President Declares Opioid Crisis a National Emergency

President Trump has declared the opioid crisis a national emergency. This action was the primary recommendation of the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

The Washington Post reports:

“It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” Trump said, speaking to reporters outside a national security briefing at his golf club in Bedminster, N.J., where he is on a working vacation. “It is a serious problem, the likes of which we’ve never had. You know, when I was growing up, they had the LSD, and they had certain generations of drugs. There’s never been anything like what’s happened to this country over the last four or five years.”

Trump’s announcement is a change of course from earlier this week when the president stopped short of issuing such a declaration during a press conference about the commission’s report. The designation opens the opportunity for additional funding that could be used for treatment and prevention efforts. It also provides federal agencies with flexibility to allow waivers of certain rules and regulations that could help local government adapt programs to meet their needs.

The national emergency announcement is welcome news to many. Especially as NBC News notes a new report that has concluded that overdose deaths have been under-reported:

Nearly 35,000 people across America died of heroin or opioid overdoses in 2015, according to the National Institute on Drug Abuse. But a new University of Virginia study released on Monday concluded the mortality rates were 24 percent higher for opioids and 22 percent higher for heroin than had been previously reported.

For more information:

Trump declares opioid crisis is a national emergency, pledges more money and attention (The Washington Post)

Trump Declares Opioid Crisis National Emergency (NBC News)

Federal Commission Releases Opioid Report, President Declines Declaring National Emergency (Conduit Street)

Federal Commission Releases Opioid Report, President Declines Declaring National Emergency

Last week the President’s Commission on Combating Drug Addiction and the Opioid Crisis released a preliminary report proposing recommendations for addressing the nation’s opioid crisis. One of their top recommendations was for the president to declare the opioid crisis a national public health emergency.

At a news conference this week the president declined to declare such an emergency.

The Washington Post reports that following an update from his health officials on the report, the president held a press conference and made statements focused on the importance of preventing people, particularly the youth, from ever starting to use drugs. Additionally, Health and Human Services Secretary Tom Price provided background to the decision not to declare a national emergency but assured those in attendance that the crisis would still be treated as an emergency:

Health and Human Services Secretary Tom Price later told reporters that declaring a national emergency is a step usually reserved for “a time-limited problem,” like the Zika outbreak or problems caused by Hurricane Sandy in 2012. Declaring a state of emergency allows the government to quickly lift restrictions or waive rules so that states and local governments don’t have to wait to take action. Price said that the administration can do the same sorts of things without declaring an emergency, although he said Trump is keeping the option on the table.

“The president certainly believes that it is, that we will treat it as an emergency — and it is an emergency,” Price said during a news briefing held about eight miles from Trump’s golf club, where he is on a 17-day working vacation. “When you have the capacity of Yankee stadium or Dodger stadium dying every single year in this nation, that’s a crisis that has to be given incredible attention, and the president is giving it that attention.”

What does it mean to declare a public health emergency? Route Fifty reports on what a declaration of state of emergency on the opioid crisis would have meant. Generally a declaration would open the option for states to apply for additional funds from the Federal Emergency Management Agency, that could be used for treatment and prevention efforts. It would also provide flexibility to federal programs to allow for waivers of certain rules and regulations:

First, an emergency declaration would allow states that are declared disaster zones—areas that have been particularly hard-hit by the crisis—to receive funds from the federal Disaster Relief Fund, which as of June 30, 2017, had a balance of nearly $4.4 billion.

..

And, if the Trump administration declares an emergency under both the Stafford Act and Section 319 of the Public Health Service Act, it would allow temporary waivers on specific rules regarding federal programs like Medicare, Medicaid and CHIP. For example, Medicaid does not currently reimburse the costs of receiving drug treatment in facilities that have more than 16 beds. Many states have already applied for waivers on this rule, but an emergency declaration could give a blanket waiver to all 50 states.

An article in The Intercept decried the President’s focus on “just say no” and harsher sentences as a return to the 80’s war on drugs (that was ultimately found to be ineffective), but offers support for the Commission’s recommendation regarding Medication Assisted Treatment (MAT):

Even without the emergency declaration, at least one of the commission’s recommendations would transform the U.S. approach to the crisis and give those in its grip a real chance at recovery. It’s an approach that was embraced by the surgeon general in a report in November and consistently by the Office of National Drug Control Policy under Obama.

The recommendation is a direct shot at a drug-treatment industry that still relies on strict abstinence as the only form of true recovery, rejecting any intervention by medication. The stigma associated with what’s known as medication-assisted treatment is leading to unnecessary death and suffering across the country.

