Support for Patients and Communities Reauthorization Act of 2025
Floor Speech
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Mr. GUTHRIE. 2483.
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Mr. GUTHRIE. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I rise today in support of H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act.
When the Committee on Energy and Commerce led the way on the original SUPPORT for Patients and Communities Act 7 years ago under the leadership of Chairman Greg Walden, the opioid crisis looked different. Overdose deaths were largely driven by prescription and semisynthetic opioids, like oxycodone and heroin.
When the COVID-19 pandemic hit, government-enforced lockdowns hurt patients in recovery and sent more people into despair, increasing the amount of people taking illegal drugs for the first time.
Since then, the heartbreaking stories about the toll illicit fentanyl and fentanyl-related substances have on our communities have continued. The rate at which Americans are dying from fentanyl poisoning is just devastating.
In our first Health Committee hearing this Congress, my colleagues listened to the testimony of Ray Cullen, who lost his son Zach to fentanyl poisoning. Nobody should have to experience this pain.
Earlier this year, the House took a critical step to get illicit fentanyl off our streets in passing the HALT Fentanyl Act, which was led by my friend, Congressman Morgan Griffith.
I am proud today to lead the reauthorization of the SUPPORT for Patients and Communities Act. By passing this bill, my colleagues continue our work to help improve treatment and recovery opportunities, bolster prevention initiatives, and fight the fentanyl crisis.
This bill is about offering hope to those in despair, those battling substance use disorder, their families and loved ones, healthcare heroes, and first responders who need continued support to help save lives.
I thank Congresswoman Pettersen and all the Members who have supported this important bipartisan piece of legislation.
I am hopeful that by reauthorizing programs with proven success and increasing access to treatment, Congress can continue to address and prevent these tragic drug-related deaths and restore hope and healing to those who need it.
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Mr. GUTHRIE. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I point out, as they have had efficiencies in HHS in this area, it has been reported to us that there are no material changes in the programs before us today, showing that the Trump administration has substance use disorder and drug addiction as a number one priority.
Mr. Chair, I don't understand the logic that the best way to send a message to the President that you support these programs is to vote ``no'' on the bill. I just don't understand that logic. I hope we can get bipartisan support. We will put the bill on the President's desk, and I believe the President will sign the bill.
Mr. Chair, I yield 2 minutes the gentleman from Ohio (Mr. Latta), the chairman of the Subcommittee on Energy.
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Mr. GUTHRIE. Mr. Chair, I yield 2 minutes to the gentleman from Georgia (Mr. Carter), the chair of the Subcommittee on Health, an important worker on this piece of legislation and my good friend.
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Mr. GUTHRIE. Mr. Chair, I yield 2 minutes to the gentleman from Florida (Mr. Dunn), my good friend who is the vice chair of the Health Subcommittee of the Energy and Commerce Committee.
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Mr. GUTHRIE. Mr. Chair, I want to point out that Medicaid reform specifically exempted people with substance use disorder from being defined as able-bodied for the purpose of the work requirement. It specifically exempted them. We understand that Medicaid is a big payer for people with substance use disorder recovery services, and our bill exempted them. That will continue.
Mr. Chair, I yield 2 minutes to the gentleman from Ohio (Mr. Balderson), my good friend.
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Mr. GUTHRIE. Mr. Chair, I want to point out one more time that in Medicaid reform, people with substance use disorder and mental health issues are exempted from having to comply with the work requirement so that hardworking taxpayers who go to work will provide the categories we were just talking about today with Medicaid. They are not going to provide for the able-bodied. There is an exemption from the able-bodied requirement for substance use disorder recovery and mental health.
Mr. Chair, I yield 2 minutes to the gentlewoman from Florida (Mrs. Cammack), my great friend and a member of the Energy and Commerce Committee.
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Mr. GUTHRIE. Mr. Chair, I will remind you that we spend about almost $700 billion in Medicaid. When this bill goes into effect, 10 years from now, we are going to spend $1.1 trillion in Medicaid. I just want to make sure that point is made.
Mr. Chair, I yield 2 minutes to the gentleman from California (Mr. Obernolte), my good friend and a great leader on the Energy and Commerce Committee.
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Mr. GUTHRIE. Mr. Chair, I yield 2 minutes to the gentleman from Michigan (Mr. James), my good friend and very strong leader on the Energy and Commerce Committee.
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Mr. GUTHRIE. Mr. Chair, I yield 2 minutes to the gentleman from Kansas (Mr. Schmidt), one of our freshman Members, not a member of the Energy and Commerce Committee, but he has been on the front lines of the opioid crisis in Topeka as attorney general, and it is great to have his expertise in the Congress.
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Mr. GUTHRIE. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, this isn't a hollow exercise. This is our opportunity to say these programs are important to us. Article I of the Constitution clearly gives us legislative authority: All legislative authority will vest in the Congress of the United States.
We authorize these programs. I don't think the answer is to say we believe in these programs, therefore we are not going to vote to reauthorize them because we don't believe they are going to be carried out. It is our job to authorize them, to work the appropriations process, and then to do the oversight to make sure these are implemented.
