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February 23, 2023 | Volume 27, No. 1| Archives

ICYMI: A Substantive Advocacy WIN on Federal Drug Policy

In This Issue: 
  • Advocacy Win that Expands Opioid Use Treatment and Saves Lives
  • Better Know an Advocate: Interview with Erin Schanning
  • Medicaid:
    • Redeterminations and the End of the Public Health Emergency
    • The Battle to Protect Medicaid, Again
  • The White House
  • Federal Encampment Clearing
  • COVID Corner
  • What We're Reading 
Advocacy Win that Expands Opioid Use Treatment and Saves Lives
    Prescribe bupe and save lives.
    At the end of December, President Biden signed into law the bipartisan omnibus appropriations bill that included the Mainstreaming Addiction Treatment Act (H.R. 1384 / S. 445), which eliminates the need for providers to obtain a special waiver to prescribe buprenorphine for opioid use disorder. This is a critical step at a time when fewer than 1 in 10 Americans who need treatment can access it. Likewise, many providers cite the regulatory burden as a primary reason they do not prescribe.
    Here’s a summary of the MAT Act’s key provisions:
    • Removes the X-Waiver registration requirement
    • Removes the patient limits
    • Removes the special DEA "X" prescribing number
    • Removes counseling referral and ancillary services requirement
    • Removes X-Waiver training requirement
    • Removes list of health care providers who can prescribe buprenorphine for opioid use disorder.
    Bottom line: Effective immediately, all health care providers with a DEA registration that includes Schedule III medications can begin to prescribe buprenorphine for opioid use disorder.
    This is a tangible advocacy WIN! Not only will removing these barriers increase access to care by making prescribing easier, it will save lives and reduce the stigma of this specific medication. Read our coalition’s support letter to Congressional leadership as well as the support statements from both the Office of National Drug Control Policy Director and the Drug Enforcement Administration (DEA) Administrator. On Jan. 24, the White House held an event to highlight removing barriers to addiction treatment, which featured many of the advocates leading the charge to remove the X-waiver (including NHCHC; see photo below!).

    Take Action on Addiction Treatment: 

    • Increase access to treatment by screening and prescribing (as appropriate) at higher rates.
    • Lower barriers to care using a harm reduction approach.
    • Encourage your agency/organization to make access to buprenorphine a priority clinical issue
    • Educate other community providers about the change in law.
    • Fight stigma. Increase access to care. Prescribe “bupe.” Save lives.
    Better Know an Advocate: Interview with Erin Schanning
    To better understand what made the MAT Act advocacy successful, we talked with Erin Schanning, President of End Substance Use Disorder, one of the key advocates in the pursuit of passing The MAT Act.
    How did you get started in this work?
    I lost my little brother Ethan about six years ago to an overdose. Ethan had doggedly pursued treatment for eight years before passing away. Our family didn’t even know about buprenorphine and how critical it is to preventing overdose and supporting recovery. Then I learned that a federal rule prevented health care providers from prescribing the medication—and I was passionate about removing that federal rule. I also learned there was already a bill in Congress that would do this, but it had stalled and needed additional momentum. We built an amazing coalition that helped push that forward.
    How long did it take to get the MAT Act passed, and what did it take to achieve ultimate success?
    It took 4 years for the MAT Act to pass from first introduction to being signed into law—over two congressional sessions. I think the turning point was bringing together a coalition of organizations to collaborate on strategy and advocacy on a daily basis. Once we did this, the MAT Act picked up a lot of awareness in Congress—and with the Biden-Harris Administration. So coming together really made a difference.
    What keeps you motivated in your advocacy, and how do you keep from giving up or getting burned out?
    On a personal level, I have to live with the reality every day that my family didn’t know about treatments that could have saved my brother’s life. Ethan should still be here with us and contributing to his community. I don’t want anyone else to face that tragedy. So that’s what keeps me going on a daily basis. In addition, I’m grateful to work with coalition members to end the overdose crisis and ensure universal access to treatment. Each coalition member is a leader who has passion and drive and it’s been an honor to work with such talented changemakers.
    In your opinion, why does it take so long to pass even small measures that seem like common sense?
    It takes constant and continuous engagement to move a bill through Congress. Nearly 10,000 bills are introduced every session and it’s not possible for Congressional staffers to develop expertise on all of them—so it takes time to educate each office about the problem and how the bill addresses it. They have very earnest questions about how it will impact their constituents and they need to get the right information to answer those questions.
    But beyond education, we have to engage in frequent communication with the offices to ensure they both support the bill and promote it. With Congress passing so few bills these days, we have to constantly look for a path to bring it up for a vote in both the House and the Senate. In short, it takes an unrelenting drive and collaboration over an entire Congressional session to keep a bill moving forward. You can’t just reach out to the office once—you have to keep at it to get their support and to get them to pass these life-saving bills.
    What are the next steps in the advocacy to increase access to buprenorphine, and what actions are especially needed from the HCH Community?
    I think the most important action is to get the word out about buprenorphine. We need to encourage fellow health care providers and patients to use the medication. We can do that by sharing stories with our colleagues about our positive experiences with buprenorphine and by providing them with support as they start prescribing. Most of all, we have to communicate what a positive impact buprenorphine has on a patient’s well-being and to the provider’s satisfaction to treat patients.
    Many thanks to Erin for her partnership and advocacy in the fight to expand addiction treatment!
    In other substance use news:


