[Congressional Record (Bound Edition), Volume 163 (2017), Part 6]
[Senate]
[Pages 8497-8498]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            OPIOID EPIDEMIC

  Mr. FRANKEN. Mr. President, I rise today to talk about the House 
Republican healthcare bill and the devastating effect that it would 
have on people with mental illness and those affected by the Nation's 
opioid epidemic.
  Nationwide, more than 52,000 Americans died from drug overdoses in 
2015, the most recent year for which data are available, with 63 
percent of those deaths involving an opioid. This means that drug 
overdose deaths now surpass the number of people who die each year from 
automobile accidents or from firearms.
  That same year in Minnesota, we lost more than 570 people to drug 
overdoses. About half of those deaths were tied to prescription 
medication--particularly, opiate pain relievers--and another 20 percent 
of those deaths were associated with heroin. We saw drug overdose 
deaths jump 11 percentage points in Minnesota from 2014 to 2015.
  The opioid epidemic knows no boundaries. It has touched people and 
families of all incomes, of all races, and of all ages. Some 
communities in Minnesota have been hit particularly hard by this 
crisis, including our Native American population. Not long ago, I 
visited the Bois Forte Indian Reservation. Bois Forte is a small, 
beautiful reservation up in northern Minnesota, a community where 
people know each other and trust each other. In fact, historically, the 
trust has run so deep that folks in Bois Forte didn't even lock their 
doors at night. But the opioid epidemic--I was told this by the Tribe 
chairman--and the impact it has had on the people in the reservation 
has changed that. Opioids are changing and destroying families and 
communities, and one clear sign of this is that people now are locking 
their doors, the chairman told me.
  Right now, we need to be doing all we can to help people, families, 
and communities that have been devastated by opioid addiction. We must 
provide support for treatments and other necessary interventions, and 
we need to be focusing on prevention. That is why we passed the 
Comprehensive Addiction and Recovery Act just last year, and why we 
followed it up with the behavioral health provisions in the 21st 
Century Cures Act--again, just at the end of last Congress.
  Now these important advances are under threat. The so-called 
healthcare bill that Republicans pushed out of the House of 
Representatives would undermine the very programs that help people with 
opioid addiction. For instance, as the CBO confirmed yesterday, the 
bill guts Medicaid, cutting the program's budget by more than $830 
billion over 10 years. These losses are compounded by the additional 
$610 billion in cuts to Medicaid proposed in President Trump's budget 
yesterday. In total, these cuts would amount to close to a 50-percent 
reduction in the funding for the Medicaid Program, causing at least 14 
million people to lose Medicaid coverage over the next decade. Medicaid 
is the No. 1 payer for behavioral health services in the Nation. It 
covers both prevention and treatment for people at risk for or actively 
battling opioid addiction.
  For example, Medicaid pays for about one-quarter of medication-
assisted treatment for opioid and heroin addictions. Because of the 
Medicaid expansion, 1.3 million additional people gained access to 
behavioral health services, which reduced the number of low-income 
adults needing substance use treatment but not receiving it by 18 
percent.
  To further undermine coverage, the House bill would also allow States 
to eliminate essential health benefits. The essential health benefits 
are 10 key benefits that plans exchanges must offer, including 
maternity care, prescription drugs, and mental health and substance use 
disorder services. What we know is that before the ACA was passed, many 
people with private insurance did not have coverage for the mental 
health services they needed. One in three did not have coverage for 
substance use disorder treatment, and close to one in five did not have 
coverage for mental healthcare.
  Now is not the time to be cutting back on those benefits. In fact, 
last year, the Surgeon General issued a report on addiction, which 
found that there are more people with substance use disorders than 
people with cancer. What the CBO score confirmed yesterday was that 
people who live in States that rollback essential health benefits, who 
still need the services that are no longer included in the essential 
health benefits would ``experience substantial increases in out-of-
pocket spending on health care or would choose to forgo the services.''
  The report goes on to call out the fact that out-of-pocket costs for 
these patients could increase by thousands of dollars a year, and the 
benefits would again be subject to annual and lifetime limits. 
Substance use disorder services are highlighted as specific benefits 
that CBO anticipates States will exclude first.
  I want to make this clear to my colleagues and to the American 
people: You cannot say that you want to address our country's opioid 
epidemic and at the same time support this bill. Those things are in 
direct opposition to one another. So, to all of my colleagues who 
supported CARA and supported the 21st Century Cures Act, I urge you to 
work with us to build on the ACA so that we can effectively address the 
opioid epidemic ravaging our country.
  My colleague on the other side of the aisle, Senator Corker from 
Tennessee, had it right when he remarked on the secret partisan process 
currently underway in the Senate. Earlier this week he said:

       It's a very awkward process, at best. There are no experts. 
     There's no actuaries. . . . Typically, in a hearing, you'd 
     have people coming in and you'd also have the media opining 
     about if a hearing took place, and X came in and made 
     comments.