If the White House and the President can do this more efficiently, I am all about doing it more efficiently, but our job is to ensure that the mission is accomplished. If they can do that with different agencies, we need to have that debate. I think that is important. It starts with authorizing the program, and in this case reauthorizing the program.
Mr. Chair, I just want you to know there are no reasons to vote against this in substance. The language of this bill that we have before us was negotiated by both the House and the Senate, with the Democratic leaders and the Republican leaders in the House and the Senate, so it was bipartisan and bicameral discussions. That is the text of the bill before us.
What we are here doing today, it is not a hollow move. That is not it at all. We are here today to say these are important to us. If there are discussions on what is important and what is not important, the first thing we need to do is come together as a House and say these issues are important to us as a House. Let's get this bill to the Senate and put it on the President's desk.
I strongly believe the President will sign this bill because he believes, as we all believe, that people are hurting. They are hurting with substance use disorder. You have the supply coming across the border that he is shutting down and trying to shut down, but we also have to deal with the demand side. We need not just to slow down the demand, which is important, but change people's lives because when they are suffering with substance use disorder, it is just chaotic on themselves, their families, in which they live and the friends that they have.
This truly changes people's lives. It is a bipartisan bill. Everything in it is bipartisan and has been discussed. I just encourage my colleagues to vote for this bill, reauthorize these provisions, fight to get them through the Senate, put them on the President's desk, and then fight for their authorization through the appropriations process, as well. I am committed to doing that, and I look forward to hopefully a bipartisan vote on this bill.
Mr. Chair, I yield back the balance of my time.
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Mr. GUTHRIE. Madam Chair, I rise in opposition to the amendment.
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Mr. GUTHRIE. Madam Chair, I yield myself such time as I may consume.
Madam Chair, I really appreciate the hard work of the gentlewoman from Colorado (Ms. Pettersen) on this issue. She is a leader in Congress on substance use disorder.
I actually didn't know the story of my friend from Colorado's mother. Certainly, when someone is touched by an issue, they certainly become passionate about it. I greatly appreciate her passion on the issue.
The section 1115 waivers are important to the Medicaid program. States are the laboratories for democracy. Section 1115 waivers provide key State flexibility to test new authorities and ideas in the Medicaid program.
In substance use disorder alone, 1115 waivers were pivotal in early efforts to lift the IMD exclusion, an obsolete edifice to the Medicaid program that undermines access to mental health care and substance use disorder care by only allowing for Medicaid to reimburse for care in- patient facilities with fewer than 16 beds.
Under President Trump's guidance, in 2018, States were able to use 1115 waivers to waive the IMD exclusion, expanding access to care as the opioid epidemic began to grow worse.
After 5 years of State experimentation with 1115 waivers to lift the IMD exclusion, Congress stepped in and ultimately lifted the IMD exclusion. We took on that initiative in 2023, alongside the rest of the SUPPORT for Patients and Communities Act. We were able to get that signed into law, even when the Senate blocked the rest of the SUPPORT for Patients and Communities Act, because it was important to get it done.
The 1115 waivers have been on the books for decades, and States have used them a multitude of ways to transform the Medicaid program. A key tenet of those waivers, though, is that they have to be budget neutral. This wasn't a problem when 1115 waivers were used to lift the IMD exclusion. States were clearly able to demonstrate how early access to care reduced emergency room services.
Nonetheless, the Biden administration in the use of 1115 waiver authorities put forth new guidance that allowed States to rely on so- called hypothetical expenditures that let States spend Medicaid dollars on services that were over budget and unrelated to the core functions of the Medicaid program.
Some examples of this included paying for air conditioning systems for beneficiaries and for providing payments for legal support for beneficiaries. This isn't to say that HVAC systems in a hot climate or legal supports aren't important or may have some potential relation to someone's health, but they fall far outside the scope of what Medicaid is intended for. They open the door for States to draw down Federal funds or for services that are oftentimes entirely funded by the States.
In 2023, as the then-subcommittee chairman for Energy and Commerce's Health Subcommittee, I raised concerns with that direction with the Biden administration as they were moving toward these waivers.
Specifically, in this CMS, I wrote:
``The committee is also concerned about the potential for fraud, waste, and abuse in calculation and application of States' budget neutrality limits under Section 1115 Medicaid waivers.''
As chairman of the full committee, those concerns remain. Madam Chair, 2 weeks ago, House Republicans began to take steps to address this. In the reconciliation bill that we passed, we included key language to require stricter adherence to the budget neutrality requirements for 1115 waivers.
It doesn't matter if the President is Democrat or Republican who is approving these waivers. It needs to be budget neutral. We need to be good stewards for programs like Medicaid and to make sure that it is spending in a fiscally responsible manner and that we aren't just writing blank checks to States who can spend money how they choose.
I will close by saying I greatly appreciate the leadership my friend from Colorado has shown. She is a leader in this House and in ensuring that we deal with as much as we possibly can in every way possible with substance use disorder. I believe we need to stick to the budget neutrality.
Madam Chair, I oppose the amendment, and I yield back the balance of my time.
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