Some states with Republican-controlled legislatures want more data, while some controlled by Democrats want less, fearing it could be used to target patients or providers.
Tag: Indiana
Why Opioid Settlement Money Is Paying County Employees’ Salaries
More than $4.3 billion in opioid settlement money has landed in the hands of city, county and state officials to date — with billions more on the way. But instead of using the cash to add desperately needed treatment, recovery and prevention services, some places are using it to replace existing funding.
Local officials say they’re trying to stretch tight budgets, especially in rural areas. But critics say it’s a lost opportunity to bolster responses to an ongoing addiction crisis and save lives.
“To think that replacing what you’re already spending with settlement funds is going to make things better — it’s not,” said Robert Kent, former general counsel for the Office of National Drug Control Policy. “Certainly, the spirit of the settlements wasn’t to keep doing what you’re doing. It was to do more.”
The debate is playing out in Scott County, Ind. The rural community made headlines in 2015 after intravenous drug use led to a massive HIV outbreak and then-Gov. Mike Pence (R) legalized syringe service programs. (The county has since shuttered its syringe program.)
In 2022, the county received more than $570,000 in opioid settlement funds. It spent about 45 percent of that on salaries for its health director and emergency medical services staff, according to reports it filed with the state. The money usually budgeted for those salaries was freed to buy an ambulance and create a rainy-day fund for the health department.
In public meetings, Scott County leaders said they hoped to reimburse the departments for resources they dedicated to the HIV outbreak years ago.
Their conversations echo the struggles of other rural counties, which have tight budgets in part because for years they poured money into combating the opioid crisis. Now they want to recoup some of those expenses.
But many families affected by addiction, recovery advocates, and legal and public health experts say that misses the point, that the settlements were aimed at helping the nation make progress against the overdose epidemic.
Thirteen states and Washington, D.C., have restricted substituting opioid settlement funds for existing government spending, according to state guides created by OpioidSettlementTracker.com and the public health organization Vital Strategies. A national set of principles created by Johns Hopkins University also advises against the practice, known as supplantation.
But it’s happening anyway.
County commissioners in Blair County, Pa., used about $320,000 of settlement funds for a drug court that has been operating with other sources of money for more than two decades, according to a report the county filed with a state council overseeing settlement funds.
In New York, some lawmakers and treatment advocates say the governor’s proposed budget substitutes millions of opioid settlement dollars for a portion of the state addiction agency’s normal funding.
Given the complexities of state and local budgets, it’s often difficult to spot supplantation. But one place to start is identifying how much opioid settlement money your community has received so far. Use our searchable database to find out. Then ask elected officials how they’re spending those dollars. In many places, dedicated citizens are the only watchdogs for this money.
If you discover anything interesting, shoot me a note.
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Swap Funds or Add Services? Use of Opioid Settlement Cash Sparks Strong Disagreements
State and local governments are receiving billions of dollars in opioid settlements to address the drug crisis that has ravaged America for decades. But instead of spending the money on new addiction treatment and prevention services they couldn’t afford before, some jurisdictions are using it to replace existing funding and stretch tight budgets.
Scott County, Indiana, for example, has spent more than $250,000 of opioid settlement dollars on salaries for its health director and emergency medical services staff. The money usually budgeted for those salaries was freed to buy an ambulance and create a financial cushion for the health department.
In Blair County, Pennsylvania, about $320,000 went to a drug court the county has been operating with other sources of money for more than two decades.
And in New York, some lawmakers and treatment advocates say the governor’s proposed budget substitutes millions of opioid settlement dollars for a portion of the state addiction agency’s normal funding.
The national opioid settlements don’t prohibit the use of money for initiatives already supported by other means. But families affected by addiction, recovery advocates, and legal and public health experts say doing so squanders a rare opportunity to direct additional resources toward saving lives.
“To think that replacing what you’re already spending with settlement funds is going to make things better — it’s not,” said Robert Kent, former general counsel for the Office of National Drug Control Policy. “Certainly, the spirit of the settlements wasn’t to keep doing what you’re doing. It was to do more.”
Settlement money is a new funding stream, separate from tax dollars. It comes from more than a dozen companies that were accused of aggressively marketing and distributing prescription painkillers. States are required to spend at least 85% of the funds on addressing the opioid crisis. Now, with illicit fentanyl flooding the drug market and killing tens of thousands of Americans annually, the need for treatment and social services is more urgent.