While much of the focus has been on the recommendation to declare a public health emergency, the report included a number of additional recommendations:

– Rapidly increase treatment capacity. Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.

– Mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts. Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities, including continuing education courses for professionals.

– Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives.

– Prioritize funding and manpower to the Department of Homeland Security’s (DHS)Customs and Border Protection, the DOJ Federal Bureau of Investigation (FBI), and the DEA to quickly develop fentanyl detection sensors and disseminate them to federal, state,local, and tribal law enforcement agencies. Support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service (USPS).

– Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion. Ensure federal health care systems, including Veteran’s Hospitals, participate in state-based data sharing.

– Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law.

– Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.

For more information:

President’s Commission on Combating Drug Addiction and the Opioid Crisis Preliminary Report

Trump Holds off on Declaring Opioid Crisis a National Emergency (The Washington Post)

Trump Didn’t Declare the Opioid Crisis a National Emergency. What If He Had? (Route Fifty)

Trump’s Opioid Commission Had Some Stunningly Good Recommendations. He Ignored Them for 80s Drug War Nostalgia (The Intercept)

To Boost Veterans’ Health Services President Touts Technology

The Trump Administration has announced new technology based initiatives to improve access to and delivery of veterans’ health services. The initiatives are expected to expand access to services in rural areas, and access to mental health and suicide prevention services across the board.

The AP reports:

Initiatives include using video technology and diagnostic tools to conduct medical exams. Veterans also will be able to use mobile devices to make and manage appointments with Veterans Administration doctors.

“We call it ‘anywhere to anywhere’ VA health care,” VA Secretary David Shulkin said. Shulkin said the goal is better health care for veterans wherever they are. He said existing “telehealth” programs provided care to more than 700,000 veterans last year.

The article notes that the initiatives await regulations in order to be launched.

Read the AP article to learn more.

Learn about how counties are working to provide innovative services and support to veterans at the 2017 MACo Summer Conference session “Serving Those Who Served Our Country” on Friday, August 18, from 2:15 pm – 3:15 pm.

The MACo summer conference is August 16-19, 2017 at the Roland Powell Convention Center in Ocean City Maryland. This year’s theme is “You’re Hired!”.

Learn more about MACo’s Summer Conference:

State Health Insurance Coverage Protection Commission Holds First Meeting

The Maryland Health Insurance Coverage Protection Commission, established to monitor and assess the actual and potential impacts that federal changes to the Affordable Health Care Act (ACA), Medicaid, and Medicare may have on Maryland, met for the first time this week.

The Washington Post reports on the difficulties the Commission faces as federal reform efforts remain a moving target:

The Maryland Health Insurance Coverage Protection Commission, co-chaired by Sen. Brian J. Feldman (D-Montgomery) and Del. Joseline Peña-Melnyk (D-Prince George’s), is set to issue legislative recommendations by the end of the year. Its job is complicated by the constantly shifting prospects of the stalled federal health-care legislation.

“We know it’s chaos,” Peña-Melnyk said. “We are constantly being threatened, so we have to be vigilant, and we have to assess the impact of actual and potential federal changes.”

The leader of Maryland’s state-run health insurance marketplace told the commission that the Affordable Care Act was instrumental in cutting the state’s uninsured rate in half to about 6.6 percent, after the state exchange recovered from a disastrous launch.

The Baltimore Sun reports that over a million Marylanders have insurance either through exchange or through Medicaid and notes the biggest threats to coverage in the state at this time:

The most immediate peril facing the states is that the Republican administration would refuse to pay Obamacare’s cost-sharing subsidies to insurers that allow them to provide coverage to lower-income customers.

The Commission, which is comprised of 12 members (six legislators and six stakeholders), must submit a report to the general assembly annually through 2020 providing findings and recommendations on actions the state should take to protect access to affordable health care coverage for Marylanders.

To learn more:

Maryland panel to monitor health-care overhaul efforts meets for first time (The Washington Post)

Panel Hears of Obamacare Successes, Perils in Maryland (The Baltimore Sun)

Healthcare reform will be discussed at the 2017 MACo Summer Conference session “ABCs of ACA, AHCA, BCRA and Healthcare in Maryland“ on Thursday, August 17, from 3:30 pm – 4:30 pm.

The MACo summer conference is August 16-19, 2017 at the Roland Powell Convention Center in Ocean City Maryland. This year’s theme is “You’re Hired!”.

Learn more about MACo’s Summer Conference:

NACo: Keeping An Eye On Tax Reform

The National Association of Counties (NACo) has weighed in on the Joint Statement on Tax Reform issued by the Administration and congressional leadership. While calling the “much-anticipated statement … light on details,” NACo emphasizes that it will continue to advocate on behalf of all counties to retain the  tax-exempt status of municipal bonds and the deductibility of state and local taxes.