    UPDATED POLICY BRIEF: Medicaid redeterminations will begin soon (some states have begun already!) and there is a lot you can do to help your client get ready. Our 2023 FY Spending Bill and the Medicaid Unwinding: Implications for the HCH Community offers important guidance and timeline information to help you and your health centers minimize and mitigate the impact of the unwinding process on the people you serve.
    WEBINAR ON MEDICAID UNWINDING: Join us for a cohosted webinar with the Corporation for Supportive Housing (CSH) and the National Alliance to End Homelessness (NAEH) titled Medicaid Unwinding: Helping Service Recipients Keep their Health Care Coverage on Tuesday, March 14, 2023, at 1:30pm EST / 12:30pm CST. This webinar will cover what Medicaid redetermination means and how you can assist your clients in taking steps now to get ready for the process and respond to states’ requests in a timely manner. Register here

    Take Action on Medicaid Redeterminations: 

    Read the policy brief. Attend the webinar. Ensure everyone receiving Medicaid has updated/confirmed their contact information. Advocate with state Medicaid agencies to conduct automated verification (and other strategies in the brief).
    Remember, 15 million are estimated to lose coverage—and that includes nearly 7 million who are still eligible!
    Every state will likely experience significant disenrollments.
    Here’s what it means for Florida, Kansas, Maryland, Ohio, Oklahoma, and Pennsylvania (as examples).
    Related reading:
    The Battle to Protect Medicaid, Again
    While Congressional leadership and the President all attest they will not cut Medicare and Social Security, notice they are silent on whether they will protect Medicaid. The President’s budget gets released on March 9; this will serve as a road map for the Congressional negotiations to come. But get ready: There’s no doubt we’ll need to fight to protect Medicaid once again, such as by preventing per capita caps (a fancy term for “capping” Medicaid coverage) or federal allowances for work requirements. Stay tuned for developments.


    WHITE HOUSE graphic
    On Feb. 7, President Biden delivered his 2023 State of the Union address, where he recommitted to lowering the cost of prescription drugs, expanding Medicaid, reducing gun violence, and advancing other policy goals
    On Feb. 16, President Biden released an Executive Order on Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government. This EO promises seven actions—outlined further in an accompanying fact sheet:
    • Launches a new annual process to strengthen racial equity and support for underserved communities
    • Empowers Federal equity leader
    • Strengthens community partnerships and engagemen
    • Invests in underserved communitie
    • Improves economic opportunity in rural and urban communitie
    • Addresses emerging civil rights risks
    • Promotes data equity and transparency


    scales graphic
    While forcible clearings of homeless encampments have been getting a lot of attention in local news across the country, the recent clearing of the McPherson Square encampment by the U.S. National Park Service (in partnership with D.C. police) has put a spotlight on the Biden Administration’s actions. In December, the U.S. Interagency Council on Homelessness (USICH) released the federal strategic plan to prevent and end homelessness—a document which specifically says:
    “Unless encampment closures are conducted in a coordinated, humane, and solutions-oriented way that makes housing and supports adequately available, these “out of sight, out of mind” policies can lead to lost belongings and identification which can set people back in their pathway to housing; breakdowns in connection with outreach teams, health care facilities, and housing providers; increased interactions with the criminal justice system; and significant traumatization—all of which can set people back in their pathway to housing and disrupt the work of ending homelessness.” (p. 20)
    Unfortunately, on Feb. 15, the Biden Administration defied its own guidance (and its own principles for addressing encampments) and forcibly evicted about 70 people—many with no linkages to housing or ongoing services. Many of those who left said they didn’t know where they would go, and two were arrested. Tents, sleeping bags, and all other items were hauled away in trash trucks—with no attempt to secure or store personal belongings. National and local advocates had offered to facilitate a discussion that included camp residents and to assist in a more planful transition to housing, but were rebuffed. In response, 10 national organizations (to include National HCH Council, issued a public statement condemning the Administration for its actions.
    The McPherson Square encampment clearing is especially concerning specifically because it was authorized and carried out by federal agencies—and approved by an administration that specifically said it was committed to a better way to end homelessness. Now, the Biden Administration has compromised its ability to advise local jurisdictions on more constructive approaches to unsheltered homelessness. Local officials nationwide can easily point to the Biden Administration’s own actions as justification for forcible clearings of unhoused people with no connections to housing (without even the pretense of securing personal belongings). Clearly this is a very troubling development, and will make it harder to advocate locally for the humane treatment of human beings forced to live their private life in public spaces. 

    Take Action on Encampments with New Resource: 

    Don’t give up fighting against encampment sweeps! Use our new issue brief: Impact of Encampment Sweeps on People Experiencing Homelessness to educate local policy makers about the harms of forcible evictions, and demand an end to the criminalization of homelessness.


    The end of the public health emergency (May 11, 2023) will also mark some changes in how COVID services are reimbursed. Individuals with private insurance, most Medicare plans, and those who are uninsured will no longer have unlimited and free access to COVID vaccines, testing and treatment. Individuals with Medicaid will continue to have these services covered at no cost.
    Moderna reversed their initial plan to begin charging for their vaccines when the public health emergency ends. On February 15 Moderna announced that it is committed to providing their vaccines to individuals regardless of their ability to pay. This change is particularly important as it is widely expected that the CDC will recommend regular COVID booster shots.
    What We're Reading
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    Barbara DiPietro
    Senior Director of Policy
    National HCH Council
    Baltimore, MD
    (443) 703-1346

    This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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