Capital Beat: Distribution of opioid aid unlikely to change soon

Monday, December 18, 2017

Pour one out for our share of the 21st Century Cures Act.

The law, passed with robust support in the waning weeks of 2016, has seen quite the year. It arrived triumphantly, a bipartisan financial pledge to tackle the opioid crisis at its peak. Congress set aside $1 billion to distribute to states over two years; coming on the heels of the underfunded Comprehensive Addiction and Recovery Act, the Granite State welcomed the aid.

But then came the distribution details. Following past practice, the Substance Abuse and Mental Health Services Administration, a subset of the U.S. Department of Health and Human Services, decided to allocate funds based on population size, not crisis severity.

Tiny New Hampshire, whose per capita opioid overdose rate was the nation’s second highest in 2015, saw a fraction of the overall funding – $6 million. Large states like California and Texas, with comparatively low rates of overdose deaths, took the lion’s share.

Our representatives fought. Sen. Jeanne Shaheen spoke against the formula in December 2016, soon after the distribution scheme was revealed; Sen. Maggie Hassan has also pressed for changes from her perch on the Senate’s health committee. In an October visit, Republican Gov. Chris Sununu broached the topic with the president himself.

Even after the first round of funding was released – and with it New Hampshire’s $3 million share – some kept hope that the agency would change the formula in time for the 2018 tranche.

Today, however, the fight is fading. At a hearing Wednesday, Elinore McCance-Katz, assistant secretary for Mental Health and Substance Abuse at SAMHSA, all but delivered the final blow.

“The decision was made to not have any substantive changes in the second year of funding,” she said.

It isn’t that the writing wasn’t on the wall. SAMHSA had been clear that it would be sticking to the previous administration’s formula, reasoning that too many states had made commitments based on the expectation of continued funds, and that a re-application process would be unfair.

Political headwinds played their own role. Few of the large states could be expected to give up a tranche of federal funds without resistance. Many, in fact, reached out to SAMHSA to request to preserve their shares, according to an Oct. 30 news release.

In November, the Monitor reached out to senators from the 10 states statistically receiving the most disproportionate share: Sens. Kamala Harris and Diane Feinstein of California; John Cornyn and Ted Cruz of Texas; Chuck Schumer and Kirsten Gillibrand of New York; Marco Rubio and Bill Nelson of Florida; Dick Durbin and Tammy Duckworth of Illinois; Richard Burr and Thom Tillis of North Carolina; David Perdue and Johnny Isakson of Georgia; Rob Portman and Sherrod Brown of Ohio; Gary Peters and Debby Stabenow of Michigan; and Patty Murray and Maria Cantwell of Washington.

Would any of them consider supporting efforts to change the funding formula ahead of the second funding round? None returned emails or calls.

But New Hampshire’s representatives pressed ahead. Hassan and Shaheen paired up with West Virginia Sens. Joe Manchin and Shelley Moore Capito to submit a bill that would require SAMHSA to change its allocation formula, echoing a House bill co-sponsored by Rep. Ann Kuster in October. Speaking from Washington in October, Sununu said the president was receptive to the frustration – “Oh, he got it 100 percent,” he said.

By November, the tune had shifted slightly. “We would love for them to make that change,” Sununu said after a Nov. 29 visit. But he added: “My sense is they know that funding commitments were made to states based on that funding formula. They’re trying to live up to that commitment as it was made in 2016 prior to the administration coming in.”

So what follows? Ask any of New Hampshire’s political leaders and they’ll point to efforts to get new types of funding to New Hampshire. In November, Sununu approached the White House drug czar with a request for a weighty $350 million. Congressional representatives have been pressing a standalone bill that would invest $45 billion into opioid relief; Senate staffers say a separate front has opened for funding through the end-of-the-year spending bill.

Hassan, in a statement Friday, said she would continue pushing for her funding formula act, the Targeting Opioid Funding Act, “to ensure that the federal government prioritizes resources for states like New Hampshire that need it most.”

And all who say there’s hope that distribution will be better the next time around. Even without 21st Century Cures, Hassan and Shaheen’s funding bill could apply to future disbursements.

“There is still time to change the way this funding is distributed,” Shaheen said in a statement Friday. “In the meantime, I’m urging Congressional leadership to provide additional opioid response resources in any year-end bill to fund the government.”

Sununu, meanwhile, is focusing on the Oval.

“You still have states out there that haven’t even spent their Cures Act money,” Sununu said in the Nov. 29 call. “That’s not necessarily a good use of the dollars. So we want to make sure that when Trump designs his plan, and the president is moving forward, that they are focusing dollars where you can get the biggest bang for your buck, so they say.”

By the standards of the last ordeal, it’s a bar that should be easy to clear.

 (Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)