Thirteen states and Washington, D.C., have restricted the practice of substituting opioid settlement funds for existing dollars, according to state guides created by OpioidSettlementTracker.com and the public health organization Vital Strategies. A national set of principles created by Johns Hopkins University also advises against the practice, known as supplantation.
Paying Staff Salaries
Scott County, Indiana — a small, rural place known nationally as the site of an HIV outbreak in 2015 sparked by intravenous drug use — received more than $570,000 in opioid settlement funds in 2022.
From August 2022 to July 2023, the county reported using roughly $191,000 for the salaries of its EMS director, deputy director, and training officer/clinical coordinator, as well as about $60,000 for its health administrator. The county also awarded about $151,000 total to three community organizations that address addiction and related issues.
In a public meeting discussing the settlement dollars, county attorney Zachary Stewart voiced concerns. “I don’t know whether or not we’re supposed to be using that money to add, rather than supplement, already existing resources,” he said.
But a couple of months later, the county council approved the allocations.
Council President Lyndi Hughbanks did not respond to repeated requests to explain this decision. But council members and county commissioners said in public meetings that they hoped to compensate county departments for resources expended during the HIV outbreak.
Their conversations echoed the struggles of many rural counties nationwide, which have tight budgets, in part because they poured money into addressing the opioid crisis for years. Now as they receive settlement funds, they want to recoup some of those expenses.
The Scott County Health Department did not respond to questions about how the funds typically allocated for salary were used instead. But at the public meeting, it was suggested they could be used at the department’s discretion.
EMS Chief Nick Oleck told KFF Health News the money saved on salaries was put toward loan payments for a new ambulance, purchased in spring 2023.
Unlike other departments, which are funded from local tax dollars and start each year with a full budget, the county EMS is mostly funded through insurance reimbursements for transporting patients, Oleck said. The opioid settlement funds provided enough cash flow to make payments on the new ambulance while his department waited for reimbursements.
Oleck said this use of settlement dollars will save lives. His staff needs vehicles to respond to overdose calls, and his department regularly trains area emergency responders on overdose response.
“It can be played that it was just money used to buy an ambulance, but there’s a lot more behind the scenes,” Oleck said.
Still, Jonathan White — the only council member to vote against using settlement funds for EMS salaries — said he felt the expense did not fit the money’s intended purpose.
The settlement “was written to pay for certain things: helping people get off drugs,” White told KFF Health News. “We got drug rehab facilities and stuff like that that I believe could have used that money more.”
Phil Stucky, executive director of a local nonprofit called Thrive, said his organization could have used the money too. Founded in the wake of the HIV outbreak, Thrive employs people in recovery to provide support to peers with mental health and substance use disorders.
Stucky, who is in recovery himself, asked Scott County for $300,000 in opioid settlement funds to hire three peer specialists and purchase a vehicle to transport people to treatment. He ultimately received one-sixth of that amount — enough to hire one person.
In Blair County, Pennsylvania, Marianne Sinisi was frustrated to learn her county used about $322,000 of opioid settlement funds to pay for a drug court that has existed for decades.
“This is an opioid epidemic, which is not being treated enough as it is now,” said Sinisi, who lost her 26-year-old son to an overdose in 2018. The county received extra money to help people, but instead it pulled back its own money, she said. “How do you expect that to change? Isn’t that the definition of insanity?”
Blair County Commissioner Laura Burke told KFF Health News that salaries for drug court probation officers and aides were previously covered by a state grant and parole fees. But in recent years that funding has been inadequate, and the county general fund has picked up the slack. Using opioid settlement funds provides a small reprieve since the general fund is overburdened, she said. The county’s most recent budget faces a $2 million deficit.
Forfeited Federal Dollars
Supplantation can take many forms, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. Replacing general funds with opioid settlement dollars is an obvious one, but there are subtler approaches.
The federal government pours billions of dollars into addiction-related initiatives annually. But some states forfeit federal grants or decline to expand Medicaid, which is the largest payer of mental health and addiction treatment.
If those jurisdictions then use opioid settlement funds for activities that could have been covered with federal money, Weizman considers it supplantation.
“It’s really letting down the citizens of their state,” she said.
Officials in Bucks County, Pennsylvania, forfeited more than $1 million in federal funds from September 2022 to September 2023, the bulk of which was meant to support the construction of a behavioral health crisis stabilization center.
“We were probably overly optimistic” about spending the money by the grant deadline, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.
