Madam President, I would like to first thank my colleague, Senator Manchin, for arranging this time to talk about the ongoing opioid epidemic across the country. I know that his home state of West Virginia – much like my home state of Rhode Island – has been hit particularly hard by this epidemic. This is not happening in some far-off place or distant country, it’s happening in Rhode Island, West Virginia, and indeed every state throughout the nation.

Last year, over 330 Rhode Islanders lost their lives due to an overdose.  Rhode Island is a small state, so let me talk about national statistics that show the extent of this crisis. Last year, drug overdoses killed 50,000 Americans. That means more people died last year because of drug overdoses than due to car crashes or gun violence. These numbers are staggering, and it’s happening in all of our communities.

Since 2011, the number of overdose deaths has increased by more than 90 percent.  Unfortunately, year after year, Rhode Island continues to top the nation in terms of rates of overdose deaths.  We must work to turn this around and get more people access to treatment for opioid addiction.

Almost a decade ago, in 2008, Congress enacted the landmark Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity law.  For the first time, the law required insurance companies to cover behavioral health services in the same way that physical health services are covered.  This was a critical step, but it ultimately did not solve the problem as some insurance companies continued to find ways to avoid complying with the law or at least its spirit. 

It took passage of the Affordable Care Act to improve access to behavioral health services.  For the first time, critical consumer protections like banning discrimination based on pre-existing conditions ensured that individuals with substance use disorders could not be denied coverage.  Further, the ACA established a set of essential health benefits that all insurance plans must cover, including mental health and substance abuse treatment.  Gone are the days when consumers would pay steep prices for health insurance that in actuality did not even cover basic health services, such as mental health care or maternity care.  In addition, the ACA prohibits lifetime and annual limits on care.  Before the ACA, many people with chronic health conditions, such as substance use disorders, would hit their annual cap just a couple of months into the year and then would have to pay all other costs out of pocket for the rest of the year.

Lastly, the expansion of Medicaid has made a tremendous improvement in access to behavioral health services.  In states like Rhode Island that have expanded Medicaid, we have seen a sharp drop in the percentage of people with substance use disorders who seek care in the emergency department because they are uninsured.  Medicaid is the single largest payer of substance use disorder services and pays for a third of all medication-assisted treatment in the country.

Trumpcare would reverse all of these gains. According to the Center on Budget Policy and Priorities, repeal of the ACA would mean 2.8 million people with substance use disorders would be at risk of losing coverage.  Repeal of the Medicaid expansion would cut $4.5 billion from mental health and substance use disorders for the low-income, to say nothing of Trumpcare’s broader goal of ending Medicaid as we know it.  Trumpcare would all but eliminate this critical safety net. 

Trumpcare goes even further to turn back the clock on consumer protections like pre-existing conditions.  People with substance use disorders would be disadvantaged immediately, as their substance use disorder could be considered a pre-existing condition.  This has the double effect of pricing people with mental and behavioral health issues out of the market entirely and encouraging people to not seek care out of fear of being labeled by their insurance company as having a pre-existing condition. 

On top of that, Trumpcare would gut the essential health benefits protections in the ACA.  This means that there would be no rules about what health insurance must cover, such as preventive health services and mental and behavioral health services.  Even with coverage, people will have to pay out of pocket for the services they need.  For substance use disorders, that could add up to $20,000 a year in out of pocket costs alone.

Over the last couple of years, I have worked with my colleagues on the Senate Appropriations Committee to include historic funding increases for programs to help combat the opioid crisis.  In fact, the Fiscal Year 2017 Omnibus provided $511 million for prevention, enforcement, treatment, and recovery across various agencies, including over $300 million for the Department of Health and Human Services, $50 million for the Department of Veterans Affairs, and over $160 million for the Department of Justice. And last year, we passed the 21st Century Cures Act, which directed $1 billion to states to help combat the opioid crisis.  We must continue these efforts.

However, this week, the President released his budget proposal for next year and it does the exact opposite.  First of all, the President’s budget doubles down on his plan to decimate Medicaid.  The President has proposed cutting hundreds of billions of dollars from Medicaid, block granting the program, with no protections for the most vulnerable.  In fact, his budget offers no details on how he plans to structure Medicaid, just that he intends to cut the program beyond repair.  On top of that, the President’s budget makes enormous cuts to the Substance Abuse and Mental Health Services Agency (SAMHSA), which implements many of our most effective substance use disorder prevention and treatment programs, such as the community mental health services block grant, which President Trump has proposed cutting by over 20 percent.  Further, President Trump has proposed cutting the National Institutes of Health by nearly $6 billion, which would interrupt critical research into new and better ways to treat substance use disorders, along with research into how we can better treat pain without the use of addicting opioid painkillers.  Coupled with Trumpcare, this budget proposal will only worsen the opioid crisis. 

I am committed to continuing to work with my colleagues to prevent that from happening.  I am heartened to see so many of my colleagues talking about these very issues this afternoon and it is my hope that we will be able to work together over the coming months to ensure that the gains we have made in the fiscal year 2017 Omnibus and the Cures Act are not lost.  We have much more work to do and people in my state and across the country are counting on us to do that for them.

With that, Madam President, I yield the floor.