Policy News Roundup: June 24, 2021

Key reads

Supreme Court tosses latest challenge to the Affordable Care Act

The Supreme Court tossed aside conservatives’ latest challenge to the Affordable Care Act, rejecting the Trump administration’s bid to get the law thrown out. The 7-2 ruling will allow the ACA to continue operating. The group of Republican state attorneys general sought the case due to a 2017 decision by Congress that zeroed out an individual mandate requiring most Americans to obtain health insurance or pay a penalty, arguing that the mandate had become unconstitutional. The court said the Republican state attorneys general bringing the suit did not have legal standing to bring the lawsuit because they could not show that they would suffer any injury from the fact that the individual mandate was still in the law. Justices Alito and Gorsuch dissented, arguing the states’ lawsuit should have been able to proceed and that the shell of the mandate is “clearly unconstitutional, and to the extent that the provisions of the ACA that burden the States are inextricably linked to the individual mandate, they too are unenforceable.”

Source: Supreme Court rejects Republican challenge to Affordable Care Act (Axios)

50 years after the start of the War on Drugs, consensus is growing that the approach failed

Last week marked the 50^th anniversary of Nixon declaring the War on Drugs in an address in which he declared the federal government would treat addiction as “public enemy No. 1.” There is growing consensus across the political spectrum that the response should be handled by health professionals, not law enforcement, and that the drug war model is ineffective and racially biased. Though the House bill introduced last week to decriminalize drugs likely has no chance of passage, there is increasing support for marijuana legalization, Oregon has decriminalized small amounts of drugs and other areas are removing some of the strictest drug war policies. However, billions of dollars are still spent each year on interdiction and millions of people incarcerated on drug charges. There has been a decline in inmate populations in the past decade, though, as well as substantial growth in public funding for substance use treatment. While few believe the drug war will conclusively end soon, the end of bipartisan backing for punitive drug laws is significant.

Source: After 50 Years of the War on Drugs, “What Good Is It Doing For Us?” (NPR)

Biden administration endorses legislation to end the sentencing disparities for crack and powder cocaine

The Biden administration endorsed legislation that would end the disparity in sentences between crack and powder cocaine offenses, highlighting how Biden’s attitudes have shifted over his tenure in elected office, as he helped craft the bill that led to the disparities in 1986. At a Senate Judiciary Committee hearing, Acting ONDCP Director Regina LaBelle expressed the administration’s support for the Eliminating a Quantifiably Unjust Application of the Law (EQUAL) Act, which would eliminate the sentencing disparity and give people who were convicted or sentenced for a federal cocaine offense a resentencing. LaBelle said the disparity is not based on evidence and has caused significant harm for decades, particularly to communities of color. Supporting the bill is a follow-through on a campaign promise for Biden. Many activists and lawmakers have long argued in favor of closing the gap, and Biden introduced legislation to do so in his final years in the Senate. It was reduced from 100-to-1 to 18-to-1 in 2010. Arkansas Governor Hutchinson, a Republican who led the DEA under President Bush, also testified in favor of the law, as did Russell Coleman, former counsel to Sen. McConnell and former U.S. attorney in Kentucky.

Source: Biden administration to endorse bill to end disparity in drug sentencing between crack and powder cocaine (Washington Post); Biden administration to back bill ending crack, powder cocaine sentencing disparity: report (The Hill)

Bill introduced to expand CCBHCs nationwide

U.S. Senators Stabenow and Blunt have introduced the Excellence in Mental Health and Addiction Treatment Act of 2021, which would expand high-quality mental health and addiction services nationwide by giving every state the opportunity to fully fund the creation of Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs are required to provide a comprehensive set of services including 24/7/365 crisis services; outpatient treatment services; immediate screenings, risk assessments and diagnoses; and care coordination. Ten states have been selected so far for full participation in the program created through a 2014 law, and startup grants have expanded clinics to 40 states.

Source: Senators Stabenow, Blunt Announce New Bill to Expand Community Mental Health and Addiction Services Nationwide (Senator Debbie Stabenow)

Legislation introduced to support police-free crisis response

U.S. Senator Van Hollen and U.S. Representative Bass have reintroduced the Community-Based Response Act to improve emergency response capabilities by creating systemic alternatives to police involvement in appropriate situations. The bill would create a new Community-Based Emergency and Non-Emergency Response Grant Program through HHS to establish programs to encourage local governments to develop additional options beyond law enforcement for certain kinds of community-based emergency response. It would also help provide for the dispatch of professionals trained in behavioral health, crisis response and mediation instead of law enforcement.

Source: Van Hollen, Bass Reintroduce Community-Based Crisis Response Legislation (Senator Chris Van Hollen)

Connecticut legalizes recreational marijuana

Connecticut Governor Lamont has signed a bill to legalize the use and cultivation of recreational cannabis and expunge thousands of past possession convictions. Connecticut became the 19^th state to legalize recreational marijuana and the fifth to do so this year. The law takes effect July 1 and will allow adults ages 21+ to possess up to 1.5 ounces. The Department of Consumer Protection is aiming to begin issuing licenses to grow and sell marijuana by the end of next year, with half of licenses to be issued to low-income applicants. Those convicted of possession 2000-2015 will have their records automatically cleared beginning in 2023, and others can apply to have their records expunged starting next July. The smell of marijuana alone will no longer be legal grounds to stop and search people, nor will the suspected possession of up to five ounces.

