each of the following:
``(1) Any loan for education or training for a substance
use disorder treatment job.
``(2) Any loan under part E of title VIII (relating to
nursing student loans).
``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS
Loan, or Federal Direct Unsubsidized Stafford Loan, or
Federal Direct Consolidation Loan (as such terms are used in
section 455 of the Higher Education Act of 1965).
``(4) Any Federal Perkins Loan under part E of title I of
the Higher Education Act of 1965.
``(5) Any other Federal loan as determined appropriate by
the Secretary.
``(d) Period of Service.--The period of service required by
an agreement under subsection (a) shall consist of up to 6
years of full-time employment, with no more than one year
passing between any two years of covered employment, in a
substance use disorder treatment job in the United States
in--
``(1) a Mental Health Professional Shortage Area, as
designated under section 332; or
``(2) a county (or a municipality, if not contained within
any county) where the mean drug overdose death rate per
100,000 people over the past 3 years for which official data
is available from the State, is higher than the most recent
available national average overdose death rate per 100,000
people, as reported by the Centers for Disease Control and
Prevention.
``(e) Ineligibility for Double Benefits.--No borrower may,
for the same service, receive a reduction of loan obligations
or a loan repayment under both--
``(1) this subsection; and
``(2) any Federally supported loan forgiveness program,
including under section 338B, 338I, or 846 of this Act, or
section 428J, 428 L, 455(m), or 460 of the Higher Education
Act of 1965.
``(f) Breach.--
``(1) Liquidated damages formula.--The Secretary may
establish a liquidated damages formula to be used in the
event of a breach of an agreement entered into under
subsection (a).
``(2) Limitation.--The failure by an individual to complete
the full period of service obligated pursuant to such an
agreement, taken alone, shall not constitute a breach of the
agreement, so long as the individual completed in good faith
the years of service for which payments were made to the
individual under this section.
``(g) Additional Criteria.--The Secretary--
``(1) may establish such criteria and rules to carry out
this section as the Secretary determines are needed and in
addition to the criteria and rules specified in this section;
and
``(2) shall give notice to the committees specified in
subsection (h) of any criteria and rules so established.
``(h) Report to Congress.--Not later than 5 years after the
date of enactment of the Substance Use Disorder Workforce
Loan Repayment Act of 2018, and every other year thereafter,
the Secretary shall prepare and submit to the Committee on
Energy and Commerce of the House of Representatives and the
Committee on Health, Education, Labor, and Pensions of the
Senate a report on--
``(1) the number and location of borrowers who have
qualified for loan repayments under this section; and
``(2) the impact of this section on the availability of
substance use disorder treatment employees nationally and in
shortage areas and counties described in subsection (d).
``(i) Definition.--In this section:
``(1) The term `municipality' means a city, town, or other
public body created by or pursuant to State law, or an Indian
Tribe.
``(2) The term `substance use disorder treatment job' means
a full-time job (including a fellowship)--
``(A) where the primary intent and function of the job is
the direct treatment or recovery support of patients with or
in recovery from a substance use disorder, such as a
physician, physician assistant, registered nurse, nurse
practitioner, advanced practice registered nurse, social
worker, recovery coach, mental health counselor, addictions
counselor, psychologist or other behavioral health
professional, or any other relevant professional as determine
by the Secretary; and
``(B) which is located at a substance use disorder
treatment program, private physician practice, hospital or
health system-affiliated inpatient treatment center or
outpatient clinic (including an academic medical center-
affiliated treatment program), correctional facility or
program, youth detention center or program, inpatient
psychiatric facility, crisis stabilization unit,
[[Page H5046]]
community health center, community mental health or other
specialty community behavioral health center, recovery
center, school, community-based organization, telehealth
platform, migrant health center, health program or facility
operated by a tribe or tribal organization, Federal medical
facility, or any other facility as determined appropriate for
purposes of this section by the Secretary.
``(j) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$25,000,000 for each of fiscal years 2019 through 2028.''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Oregon (Mr. Walden) and the gentleman from New Jersey (Mr. Pallone)
each will control 20 minutes.
The Chair recognizes the gentleman from Oregon.
General Leave
Mr. WALDEN. I ask unanimous consent that all Members may have 5
legislative days in which to revise and extend their remarks and insert
extraneous materials into the Record on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Oregon?
There was no objection.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today to express my strong support for H.R. 5102.
This is the Substance Use Disorder Workforce Loan Repayment Act. It is
legislation that would create a loan repayment program for substance
use disorder treatment providers.
Serious workforce shortages exist for all health professions across
the United States. We know that. But a delay in addiction treatment for
a patient with substance use disorder can be a life-or-death situation.
By offering student loan repayment for those who agree to work as a
substance use disorder treatment professional in an underserved area,
this bill encourages more people to enter the substance use disorder
treatment field and get critical services to areas that are seriously
in dire need of treatment.