From the NACo blog post:

Counties have a significant stake in tax reform discussions, as simplification and lowering of rates could significantly boost economic development and help constituents around the country. However, key county priorities remain in the crosshairs of tax reform discussions: the tax-exempt status of municipal bonds and the deductibility of state and local taxes.

Tax-exempt municipal bonds are a critical county financing tool for major infrastructure purposes, including roads, bridges, hospitals and schools. Additionally, eliminating deductibility of state and local taxes would be a double tax on constituents, significantly impacting local middle class tax payers and asking them to shoulder an increased burden for key local priorities. …

NACo will continue monitor tax reform efforts and advocate for key county priorities as the process moves forward.

NACo will be exhibiting at MACo’s Summer Conference this August 16-19. Visit them in Booth 525. Register today for lowest available rates – they expire on August 4!

Learn more about MACo’s Summer Conference:

ALEC Fostering Group Focusing on Local Governments

The American Legislative Exchange Council (ALEC), a conservative national group probably best known for developing model legislation for introduction in state legislatures, is fostering a fairly new initiative to focus efforts at the city and county level.

From an AP news report:

The American Legislative Exchange Council is one of the country’s most prominent conservative groups, and its annual convention in Denver last week drew thousands of state legislators and lobbyists for panels on school choice and marijuana legalization, as well as speeches from conservative luminaries like Secretary of Education Betsy DeVos and former Senator James DeMint.

But as attendees rubbed shoulders with the right’s elite, a few dozen crowded into a small conference room for the fourth meeting of the American City County Exchange, the conservative group’s new local government wing.

The city council project is the brainchild of Jon Russell, a councilman from the Virginia town of Culpepper, population 18,000. He was dissatisfied that the traditional, nonpartisan municipal groups, like the National League of Cities, seemed to constantly think more government was the answer to problems.

“Now we can communicate with 2,500 elected officials across the country that we know share our values and push back against some of the progressivism that’s gotten into cities,” Russell said.

Federal Transportation Grant May Survive With Help From U.S. Senate

Funding for transportation and community development grant programs may be maintained in the federal budget despite threatening proposals from the White House and legislation passed by the House of Representatives.

Screenshot 2017-07-27 21.26.32
Members of the Senate Committee on Appropriations, photo courtesy of U.S. Senator Jack Reed’s website.

As reported by Route Fifty, a bill in the US Senate Committee on Appropriations would preserve funding for TIGER and community development grants for state, county, and municipal governments,

The Senate legislation includes $550 million for Transportation Investment Generating Economic Recovery, or TIGER, grants, which Congress allocated $500 million in fiscal 2017. The grants have funded road and transit projects in urban and rural areas across the U.S.

President Trump’s budget proposes eliminating all funding for the program.

And House appropriators passed a bill earlier this month that would zero-out funding for it. But, in recent years, a similar dynamic has unfolded, where House lawmakers seek to slash TIGER funding and the Senate provides money for the program.

The Senate bill would also provide $3 billion for the Community Development Block Grant, or CDBG, program and $950 million for the HOME Investment Partnerships initiative, which provides states and localities with grants meant to support affordable housing.

For more information, see Senate Panel Advances Bill That Would Boost TIGER, Maintain CDBG Funding from Route Fifty.

Congressional Leadership On Tax Reform: No Border Adjustment Tax

Congressional Republican leadership and the Trump administration just released a joint statement on tax reform – and it abandons the border adjustment tax as a possible solution.

As previously reported in Conduit Street, a federal border adjustment tax could negatively affect counties’ cash flow by causing downturns in the municipal bond market.

From the joint statement:

We are all united in the belief that the single most important action we can take to grow our economy and help the middle class get ahead is to fix our broken tax code for families, small business, and American job creators competing at home and around the globe. …

Above all, the mission of the [House Ways and Means and Senate Finance] committees is to protect American jobs and make taxes simpler, fairer, and lower for hard-working American families. We have always been in agreement that tax relief for American families should be at the heart of our plan. We also believe there should be a lower tax rate for small businesses so they can compete with larger ones, and lower rates for all American businesses so they can compete with foreign ones. The goal is a plan that reduces tax rates as much as possible, allows unprecedented capital expensing, places a priority on permanence, and creates a system that encourages American companies to bring back jobs and profits trapped overseas. And we are now confident that, without transitioning to a new domestic consumption-based tax system, there is a viable approach for ensuring a level playing field between American and foreign companies and workers, while protecting American jobs and the U.S. tax base. While we have debated the pro-growth benefits of border adjustability, we appreciate that there are many unknowns associated with it and have decided to set this policy aside in order to advance tax reform.

