Where is the $1.1 billion the White House keeps talking about? Not in any bills currently under consideration on Capitol Hill. In fact, the 18 drug-related bills passed by the House of Representatives during the week ending May 13 included no appropriations; any amendments that included funding were voted down.
From the beginning, the $1.1 billion was more public relations than reality. The $1.1 billion was announced by the White House days before President Obama’s budget request to Congress was actually released (see ADAW, February 8). At the time, the White House, via the Office of National Drug Control Policy (ONDCP), said most of the money would go toward medication-assisted treatment (MAT) to treat the opioid epidemic. However, when the budget request was released February 9, that money was nowhere to be found (see ADAW, February 15).
The ONDCP and the Department of Health and Human Services (HHS) called the funding “mandatory,” meaning it would not come from appropriations and that Congress would have to figure out another way to come up with the money. That was what led the field back in February to call the $1.1 billion “smoke and mirrors” and a “gimmick.”
This month, the White House has ratcheted up its message — via a stakeholder meeting in the White House itself, Twitter chats and even a May 14 national radio address by President Obama joined by Macklemore — about the need for funding. During the same week that advocates were scurrying to follow House bills, ONDCP Director Michael Botticelli called a stakeholders meeting to ask advocates to help in getting the $1.1 billion out of Congress. Of course, advocates have been asking for money for the opioid crisis for years. For the White House to tell them they were not doing enough was, in the view of some advocates, just a “guilt trip.”
The ‘guilt trip’ on advocates
Speaking on background, some advocates told ADAW that it was “politically inept” for the White House, in the last months of its administration following an opioid epidemic that has been building for years, to now beg for assistance with Congress and even to chastise them for not doing enough. “What do they think we’ve been doing?” said one.
With no guidance from the White House on how to offset the $1.1 billion, advocates are at a loss for what to tell their Capitol Hill contacts. “You cannot pass a bill off the House floor that is not paid for,” said one. “Congress has the power of the purse, and to tell them to do this did nothing but annoy appropriators. This was DOA from day one.”
It's important to note that the White House was bound by the spending caps agreed to with Congress, so it could not simply add money to the budget.
While advocates appreciate the White House effort to get additional funding, they do not appreciate being told to “get this $1.1 billion when there’s no vehicle,” said one. The administration could have submitted a supplemental emergency request for the money, as it did for Zika — for which it got $600 million. “If you’re going to offer money, have a path forward. You can’t do it on messaging alone.”
Another advocate said that ONDCP well knows that the opioid epidemic has been “a long time coming, and now we’re in the last year of the presidency, and we’re getting lectured about the need to step up our game?”
Support for administration
Others, however, do blame Congress. “This is a chicken and egg question,” said Daniel Raymond, policy director of the Harm Reduction Coalition. “The White House started the conversation, and I would like to think that if Congress had shown any interest or inclination to take it up, the administration would work on mechanisms and offsets,” he told ADAW, noting that the House refused to even hold a budget hearing. “For myself as an advocate, my job is to tell Congress and the administration what I think is needed and how the lack of resources are hurting people,” he said. “It’s not my job to figure out offsets, it’s not my job to come up with the exact language — that’s between Congress and the administration.” It’s not the fault of the White House that Congress has fought back all kinds of budget requests. As for the flurry of House bills two weeks ago, Raymond said he liked them, “but it feels like smoke and mirrors.”
“The federal funding piece for this year is one of the most complicated pictures we’ve seen in some time,” said Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD). There was a proposal in the Senate to provide $600 million through a mechanism of emergency supplemental appropriations for the opioid problem as part of the CARA discussion. “It was real, it was tangible,” said Morrison. It passed by a 48-47 vote on the Senate floor, but didn’t meet the 60-vote threshold.
Morrison doesn’t believe in saying anything is impossible. “The appropriation process is difficult to predict — you keep going until the ink is dry,” he told ADAW. “For anyone to say that they know the exact algorithm for what’s going to lead us to an end product, I would call their bluff.”
A veteran Capitol Hill observer — and former lobbyist — Morrison said messaging is a very common and important approach by all White House administrations. “They’ll say it’s up to Congress,” he said. But he acknowledged that this time it’s more difficult, because the mechanism is “mandatory,” requiring legislation and offsets.
Still, Botticelli’s relentless insistence that substance use disorders are a health problem, not a criminal problem, is a major victory. “We have one of the best ONDCPs ever now,” said Morrison. “What a different problem to have — a strategy problem about trying to get more dollars, whereas before it was about trying to fix very problematic proposals on the budget side.”
It’s getting late
The timing was also mentioned by Andrew Kessler, principal of Slingshot Solutions. “While this effort by the White House shows commitment to treating opioid abuse, there are political realities that place some real hurdles in the way of the $1.1 billion in mandatory funding becoming reality,” Kessler told ADAW. “Not only are we dealing with a short election year calendar and a fiscally conservative Congress, we are also competing with other vital public health interests, such as the Zika virus and the Flint water crisis.”
There is also the Comprehensive Addiction and Recovery Act (CARA), which was passed overwhelmingly by the Senate but the House didn’t even take up (see ADAW, May 2). “A large part of the advocacy community have spent a large part of the last year advocating for CARA,” said Raymond. “We’re in the final quarter, everybody agrees it will get signed into law, and suddenly we don’t have any money attached.”
As one lobbyist said, the aim now is to get funding for whatever compromise bills come out of the House and Senate. “This isn’t partisan, it’s just good policy.”
The ONDCP responded to our multiple requests for an interview with this statement from spokesman Mario Zepeda: “The administration looks forward to working with Congress on securing funding to provide families and communities with the support they need for prevention and to ensure that treatment is available to those who seek it.”
Advocates, somewhat disgruntled by a White House “guilt trip” telling them they haven’t been doing enough, still stand strong behind the need for funding.