I would like to thank my colleagues, Representatives Katherine Clark,
Hal Rogers, John Sarbanes, and Brett Guthrie, for leading this
important initiative. It is brought to you from your Energy and
Commerce Committee with a unanimous vote.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in support of H.R. 5102, the Substance Use
Disorder Workforce Loan Repayment Act. This bill would create a loan
repayment program to provide loan repayment assistance to substance use
disorder providers in exchange for providing substance use disorder
treatment and recovery support services in areas with high need for
such services.
Mr. Speaker, I urge my colleagues to support this legislation.
I thank the main sponsor, Representative Clark, for her leadership
and Representative Sarbanes.
Mr. Speaker, I reserve the balance of my time.
Mr. WALDEN. Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield such time as she may consume to the
gentlewoman from Massachusetts (Ms. Clark).
Ms. CLARK of Massachusetts. Mr. Speaker, I thank the gentleman for
yielding.
Mr. Speaker, I rise today in support of H.R. 5102, the Substance Use
Disorder Workforce Loan Repayment Act.
As families at home know too well, our country is in the midst of a
devastating public health crisis. The opioid epidemic claims more than
115 lives every day, and in 2016 alone, more than 42,000 people lost
their lives to opioid-related drug overdoses, and more than 64,000 died
from drug overdoses overall. Every one of those lives lost left
heartbroken families, friends, and communities.
Part of addressing this epidemic is making sure that everyone who is
looking for help can access effective treatment and ongoing management
of this chronic condition. To date, however, we have failed in this
endeavor. The Surgeon General's 2016 report on addiction estimates that
only 10 percent of Americans living with substance use disorder receive
any treatment.
There are a range of barriers to accessing treatment, but one of the
most significant is a shortage in the workforce needed to provide it.
Between the rising cost of education, low salaries, and a high burnout
rate from the stressful and emotional work, it is a struggle to attract
new people to the treatment field and keep those who work in it long
term.
In my district, I have heard time and again from families and
providers that there simply aren't enough treatment specialists
available to help the growing number of people who desperately need
treatment. I have heard from families who have tried to get their loved
ones into treatment and lost them to an overdose before they were able
to get them the help they needed.
No one should have to live with that heartbreak. That is why I
authored this legislation with my esteemed colleague from Kentucky,
Chairman Hal Rogers. This bill will help recruit and retain more
treatment experts by offering up to $250,000 in student loan repayment
for participants who agree to work in the treatment field for up to 6
years.
The program will cover professionals who represent the whole spectrum
of treatment, from physicians to nurses, to social workers, to recovery
coaches, promoting the kind of wraparound treatment approach that we
know gives patients the best chance for success.
By providing a portion of loan repayment for each year of service,
the program encourages treatment professionals to stay in the field
longer.
Further, this legislation is designed to send help where it is needed
the most. Participants in the program must work in a county or
municipality with either a shortage of mental health professionals or
an above-average rate of overdose deaths. Whether you live in an urban
or rural area, from Massachusetts to Kentucky, more need will mean more
available treatment.
Mr. Speaker, I thank Chairman Rogers for his partnership on this
important legislation and the other original cosponsors, as well as the
Energy and Commerce Committee and their staff for their work throughout
this process.
We need to make significant long-term investments in the
professionals who make recovery possible. People's lives depend on it.
Mr. Speaker, I urge my colleagues to vote in favor of this legislation.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Before I recognize my colleague from Kentucky, I just want to say,
Mr. Rogers has spent many, many years leading nationally not only here
in the Congress, but nationally and in Kentucky on this issue of
addiction and the scourge of opioids as they have flooded into our
area. His leadership has been very, very valuable in this endeavor.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Kentucky (Mr. Rogers).
Mr. ROGERS of Kentucky. Mr. Speaker, I thank Chairman Walden for
those words.
This is a fight that is critical to the country, and I want to thank
the chairman of the committee, Mr. Walden, and Mr. Pallone and the
other members of the Energy and Commerce Committee for reporting out
for consideration today this multipronged assault on this cruel
epidemic that is ravaging the country. The committee has responded, and
I thank Chairman Walden for all of these bills that are here with us
today, especially the bill that we are debating now, and that is the
Substance Use Disorder Workforce Loan Repayment Act.
We have invested billions of dollars in treatment and recovery
services. As the gentlewoman from Massachusetts has just said, only 10
percent of Americans with a disorder actually receive treatment; 90
percent go without treatment.
That situation is even more dire in small communities. Far too often,
when our rural constituents recognize their addiction, they are not
able to find treatment or recovery services anywhere close to home or
at all.
Those who do enter the treatment profession often don't stay long due
to the stress of the job. They don't work in areas most in need of
their services, or they have difficulty repaying these sizeable student
loans. If we want to maximize our downpayment for the future, these
professionals are the key.
H.R. 5102 creates a substantial student loan repayment benefit for a
[[Page H5047]]
broad spectrum of medical professionals who enter this noble vocation.
It also ensures that these individuals serve in areas most in need of
their services for the long haul, offering periodic payments over 6
years.