Source: Connecticut Legalizes Recreational Marijuana, With Sales Aimed for 2022 (New York Times)

Marijuana legalization continues to gain traction

Almost half of the U.S. population lives in a state where marijuana is, or soon will be, legal for recreational use. A decade ago, no states allowed marijuana for recreational use, and now, 18 states and DC have legalized it, with five doing so this year. At least two-thirds of the public support legalization. Of the 15 states where legalization has been on the ballot since 2012, it was approved in 13, including in Republican-dominated Alaska, Montana and South Dakota. Legalization has created a big new industry, which will continue to expand. While some high-profile Democrats, including Senate Majority Leader Schumer, have come out in support, Biden continues to oppose legalization and Republicans are almost entirely opposed. However, some warn that lawmakers may soon have to follow public opinion or risk losing an election. It is unclear, however, if the move toward nationwide legalization will be a slow, state-by-state battle or if federal action will lead to a flurry of states legalizing.

Source: Marijuana legalization has won (Vox)

New Mexico county uniquely uses care coordination model for opioid use disorder

Rio Arriba Health and Human Services, the first county-run health and human services department in New Mexico, was established in 1997 in response to a growing and seemingly localized opioid epidemic. Staff reach out to those with substance use disorder, including people who have survived overdose at the local hospital, those identified by the justice system, and those referred by providers or who self-refer. In 2006, RAHHS adopted the Pathways model of intensive care management for opioid use disorder (OUD). Pathways Care Coordination is an outcomes-based chronic disease case management delivery model that works to mitigate social factors that influence patients’ ability to manage their disease. Rio Arriba is the first county to use this model for OUD. It connects clients to education, employment opportunities and secure housing.

Source: In New Mexico, Pathways Care Coordination Supports People With Opioid Use Disorder (Pew)

Medicare offers inadequate coverage for substance use disorder care

According to a Health Affairs report, while Medicare is often the standard setter for other health care financing systems, it falls behind coverage standards of most private or employer-based insurers and Medicaid for substance use disorder (SUD) services. It covers the least and most intensive services (office-based outpatient counseling and inpatient hospitalization), but not intermediate levels of care (intensive outpatient, partial hospitalization and residential treatment). According to the report, this limited coverage defies clinical recommendations, is costly from a human and economic perspective and is discriminatory from a civil rights perspective. There is a growing unmet need for SUD care among older Americans, who make up most of the Medicare population. The report states that Medicare’s failure to cover intermediate levels of care exacerbates lack of access to care in the community and sets a discriminatory benchmark for other insurance, including for reimbursement rates. The report recommends that Congress and the Centers for Medicare and Medicaid Services (CMS) expand covered benefits to meet the full continuum of care, authorize the full range of addiction practitioners and treatment facilities and apply Parity Act standards. It also argues that Congress should amend the Social Security Act to authorize reimbursement for providers, settings and services consistent with evidence-based practices. Although exempt from the Parity Act, Medicare could still provide more equitable coverage through other CMS reforms.

Source: Medicare’s Discriminatory Coverage Policies For Substance Use Disorders (Health Affairs)

Mental health of parents and unpaid caregivers, particularly of those with mental health or addiction, suffers during pandemic

Among over 10,000 adults surveyed by CDC in December 2020 and February-March 2021, parents with children under 18, unpaid caregivers of adults and parents-caregivers had significantly worse mental health than adults not in these roles, including five times the odds of any adverse mental health symptoms (parents-caregivers). Those who had someone to rely on for support had lower odds of experiencing any adverse mental health symptoms. The highest adjusted odds ratio for adverse mental health symptoms was observed for caregivers of adults with mental health or substance use disorder, highlighting the need for education and support for caregivers in this role.

Source: Mental Health Among Parents of Children <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic – United States, December 2020 and February-March 2021 (Centers for Disease Control and Prevention)

While there has been some progress, laws continue to increase harm to people who use drugs

According to a report from the Network for Public Health Law, laws often work to increase, rather than decrease, risks to people who use substances, despite common claims that “we can’t arrest our way out” and evidence that the War on Drugs approach increases harm. Over the past decade, nearly a dozen states have passed “drug-induced homicide” laws that often penalize low-level dealers and friends of people who have overdosed, not traffickers. Over three dozen states have passed laws to increase fentanyl-related penalties, and several localities have passed laws making it difficult or impossible for syringe service programs (SSPs) to operate. The federal government has prevented the opening of overdose prevention sites and continues to spend tens of billions of dollars on law enforcement and interdiction, and HHS is still barred from spending federal funding on syringes. However, all states have passed laws increasing access to naloxone, nearly all have passed overdose Good Samaritan laws, several have legalized SSPs and Oregon has decriminalized possession of small amounts of drugs. During COVID-19, the federal government acted quickly to remove some barriers to medications for opioid use disorder, and the Biden administration has made it slightly easier to prescribe buprenorphine.

Source: A Decade of Both Progress and Missed Opportunities to Reduce Drug-Related Harm (Network for Public Health Law)