Now the county plans to use $3.9 million in local and state opioid settlement funds to support the center.
Susan Ousterman finds these developments difficult to stomach. Her 24-year-old son died of an overdose in 2020, and she later joined the Bucks County Opioid Settlement Advisory Committee, which developed a plan to spend the funds.
In a September 2022 email to other committee members, she expressed disappointment in the suggested uses: “Please keep in mind, the settlement funds are not meant to fund existing programs or programs that can be funded by other sources, such as federal grants.”
But Rosati said the county is maximizing its resources. Settlement funds will create a host of services, including grief groups for families and transportation to treatment facilities.
“We’re determined to utilize every bit of funding that’s available to Bucks County, using every funding source, every stream, and frankly every grant opportunity that comes our way,” Rosati said.
The county’s guiding principles for settlement funds demand as much. They say, “Whenever possible, use existing resources in order that Opioid Settlement funds can be directed to addressing gaps in services.”
Ed Mahon of Spotlight PA contributed to this report.
KFF Health News’ ‘What the Health?’: Arizona Turns Back the Clock on Abortion Access
The Host
The Arizona Supreme Court shook up the national abortion debate this week, ruling that a ban originally passed in 1864 — before the end of the Civil War and decades before Arizona became a state — could be enforced. As in some other states, including Florida, voters will likely have the chance to decide whether to enshrine abortion rights in the state constitution in November.
The Arizona ruling came just one day after former President Donald Trump declared that abortion should remain a state issue, although he then criticized the ruling as having gone “too far.”
This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Rachel Cohrs Zhang of Stat.
Among the takeaways from this week’s episode:
- Former President Donald Trump’s remarks this week reflect only the latest public shift in his views on abortion access. During an appearance on NBC’s “Meet the Press” in 1999, he described himself as “very pro-choice,” but by the 2016 presidential campaign, he had committed to nominating conservative Supreme Court justices likely to overturn the constitutional right to an abortion. Trump later blamed Republican losses in the 2022 elections on the overturning of that right.
- Arizona officials, as well as doctors and patients, are untangling the ramifications of a state Supreme Court ruling this week allowing the enforcement of a near-total abortion ban dating to the Civil War. Yet any ban — even one that doesn’t last long — can have lasting effects. Abortion clinics may not survive such restrictions, and doctors and residents may factor them into their decisions about where to practice medicine.
- Also in abortion news, an appeals court panel in Indiana unanimously ruled that the state cannot enforce its abortion ban against a group of non-Christians who sued, siding with mostly Jewish plaintiffs who charged that the ban violates their religious freedom rights.
- A discouraging new study finds that paying off an individual’s medical debt once it has reached collections doesn’t offer them much financial — or mental health — benefit. One factor could be that the failure to pay medical debt is only a symptom of larger financial difficulties.
Also this week, Rovner interviews KFF Health News’ Molly Castle Work, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about an air-ambulance ride for an infant with RSV that his insurer deemed not to be medically necessary. If you have an outrageous or baffling medical bill you’d like to send us, you can do that here.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: Stat’s “Your Dog Is Probably on Prozac. Experts Say That Says More About the American Mental Health Crisis Than Pets,” by Sarah Owermohle.
Rachel Cohrs Zhang: KFF Health News’ “Ten Doctors on FDA Panel Reviewing Abbott Heart Device Had Financial Ties With Company,” by David Hilzenrath and Holly K. Hacker.
Alice Miranda Ollstein: The Texas Tribune’s “How Texas Teens Lost the One Program That Allowed Birth Control Without Parental Consent,” by Eleanor Klibanoff.
Rachel Roubein: The Washington Post’s “As Obesity Rises, Big Food and Dietitians Push ‘Anti-Diet’ Advice,” by Sasha Chavkin, Caitlin Gilbert, Anjali Tsui, and Anahad O’Connor.
Also mentioned on this week’s podcast:
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Religious Freedom Arguments Underpin Wave of Challenges to Abortion Bans
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Covid Worsened a Health Crisis Among Pregnant Women
KHN’s ‘What the Health?’: Biden Hits the Road to Sell Democrats’ Record
Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.
What do pandemic preparedness, mental health care services, and over-the-counter hearing aids have in common? They are all things President Joe Biden touted on the campaign trail this week as he tries to maintain Democrats’ majorities in Congress in the midterm elections Nov. 8.