  Senator Corker is spot-on. The American people deserve an open and 
transparent discussion on how we can best improve healthcare in our 
Nation. Many Americans are struggling just to keep their heads above 
water, paying their bills, raising their kids, caring for their 
parents, and coping with health problems.
  Families in Minnesota and in all of our States have been or are 
currently being ripped apart by opioid addiction. They need our help. 
They don't need a bill or a budget, for that matter, that is hastily 
put together for ideological reasons. They don't need policies that 
undercut their care and their livelihood.
  Ninety-one people die every day in the United States from an opioid 
overdose. Only one in five people who currently need treatment for 
opioid use disorders is actually getting it.
  American lives hang in the balance. People are counting on us to do 
the right thing. So let's do it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, I am very pleased to join my 
colleagues, Senator Franken and Senator Warren, who are also here for 
this conversation that was kicked off earlier this afternoon by our 
friend and colleague from West Virginia, Senator Manchin.
  West Virginia does not have a whole lot in common with Rhode Island. 
We are a coastal State. Senator Manchin comes from a very landlocked 
mountainous State. Our biggest mountain in Rhode Island is probably the 
Johnson landfill. But we have something in common, which is the extent 
to which opioid addiction and opioid overdoses have stricken our State. 
We have had over 200 deaths per year. In a State our size, everyone is 
within 2 or 3 degrees of separation of everyone else. Those 200 deaths 
reverberate through our whole State.
  There is a small town in Rhode Island called Burrillville, up in our 
northwest corner. Burrillville is a very small town in Rhode Island. I 
went up there for a meeting about the opioid epidemic at Burrillville 
High School. In the previous quarter, in just 3 months, that one little 
town had six deaths from opioid overdoses. That is six times that the 
little police force had to respond, six times the funeral parlors had 
to handle grieving families, six times that death notices had to be 
published in the local paper. It felt like a battering to people in 
that community.

[[Page 8498]]

  Senator Manchin has a pretty good idea to help make sure that we have 
the funding to get treatment to people before these tragedies take 
place. He proposes what he calls the LifeBOAT Act, which is one penny 
for each milligram of active opioid in a prescription drug--one penny. 
It is only a penny, but it would have raised about $2 billion last 
year. So $2 billion would save a lot of people and save a lot of lives.
  Just to give you some idea of the scale, Purdue Pharma has generated 
estimated sales of more than $35 billion since 1995 for opioid 
medications. It has annual revenues of about $3 billion, mostly from 
OxyContin. That is just one company. So the idea of adding a penny 
really does not seem to me to be asking very much.
  The way we operate now in the Senate, I know that asking corporations 
to do anything seems impossible because they have the financial whip 
hand over so many Senators because of the unlimited money they are 
allowed to spend and threaten to spend in our politics. But really, 
after all the lives that have been lost, after all the lives have been 
affected, you would expect that just out of common decency this 
industry would step up and say: For a penny, we are in. So let's hope 
they come around to that because I think it is a good plan.
  TrumpCare, on the other hand, would be a disaster. So many people get 
their opioid treatment through Medicaid and through the expansion of 
Medicaid that the Affordable Care Act created. To undo that, to strip 
$1.4 trillion, as President Trump has proposed, out of Medicaid is 
inevitably going to deny people access to care.
  I am not the only one saying this. Someone who works in Providence 
with recovering heroin addicts wrote to me. His name is Travis. He 
wrote to me about his clients who are receiving medication-assisted 
treatments. He credits their being able to come in and get the care 
that they get to the Affordable Care Act. He said that it is the reason 
he and his colleagues have been able to help recovering addicts enter 
effective treatment programs. It works.
  Travis relates that repealing the Affordable Care Act would have what 
he calls a profound impact on his clients' ability to get needed 
addiction and recovery services.
  I will turn the floor over to Senator Warren in a minute, but I want 
to recognize one other person. I will not use last names. His name is 
Mark. He wrote to me from Rumford, RI, which is a very nice part of 
East Providence, RI.
  This is a gentleman who became addicted to opiates at the age of 52. 
He had surgery, and after the surgical procedure, his doctor gave him 
opiates for the pain. The doctor was somewhat indiscriminate about 
continuing to prescribe those opioids.
  Mark realized that he was addicted. He went to a recovery group in 
Rhode Island called CODAC, which does very good work for treatment. He 
went into recovery, and he succeeded for 8 years without using opioids.
  As sometimes happens, family stresses, business stresses, other 
stresses intervene. In his case, a family stress caused a relapse, but 
he knew what to do. He went back to CODAC. He became sober again. Now 
he is back in recovery, clean and sober.
  This pattern of recovery and then an occasional relapse and then back 
to recovery again is very often the way people who have an addiction 
get through it. To make sure that the treatment is there for them when 
they relapse can be a lifesaver.
  By the way, Mark is a success. He is in the music business. He has 
toured around the world. The fact that CODAC was there for him on those 
two occasions has allowed him to achieve that success. Again, this was 
a 52-year-old individual whom a surgery sent into addiction.
  I will close by pointing out that one of the things the CARA bill, 
which many of us worked so hard on, accomplished was to send the 
message that addiction is not a moral failing. It is a medical 
condition. It should be treated as a medical condition. Not only is it 
not a moral failing, I think many of us who have had family, loved 
ones, friends, or any experience with folks who are going through 
recovery--what we have learned is that recovery is actually a noble 
accomplishment. It is not an easy path, but it is a path that demands 
deep honesty, deep courage, deep trust, very often love. It is a path 
that people who are walking it can and should be proud of, and we 
should be proud of them for their achievements, and we should be there 
for them in their relapses and make sure the care that will put them 
back on that path is available.
  I yield the floor to my terrific colleague from Massachusetts.
  The PRESIDING OFFICER. The Senator from Massachusetts.

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