Comprehensive Addiction and Recovery Act of 2015
Floor Speech
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Mr. WHITEHOUSE. I thank the distinguished ranking member of the Judiciary Committee very much. While he is on the floor, let me thank him for his leadership, support, and passion for the Comprehensive Addiction and Recovery Act, which was shepherded through the Judiciary Committee under his guidance and with his wise and benevolent support. I am very grateful.
I am on the floor to talk about the Comprehensive Addiction and Recovery Act today because it has been said by several of my colleagues that there is funding to implement this bill and that that funding is already in the government's accounts, that if we pass the CARA bill, we will be able to fund it and put it to work right away. Let me say with regret that I disagree with that assertion.
I am sorry to have a disagreement with my colleagues over this funding question after all the very excellent bipartisan work we have done to get this bill to this point. This really has been a legislative model. For years we worked on the statute. We had five different full- on national seminars in Washington, bringing people in from all around the country to advise us on all the different aspects of the opioid problem. We had an advisory committee that supported us which was broadly represented from all the different interests that are affected by the opioid crisis. We came up with a bipartisan bill which came through committee in regular order, without objection from anyone, and which is now on the Senate floor awaiting passage. That is the way it is supposed to work. But on this question of whether it is funded, I must disagree, and I wish to explain why.
For openers, let me explain that in Congress, there are committees that authorize funding. In the case of this bill, the relevant committees are the HELP Committee and the Judiciary Committee. But it is the Appropriations Committee that actually determines what funding will go into which accounts. The Appropriations Committee, in turn, is broken up into subcommittees, which determine the funding of different accounts in different areas of government. So one subcommittee has jurisdiction in one set of accounts and another subcommittee has the appropriations authority over other accounts.
The funding my colleagues have referred to as the funding for this CARA bill was appropriated by what we call in the Senate the Labor-HHS Appropriations Subcommittee. The Labor-HHS Appropriations Subcommittee appropriates two accounts that generally correspond to the authorizing power of the HELP Committee. So there are three committees involved: Judiciary, HELP, and Appropriations. The subcommittee on Appropriations that appropriated this money generally correlates to the authorizing power and jurisdiction of the HELP Committee. There are other Appropriations subcommittees. For instance, there is one that we refer to as CJS. CJS appropriates to, among others, the accounts within the authorizing power of the Judiciary Committee. So that is the background.
Now let's go through the problems. One problem with my friend's argument that the bill is funded is that the funding measure to which they refer originally passed out of its Appropriations subcommittee last June. We didn't even take up the CARA bill in the Judiciary Committee until this February. So there is a timing problem. How could the appropriators last June have predicted this state of affairs on the floor right now? The appropriators would have had to have had an astonishing, wizard-like ability to read the future in order to fund back then an unpassed bill--indeed, a bill that then didn't even have a committee hearing scheduled, let alone markup, passage, and the choice to bring it to the floor. Clearly, in June the Labor-HHS appropriators were funding existing programs, and when the omnibus passed in December, these same programs were funded at an even higher level. In fact, Democrats demanded they be funded at nearly the identical level proposed in the President's budget. The President's budget goes even further back in time. The President's budget certainly could not have foreseen CARA, the Comprehensive Addiction and Recovery Act. So there is a timing problem.
Second, this CARA bill, back when these appropriations were passed in June, was funded through different accounts than the accounts it is funded through now as we see it on the floor. When the appropriations were passed, it was funded through accounts that would be funded by CJS appropriators. So there is a committee mismatch as well as a timing problem to any claim that these funds were intended for the CARA bill.
The bulk of the CARA bill back then--in fact, 10 out of its 13 programs--authorized funding through Judiciary Committee programs, which is why the bill was sent by the Parliamentarians here to the Judiciary Committee. So if back then the intention was to fund CARA, it would have been CJS that would have funded 10 of those 13 programs. The appropriators for the funds my colleagues speak of were not the CJS appropriators but the Labor-HHS appropriators. Again, there is a committee mismatch.
