Under Pressure, House Republicans Inch Forward On Opioid Epidemic

"Someone has passed away since the gavel dropped," says Rep. Fred Upton.

WASHINGTON -- As House Republicans come under increasing pressure to act on the opioid epidemic, a health subcommittee addressed a dozen bills this week to address the issue, with House leaders promising more to come.

The movement has done little to assuage Senate Republicans, who continue to question why the House won't simply vote on a sweeping Senate bill that passed the upper chamber 94 to 1 and was crafted over three years with significant input from the House.

Ohio Republican Rob Portman took the issue to the Senate floor Thursday for his third speech aimed at House Republicans. "Health Subcommittee Chairman Joe Pitts marked up dozen bills yesterday. I appreciate these efforts," said Portman, who is a co-author of the Comprehensive Addiction and Recovery Act (CARA).

"After our three years of work, it doesn’t make sense for the House to just set CARA aside to start from scratch. CARA is ready to become law today. There are other ideas out there, but before the House takes them up, the House should pass CARA."

It might not make sense, but that's the course Congress is on. House Majority Leader Kevin McCarthy (R-Calif.) and Speaker Paul Ryan (R-Wis.) have clearly made doing something in the House a priority, and Thursday's mark-ups won't be the last. But the decision to move ahead with fresh House bills rather than work from the Senate bill has consequences, the most significant of which is the need to reconcile the two bills in a conference committee. How the package will navigate the maze of congressional egos and reelection politics remains to be seen.

A GOP aide said that Republican leaders in both chambers have been in talks about expediting such a process, though it asks a lot of an institution that has ceased to function in any reliable way.  

Along the way, Portman said on the floor, roughly 120 people are dying every day. Energy and Commerce Committee Chairman Fred Upton (R-Mich.), who spoke at the House hearing, brought up the ongoing damage. "Nearly every 12 minutes, someone dies of a drug overdose in the United States," he said. "That means someone has passed away since the gavel dropped." Against the backdrop, the congressional process drags on.

On Friday, Portman and Ohio Democratic Sen. Sherrod Brown are holding a field hearing in Cleveland on the epidemic.

The House package is thin in many respects, but in one significant way it is a dramatic improvement over the Senate bill. Because CARA moved through the Senate Judiciary Committee rather than the rival health committee, the latter asked the bill's sponsors, Portman and Sen. Sheldon Whitehouse (D-R.I.) not to include a particular measure related to expanding access to medication-assisted treatment, according to Portman. Currently, doctors are barred from treating more than 100 patients with an anti-addiction drug known as buprenorphine, which is often the most effective treatment. Waitlists -- and deaths -- have resulted.

Additional legislation, authored by Sens. Ed Markey (D-Mass.) and Rand Paul (R-Ky.), would lift the cap from 100 to 500 patients and allow nurse practitioners and physician assistants to prescribe the medication as well. It's one of the few things Congress could do that would have an immediate effect by instantly providing more access, and it wouldn't require tax dollars or a long lead time.

A House version of the bill, from Reps. Larry Bucshon, (R-Ind.) and Paul Tonko (D-N.Y.), that passed Wednesday ups the cap to 250, a more hesitant approach, but it also expands the authority to nurse practitioners or physician assistants. HHS in March used the rulemaking process to bump the limit to 200, but the new regulations have yet to take effect, and HHS doesn't have the power to include nurse practitioners or physician assistants. The House bill explicitly gives HHS more authority to up the cap on its own.

The bill still needs to pass the fuller House Energy and Commerce Committee, which the panel chairman guessed could happen next week. It would then need to move through the House floor, which McCarthy has suggested could happen in early May.

Since the Senate health committee passed its version of the bill unanimously, the House measure could theoretically be "hotlined" -- passed quickly by unanimous consent -- through the Senate once it clears the House. But the Senate would be unlikely to be so magnanimous if the House continues to refuse to take up the Senate bill.

In the dozen bills the House committee approved, there are plenty of fine ideas -- such as one from Rep. John Sarbanes (D-Md.) to push physicians to prescribe Naloxone, an overdose reversal medication, along with opioids -- and several that would order studies related to the epidemic.  

For Portman, the parallel effort is appreciated, and more studies are great, but they shouldn't come at the expense of the bird in hand. "The House can simply put CARA on the suspension calendar," said Portman, referring to a process that requires a two-thirds vote but moves quickly. "It would pass by a large bipartisan margin, just like it did in the Senate. President Obama would sign it and it would begin to help millions of people. That’s how close we are to a historic achievement. We’re one vote away."