Given our shared sense of purpose, the time has arrived for the two tax-writing committees to develop and draft legislation that will result in the first comprehensive tax reform in a generation.

Useful Links

Trump Administration Doubles Down on Policies Against ‘Sanctuary Cities’

The Trump Administration has announced a new policy against ‘sanctuary cities’ requiring the Justice Department to withhold certain grant monies from local jurisdictions that do not cooperate with federal immigration agents.  The Hill reports:

The Justice Department said that cities must provide federal immigration officials with access to jails and give a two-day notice before releasing a person who is residing in the U.S. illegally or risk funding being cut off.

The agency’s grants now will only be available “to cities and states that comply with federal law, allow federal immigration access to detention facilities, and provide 48 hours notice before they release an illegal alien wanted by federal authorities,” according to the agency announcement.

The move marks a change from old rules under which cities could still receive federal grants as long as they could prove they were not blocking local law enforcement from flagging the citizenship status of someone they have in custody.

“We must encourage these ‘sanctuary’ jurisdictions to change their policies and partner with federal law enforcement to remove criminals,” Sessions said.

The LA Times reports on the fiscal reach and limitations of the policy change:

The new policy, announced by the Department of Justice, will apply to all cities that get grants from the so-called Byrne Justice Assistance grant program, for which the administration has requested just over $380 million for the coming year.

So far, the new policy applies only to those justice assistance grants, which local jurisdictions can use for a wide variety of programs related to law enforcement, including drug treatment, witness protection and prisoner reentry programs.

Although the move carries considerable symbolism because of the high-profile debate over sanctuaries, the money involved is roughly half a percent of federal grants to state and local governments, according to figures from the nonpartisan Congressional Budget Office.

Sessions has been pressuring so-called sanctuary cities for several months, but this is the first time that the Justice Department has set down specific rules and applied them to an entire grant program.

More information:

Trump admin escalates crackdown on sanctuary cities (The Hill)

Trump administration toughens policy toward ‘sanctuary’ cities, but the move affects only some funds (The LA Times)

Billions in County Funding Excluded from “Sanctuary” Order Provision (Conduit Street)

Sanctuary Cities, Maryland Could Lose Federal Justice Grant Dollars (Conduit Street)

Your One-Stop-Shop for Federal Advocacy on County Issues

NACo has released a timely “Summer Advocacy Toolkit” for use by county officials engaging on federal issues. Inside are links, quick summaries, and talking points on a wide range of topics relevant to county governments. Additionally, from the pdf document, users can search relevant committee membership to help target their messages.

A few quick selections from the NACo guide follow:

On Municipal Bonds:

• A fundamental feature of the first federal tax code written in 1913, tax-exempt financing is used by state and local
governments to raise capital to finance public capital improvements and other projects, including infrastructure
facilities that are vitally important to sustained economic growth.

• Between 2003 and 2012, counties, localities, states and state/local authorities financed $3.2 trillion in infrastructure
investment through tax-exempt municipal bonds.

• If municipal bonds were fully taxable during the 2003-2012 period, it is estimated that the financing for the 21 largest
infrastructure purposes would have cost state and local governments an additional $495 billion of interest expense. If
the 28 percent cap were in effect, the additional cost to state and local governments would have been approximately
$173.4 billion.

• For 2012, the debt service burden for counties would have risen by $9 billion if municipal bonds were fully taxable over
the last 15 years and roughly $3.2 billion in the case of a 28 percent cap. Americans, as investors in municipal bonds
and as taxpayers securing the payment of municipal bonds, would have borne this burden.

• The municipal bond tax-exemption represents a fair allocation of the cost of projects between federal and state/local
levels of government. Through the use of tax-exempt municipal bonds, state and local governments invested 2.5 times
more in infrastructure than the federal government.

• Tax-exempt bonds are vital for infrastructure, justice and health needs because counties own and operate 45 percent
of public roads and highways, own almost a third of the nation’s transit systems and airports, own 961 hospitals,
manage 1,943 health departments and own the vast majority of the nation’s jails.

On Infrastructure:

NACo believes that counties should be recognized as major owners of transportation infrastructure in any potential
package presented by the administration. Key funding and financing measures must include all of the following:

• Preservation of Tax-Exempt Status of Municipal Bonds

• Dedicated Funding for locally owned infrastructure

• Policies to provide an Environment for Innovative Financing

The Toolkit also includes direct links to other NACO resources, like this concise “one-pager” on State and Local Tax Deductibility (aka SALT).