With these incentives in place, more of our constituents suffering
from addiction will receive the quality treatment they so desperately
need.
Mr. Speaker, I thank Ms. Clark for her genuine concern about the
problem and her partnership, and also Dr. Burgess and his team for
their guidance on this bill.
Mr. Speaker, I again thank Chairman Walden for bringing this bill
forward and all of the others that have been reported out today, and I
thank Mr. Pallone and the rest of the committee for the great work that
they are doing in a bipartisan fashion.
Mr. PALLONE. Mr. Speaker, I yield such time as he may consume to the
gentleman from Maryland (Mr. Sarbanes).
Mr. SARBANES. Mr. Speaker, I thank Congressman Pallone for yielding.
I rise in support of H.R. 5102, the Substance Use Disorder Workforce
Loan Repayment Act of 2018.
Mr. Speaker, I thank the authors of the bill, my colleagues Katherine
Clark and Hal Rogers, for putting this together. It is a very carefully
crafted bill to address the problem which it discovered, really, which
is there is this serious shortage of substance use disorder
professionals across the country.
We are experiencing shortages in a lot of areas of the healthcare
workforce, that is true, but if we are going to address the opioid
crisis that we face, this epidemic across the country, we have to bring
particular attention to the workforce shortages with respect to
substance use disorder professionals.
According to SAMHSA, which is the agency which deals with these
issues, in 2012, the turnover rates in the addiction services workforce
ranged from 18.5 to over 50 percent. So there is a huge turnover there
that has to be addressed.
In a recent survey, nearly half of clinical directors in agencies
that specialize in substance use disorder treatment acknowledged that
they have real difficulty filling these open positions.
In my district, I have heard from many of the community health
centers--Baltimore Medical System, Health Care for the Homeless, and
others--that said they can't hire enough of these folks and they can't
keep enough of these folks to address the opioid crisis.
We need this workforce to address the millions of people who require
this important treatment, and this bill does that. It is a very, very
important step forward. It will create this loan repayment program for
professionals who are in this area of substance use disorder treatment.
They can receive up to $250,000 if they agree to work as a treatment
professional in this area and in a geographical area of high need.
Again, carefully crafted, this treatment can take place in a number
of different facilities, community health centers, hospitals, recovery
programs, correctional facilities, et cetera.
So the idea was to figure out where those shortages are and direct
the bill's support to those areas: a broad range of direct care
providers, physicians, registered nurses, social workers, and other
behavioral health providers.
This is going to help address the problem of recruitment, attracting
new people to the field, as well as help with retention of those
people. It is a very, very important bill.
Mr. Speaker, I was proud to join my colleagues, Katherine Clark, Hal
Rogers on our committee, Brett Guthrie, and others, in supporting this.
I hope all of my colleagues here today will support this important
bill.
{time} 1600
Mr. PALLONE. Mr. Speaker, I have no additional speakers, so I urge
support for the bill, and I yield back the balance of my time.
Mr. WALDEN. Mr. Speaker, I would do the same, urge passage of the
bill, and I yield back the balance of my time.
Ms. JACKSON LEE. Mr. Speaker, I rise in strong support of H.R. 5102,
the ``Substance Use Disorder Workforce Loan Repayment Act of 2018.''
H.R. 5102 would establish a loan repayment program for mental health
professionals practicing in areas with few mental health providers or
with high death rates from overdose.
Mr. Speaker, this bill will amend the Public Health Service Act to
create a loan repayment program for individuals who complete a period
of service in a substance use disorder treatment job in a mental health
professional shortage area and counties where the drug overdose death
rate is higher than the national average.
This bill authorizes $25 million per year over fiscal years 2019-
2028.
H.R. 5102 will strengthen America's substance abuse treatment
workforce and provide for greater access to care for patients who need
it the most.
Mr. Speaker, the current trends of substance abuse in the U.S. are
startling.
A Columbia University study found that over 40 million Americans age
12 and over meet the clinical criteria for drug addiction and abuse.
As substance abuse rates and death from overdose rates increase,
studies project a shortage of 85,000 physicians in 2020--the impact of
which will be the most devastating in rural communities.
In my home state of Texas, 10.1 people die per 100,000 in the
population from drug overdoses.
In 2016, in Houston there were 364 drug overdose related deaths
reported.
H.R. 5102 addresses these critical issues by providing an additional
path for health care providers to practice in rural and underserved
communities, ultimately giving greater access to care for those
suffering from substance use disorder.
This piece of legislation will strengthen rural health care systems
and will improve access to care for patients in these rural
communities.
Mr. Speaker, the ``Substance Use Disorder Workforce Loan Repayment
Act of 2018'' will help build a well-equipped workforce to combat the
current rise in substance use disorders.
The SPEAKER pro tempore (Mr. Walberg). The question is on the motion
offered by the gentleman from Oregon (Mr. Walden) that the House
suspend the rules and pass the bill, H.R. 5102.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
____________________