Date: 2016-05-11
Speaker: JACKSON LEE (democrat)
Chamber: H

Mr. Speaker. I rise in support of H.R. 4978. the "Nurturing & Supporting Healthy Babies Act." approved by the Energy and Commerce Committee. In the past decade and a half. the growth in the number of physicians prescribing opioids to help patients deal with pain from surgeries. dental work and chronic conditions has resulted in an increasing number of patients becoming dependent on the powerful and highly addictive painkillerswith patients not only abusing the use of those painkillers but often turning to heroin once their opioid prescription ended. The Centers for Disease Control and Prevention reports that nearly 259 million opioid prescriptions were written in 2012. more than enough for every adult in the United States. It is estimated that in 2013 nearly 4.5 million people in the United States without a valid medical need were using prescription painkillers. The Health and Human Services Department estimates that the number of unintentional overdose deaths from prescription painkillers almost quadrupled between 1999 and 2013 and that abuse of prescription opioids now kills nearly 30.000 Americans each year. Both states and the federal government have begun responding to this growing public health crisis. with many states moving to make antioverdose drugs more available and shield firstresponders from liability in administering those drugs. President Obama. meanwhile. has updated prescribing guidelines to encourage doctors to be more cautious when prescribing opioid painkillers and to emphasize nonopioid therapies for certain conditions. Additionally. the Obama administration has awarded $94 million to community health centers to improve and expand the delivery of substance abuse services. In the presidents FY 2017 budget the administration proposed $1.1 billion to combat drug addiction and is also considering modifying certain rules to improve treatment. Our counterparts in the Senate. on March 10. 2016. passed S. 524. an antiopioid abuse bill that would authorize grants for opioid treatment services and firstresponder training in using antioverdose drug by a 941 vote. as well as create a task force to review and update best practices for prescribing pain medication. S. 524 also mandates investigations into heroin distribution and unlawful distribution of prescription opioids. and requires the creation of a national drug awareness campaign that takes into account the association between prescription opioid abuse and heroin use. The science indicates that opioids can have particularly harrowing effects on infants whose mothers took the drugs during pregnancy. including medical issues stemming from drug withdrawal known as neonatal abstinence syndrome. Advocacy groups note that the incidence of neonatal abstinence syndrome almost tripled from 1.20 per 1.000 hospital births in 2000 to 3.39 per 1.000 hospital births in 2009. In conjunction with H.R. 4978. the "Nurturing & Supporting Healthy Babies Act." the Congressional Budget Office (CBO) has estimated that 45 percent of births in the United States are now covered by the joint federalstate Medicaid program. This bill directs the Government Accountability Office (GAO) to report to Congress on neonatal abstinence syndrome among children covered by Medicaid. including any federal barriers to treating such infants. The GAO must also provide recommendations for improvements that will ensure access to treatment for infants with neonatal abstinence syndrome under state Medicaid programs. Additionally. the measure modifies Medicaid to provide incentives for the development of abusedeterrent formulations of prescription drugs and to prevent disclosure of Medicaid antifraud algorithms. The bill requires that GAOs report identify the prevalence of neonatal abstinence syndrome in the United States. including the proportion of affected children who are eligible for Medicaid at birth and the costs associated with neonatal abstinence syndrome. GAO will also be required to examine Medicaideligible services that are available for treatment of infants with neonatal abstinence syndrome. settings for such treatment. related reimbursement methodologies and costs. and the utilization of various care settings under state Medicaid programs for such treatment. This GAOs report must be submitted to Congress within one year of the bills enactment. Seeking to right the same wrongs as H.R. 4978. the "Nurturing And Supporting Healthy Babies Act." I introduced the. "Stop Infant Mortality and Recidivism Reduction Act of 2016." or the "SIMARRA Act." which will help the Federal Bureau of Prisons to improve the effectiveness and efficiency of the Federal prison system for pregnant offenders. by establishing a pilot program of criticalstage. developmental nurseries in Federal prisons for children born to inmates. It is time that our nation recognizes a longpersistent need to break the cycle of generational. institutional incarceration amongst mothers serving time for nonviolent crimes and the children they birth behind prison bars. H.R. 5130. the. "SIMARRA Act of 2016." gives those infants born to incarcerated mothers a chance to succeed in life. "SIMARRA" is not merely yet another second chance program. demanding leniency from the criminal justice system. Instead. H.R. 5130 asks our national criminal justice system what it can do for those young Americans born and relegated to a life of nearly impossible odds of survival. "SIMARRA" provides that first chancea first chance for American infantsthat many of their mothers. born themselves to mothers behind bars. never received. The bill excludes abusedeterrent formulations of prescription drugs from Medicaids additional rebate requirement for new prescription drug formulations. which is intended to encourage the development of these drugs by allowing drug companies to reduce the rebates they otherwise must pay to Medicaid. The measure also limits disclosure of predictive modeling and other analytics technologies that are used to identify and prevent waste. fraud and abuse in Medicaid. including by exempting covered program integrity algorithms from the Freedom of Information Act (FOIA) and requiring state Medicaid and Childrens Health Insurance Program (CHIP) agencies to have adequate data security policies to ensure the security of covered algorithms. Finally. the measure makes $5 million available to the Medicaid Improvement Fund for expenditures for FY 2021 and beyond. CBO estimates that enacting H.R. 4978 would not. on net. change direct spending over the 20172026 period. While opponents argue that some provisions of the bill will increase direct spending by $80 million over that period. I point out that other provisions would decrease direct spending by the same amount balancing the total cost. Enacting the legislation would affect direct spending. rather than revenues. Under current law. pharmaceutical manufacturers are required to pay rebates to states for prescription drugs provided through Medicaid. The formula which determines rebate amounts in the Medicaid program has several components. with some components generating rebates that are paid to states and shared with the federal government. and others generating rebates that are paid to states and subsequently transferred in their entirety to the federal government. Abuse deterrent formulation. or ADF. is a new technology that is being implemented by the pharmaceutical industry to prevent the abuse of prescription pain medications. For example. some ADFs make it more difficult for an individual to crush. break. or dissolve a drug to inappropriately extract and use its active ingredient. Under the bill. the component of the rebate formula that would no longer apply to ADFs of brandname drugs is one that is paid to states and transferred in full to the federal government. Therefore. states would not be directly affected by this section of the bill. CBO estimates that this section would increase federal Medicaid costs by about $75 million over the 20172026 period by reducing rebates. CBO anticipates that an increasing number of ADFs of brand name drugs will launch over time. therefore. the component of the rebate affected by H.R. 4978 would also grow over time. CBO estimates that enacting the legislation would not increase net direct spending or onbudget deficits by more than $5 billion in any of the four consecutive 10year periods beginning in 2026. H.R. 4978 contains no intergovernmental or privatesector mandate as defined in UMRA and would impose no costs on state. local. or tribal governments. In sum. H.R. 4978. the "Nurturing & Supporting Healthy Babies Act." is a valuable piece of legislation that I encourage my colleagues to support. Additionally. I urge my colleagues to join me in sponsoring and supporting all legislation targeting the improvement of care for the prevention of infant abuse and neglect. such as H.R. 5130. the. "Stop Infant Mortality and Recidivism Reduction Act of 2016" or the "SIMARRA Act."