Here is what happened that explains the shift. After the fiscal year 2016 omnibus had passed, we were informed--the sponsors and authors of the legislation--that in order to get our bill out of the Judiciary Committee, the CARA bill had to be rewritten so that it operated only through existing Federal programs. There are Republicans, as the Presiding Officer well knows, who live by the principle of no new Federal programs, even for new crises, and we were asked in the Judiciary Committee to accommodate them. So we accommodated them. We rewrote the bill in January to accommodate those concerns.
So this February, when CARA came before the Judiciary Committee, it had been revised to move the bulk of its new programs out of the Judiciary Committee accounts and into accounts under the jurisdiction of the Committee on Health, Education, Labor, and Pensions. Now, of the 10 programs remaining in the bill, 8 are located at the Department of Health and Human Services, in the jurisdiction of the HELP Committee. But that move was long after these appropriations were made. You cannot connect them.
I should interject that this change created an intrusion by our Judiciary bill into the jurisdiction of the HELP Committee. All here today who support the CARA bill owe a great debt of gratitude and appreciation to Chairman Alexander and to Ranking Member Murray for allowing this bill to proceed, even though it now involves a considerable number of accounts under their committee's jurisdiction. They have done so very graciously, without demanding further hearings or otherwise asserting their HELP Committee's turf. So to both of them I offer, and we should all offer, our sincere and heartfelt thanks.
It does seem a stretch to think that the appropriators in the Appropriations subcommittee that funds these HELP accounts could have foreseen last June not only that CARA would pass out of the Judiciary Committee in February and not only that it would come to the floor now, but also could have foreseen that so many of its programs would have been transferred from Judiciary Committee to HELP Committee accounts. That would have been an astonishing--indeed, truly magical--feat of prediction.
The simple fact is that the Labor-HHS appropriations that my friends rely on as the funding for this CARA bill passed out of the relevant subcommittee with little or no regard for CARA.
Senate, Washington, DC, April 2, 2015. Hon. Richard Shelby, Chairman, Subcommittee on Commerce, Justice, Science and Related Agencies, Committee on Appropriations, Washington, DC. Hon. Roy Blunt, Chairman, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, Committee on Appropriations, Washington, DC. Hon. Barbara Mikulski, Ranking Member, Subcommittee on Commerce, Justice, Science and Related Agencies, Committee on Appropriations, Washington, DC. Hon. Patty Murray, Ranking Member, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, Committee on Appropriations, Washington, DC.
Dear Chairman Shelby, Chairman Blunt, Ranking Member Mikulski, and Ranking Member Murray: As you may know, heroin use and prescription opioid abuse are having devastating effects on public health and safety across the United States. According to the Centers for Disease Control and Prevention (CDC), drug overdoses now surpass automobile accidents as the leading cause of injury-related death for Americans ages 25 to 64. Every day, more than 120 Americans die as a result of drug overdose. Over half of these drug overdoses are related to prescription drugs. While addiction is a treatable disease, only about ten percent of those who need treatment receive it.
We write to express our strong support for fiscal year (FY) 2016 funding for programs that would support the integrated strategies for addressing opioid abuse included in the Comprehensive Addiction and Recovery Act of 2015 (CARA, S. 524). This bipartisan legislation was developed over the past year and a half through a cooperative process involving key national stakeholders in the public health, law enforcement, criminal justice, and drug policy fields, and is designed to fight prescription opioid abuse and heroin use holistically-- from expanding prevention to supporting recovery.
Among other objectives, CARA would:
Expand prevention and educational efforts--particularly aimed at teens, parents and other caretakers, and aging populations--to prevent prescription opioid abuse and the use of heroin.
Expand the availability of the overdose reversal drug naloxone to law enforcement agencies and other first responders.
Expand resources to promptly identify and treat individuals suffering from substance use disorders in the criminal justice system.
Expand disposal sites for unwanted prescription medications to keep them out of the hands of children and adolescents.
Launch an evidence-based prescription opioid and heroin treatment and intervention program to expand best practices throughout the country.