Biden is also campaigning on his support for abortion, promising to sign a bill codifying abortion rights if Democrats retain control of the House and Senate. Recent polls, however, have shown abortion slipping as a top voting issue.
This week’s panelists are Julie Rovner of KHN, Sarah Karlin-Smith of the Pink Sheet, Sandhya Raman of CQ Roll Call, and Mary Agnes Carey of KHN.
Among the takeaways from this week’s episode:
- Among initiatives recently highlighted by the White House is a plan to prepare for future pandemics and thwart any bioterror attacks. But the question is where that money would come from. Republicans in Congress already have balked at providing more money for public health funding for some covid-19 and monkeypox programs.
- Powerful advocates in the Senate — Sens. Patty Murray (D-Wash.) and Sen. Richard Burr (R-N.C.) — have supported legislation to advance the national public health strategy, but there is very little time in this session to push such a package through. And Burr is retiring at the end of the year, so it’s not clear who on the Republican side of the aisle might be willing to take up the baton.
- Although the abortion issue appeared to be helping Democrats’ midterm prospects after the Supreme Court overturned Roe v. Wade in June, some of that excitement may be receding as the economy and other issues move to the forefront of voters’ concerns. But there are few precedents in recent U.S. history to guide voters in evaluating the issue of abortion today or reacting to such a major, sudden change.
- Even if the Democrats were to keep hold of the levers of power on Capitol Hill, they would have a tough time pushing through an abortion bill. No one expects the party to take control of 60 seats in the Senate — needed to overcome a filibuster – and Democrats might not have the votes to get rid of the filibuster, either. Nearly all Republicans are expected to oppose any such effort.
- One obstacle to passing national legislation securing abortion rights is that over the half-century since deciding Roe, the Supreme Court has approved a variety of state laws that limit access, such as allowing parents to be notified if a teen were to seek an abortion. Many Democrats object to those restrictions and would want to exclude them from any new law, while other members of Congress would demand them.
- Biden’s promise was designed to remind voters who care about this issue to come out to the polls in three weeks, but it was also a reminder to many progressives of the failure of the administration to prepare and have a strategy to protect abortion rights ready when the Supreme Court ruling came down.
- Indiana Attorney General Todd Rokita is not backing down from his criticism of an Indianapolis doctor who performed an abortion on a 10-year-old Ohio girl who could not get the procedure there because of a strict new state law. The doctor has shown that she followed all Indiana procedures, but Rokita’s criticism continues to concern others who support abortion access. That chilling effect may well be part of Rokita’s strategy.
- Pharmacists are also worried about their liability in states with strict abortion limits. Federal officials have announced a probe of CVS and Walgreens after complaints that they are not readily filling prescriptions for drugs that can be used for many medical indications but also could terminate an early pregnancy.
- An advisory committee for the FDA this week recommended removing from the market a drug used to prevent preterm births. The drug, Makena, was first approved in 2011 through an accelerated pathway that requires the company to conduct follow-up studies assessing the drug’s efficacy. Those trials found that Makena didn’t help pregnancies progress to later gestational age or improve the health of the premature babies.
- If the FDA accepts the committee’s recommendation, it would be a rare step. It would be only the second time that a drug approved on the accelerated pathway has been withdrawn over a sponsor’s objections.
- This week also marked a milestone for people with mild to moderate hearing loss. Starting last Monday, the government approved over-the-counter sales of hearing aids. The move is expected to dramatically reduce the prices of the devices and open a potentially giant market of consumers now able to afford them.
Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:
Julie Rovner: KHN and NPR’s “Kids’ Mental Health Care Leaves Parents in Debt and in the Shadows,” by Yuki Noguchi
Sarah Karlin-Smith: Scientific American’s “Some People Really Are Mosquito Magnets, and They’re Stuck That Way,” By Daniel Leonard
Sandhya Raman: Journal of the National Cancer Institute’s “Use of Straighteners and Other Hair Products and Incident Uterine Cancer,” by Che-Jung Chang, et al.
Mary Agnes Carey: KHN’s “Blind to Problems: How VA’s Electronic Record System Shuts Out Visually Impaired Patients,” by Darius Tahir
Also mentioned in this week’s episode:
KHN’s “Say What? Hearing Aids Available Over-the-Counter for as Low as $199, and Without a Prescription,” by Phil Galewitz
Politico’s “‘Michigan Could Become Texas’ — Voters See Stark Choice on Abortion Referendum” by Alice Miranda Ollstein
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And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.