Launch a medication-assisted treatment and intervention demonstration program.
Strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services.
As you begin consideration of the FY 2016 appropriations bills, we urge you to provide sufficient funding for the provisions included in CARA, which would provide the resources and incentives necessary for states and local governments to expand treatment, prevention, and recovery efforts for the millions of Americans who are affected by substance use disorders. Among other things, we ask that you ensure adequate funding for CDC's prescription drug surveillance and monitoring activities and the Substance Abuse and Mental Health Services Administration's Medication- Assisted Treatment for Prescription Drug and Opioid Addiction program. Because we know that medication-assisted treatment should be an important component in treating those suffering from opioid abuse in the criminal justice system, we urge you to continue your support for the Medication-Assisted Treatment Pilot Program at the Bureau of Prisons.
Only through a comprehensive approach that leverages evidence-based law enforcement initiatives, treatment, and support for recovery can we reverse the current skyrocketing numbers of heroin and prescription opioid overdoses and deaths. Thank you for your consideration. Sincerely, Kelly A. Ayotte, Susan Collins, Christopher A. Coons, Sheldon Whitehouse, Amy Klobuchar,
United States Senators.
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Mr. WHITEHOUSE. Mr. President, the letter I have submitted was written to bring CARA to the attention of both the CJS and the Labor- HHS subcommittees. But those subcommittees, when they got this letter, had no idea the bulk of this would move from the Judiciary Committee to the HELP Committee. Back then, CARA was mostly funded through another subcommittee--CJS. Back then, CARA had not even been scheduled for its hearing in Judiciary.
So why was the funding for the opioid crisis put in and, indeed, increased by the appropriators of the HELP accounts? Obviously, because 47,000 people died last year--in 2014, the last year we have on record--of opioid overdose deaths. This is a national crisis. They were paying attention to it. They were putting resources in, but not resources to implement the bill that we are about to vote on in the next few days.
Indeed, as we speak, SAMSHA, the relevant agency, is gearing up its grant applications to go forward and solicit bids for all the money the appropriators approved and that was dialed up in the omnibus. And SAMSHA is proceeding under the pre-CARA laws. SAMSHA intends to spend every dollar of the appropriated funds, CARA or no CARA. That means if this CARA bill passes, every dollar that goes this year to fund a CARA program will take away funds from that pre-CARA grant array that SAMSHA is preparing right now. In that case, we will necessarily be robbing Peter to pay Paul. You cannot count the same funding twice, and there is no new money for CARA.
One can make the argument, and, indeed, I would accept the argument that though we are robbing Peter to pay Paul, CARA's Paul is better than pre-CARA's Peter. CARA is, after all, a very good bill, but the funding math is still undeniable. We are, in fact, robbing pre-CARA Peter to pay for a new CARA-improved Paul. So one can argue that funded programs may improve because of CARA, at least to the extent the funding goes to new CARA-authorized purposes. But that is an argument that the same money will be better spent. It is not a fair argument that there is new money for CARA programs. There is no new money.
In sum, the timing does not support the argument that there is new funding for CARA. That money was appropriated long ago. Indeed, this bill will not even be law if we get it through the Senate. There is still the House, the Conference, and the President. What kind of wizards do we think our appropriators must have been 8 months ago at seeing a future for this bill which we even now cannot see?
On top of that, the jurisdictional problem between Judiciary and HELP shows that the HELP appropriations had to be intended back in June for other programs, specifically for the HELP grants now underway at SAMSHA, which we would be robbing to fund CARA programs.
Unless they were time-traveling wizards, if the appropriators had intended to add extra money for CARA for this fiscal year, they would have added the money to the Judiciary accounts that were what CARA authorized back then when it was introduced and when the appropriators passed the appropriations in the subcommittee.
Finally, it is a fact that all of this appropriated money my friends speak of is already on its way to being spent. It will be spent even without CARA. It will be spent even if, for some reason, CARA fails. It may even be spent before CARA becomes law, and it will be spent in programs to support addiction recovery.
That is the logic of my conclusion that there is no funding for CARA. That is the logic of my conclusion that to fund CARA without robbing other addiction recovery programs, we would need new funding, not just last year's appropriations. And that, my friends, is why Senator Shaheen's emergency funding bill is so important.
With that, I see my distinguished chairman on the floor, and I yield the floor.
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Mr. WHITEHOUSE. Mr. President, as one of the authors of the bill before us on the floor now, I wish to say that I appreciate and welcome the Senator's amendment, and I appreciate the bipartisan way in which it was achieved, with Sherrod Brown and Tim Kaine, as well as with the other cosponsors of the bill.
I yield for the Senator from New Hampshire.
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Mr. WHITEHOUSE. I yield back all time.
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Mr. WHITEHOUSE. Mr. President, we rise to express our disappointment with what just took place. I am one of the authors of the underlying bill. I think it is a very good piece of legislation, but it would make a very significant difference if it had some funding.
The simple fact that we have to face is this bill has no funding right now. I know colleagues on the other side have come to the floor to say there is funding--$80 million, $400 million--but in point of fact I must disagree with them. Let me list the points that show, I believe, why there is no funding to this bill at this point.
The first is that the funding they point to was passed out of the Appropriations subcommittee 7 months before this bill even had its markup. It would have been an astonishing feat of prediction to be able--back then--to fund this bill now.
If that weren't clear enough, there was a change in the bill between then and now. Then, if you wished to fund this bill, you would have put the bulk of the money through the CJS Appropriations Subcommittee because the bulk of this bill was written in the CJS Appropriations Subcommittee. We only changed it this January in response to Republican objections that nobody wanted to create new programs. So we rerouted the new programs through existing programs. That is when it became a Labor-HHS-dominated bill. So there is no way that last June, when this money came through that Appropriations subcommittee, they knew it was going to this.
Moreover, if you go to the agency that is responsible for distributing this money, they are bidding the money out right now. They have a use right now for every dollar of it. If we don't pass this bill, they will put the money out and it will be spent. If we do pass this bill, they will put the money out and it will be spent. If we don't get the bill out soon enough, they will have to pass it out and get it spent under existing law. So you simply can't say with a straight face that this is a funded bill.
The only way this is funded is by robbing the accounts that SAMHSA is now putting out now to bid to fund, in order to fund this bill. You can say the money will be better spent under this legislation. I think that is true. I support this bill. I am going to be for the bill all the way through, even if it is not funded, but you can't say there is funding.
This is a very solvable problem. We have done it before. As Senator Shaheen pointed out on the floor, when it was the swine flu, on an emergency appropriations process, we appropriated $2 billion and when it was Ebola, $5 billion. If you say: Well, no, now something has changed, we can't do that, we have pay for it--Senator Manchin has a pay-for. A penny per milligram of opioid raises over $1 billion. You could do half a penny that could be contributed by the pharmaceutical industry that is so culpable in this predicament, in this tragedy we have, but, no, rather than allow this good program, this bipartisan program to be expedited out there, to help the people who are dying-- 47,000 in 2014, the last year--what we have done is protect the pharmaceutical industry from having to pay any share of the solution.
I yield to my colleagues.
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Mr. WHITEHOUSE. Mr. President, if I can have 1 minute before the Senator departs.
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Mr. WHITEHOUSE. I thank the Chair.
I would like to end this conversation on a happy note, after what I consider to be a very unhappy vote, and that is to express my appreciation to Senator Portman for his collegiality and his work over many years to get this bill to where it is now in the Senate. I express my appreciation to him for voting for the amendment of Senator Shaheen. I express my appreciation to him for publicly pledging to work as hard as we can together to get funding for this bill into the appropriations process that is underway right now.
I look forward to working with him on all those endeavors. I do believe that we missed a big opportunity, because Senator Shaheen's bill, had it passed, would have flooded a lot more money, a lot faster, into the solution of this problem.
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