The NPR Politics Podcast - Opioid Emergency/Listener Mail

Episode Date: August 14, 2017

President Trump has said the opioid epidemic is an emergency but has yet to take formal action. Plus, some listener questions. This episode: host/congressional reporter Scott Detrow, White house correspondent Tamara Keith, and White House correspondent Scott Horsley. More coverage at nprpolitics.org. Email the show at [e-mail]. Find and support your local public radio station at npr.org/stations.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

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Hey there, this is Tamara Keith. I am in Cartagena, Colombia right now, traveling with Vice President Mike Pence. And because I was due to be on the road this week, and because a lot of us on the podcast are traveling or out, we pre-recorded today's episode on Friday afternoon, before the events in Charlottesville over the weekend. We'll talk more about the political issues at hand in our Thursday episode. Until then, if you want to listen to something about Charlottesville, Up First has former NPR politics podcaster Sarah McCammon on their Monday episode. She was reporting from Charlottesville all weekend, and they'll be talking about Charlottesville more throughout the week. Also, Sam Sanders will have an episode of his new show, It's Been a Minute, about Charlottesville up on Tuesday morning. And Code Switch, NPR's team

covering race, identity, and culture, will dedicate their regular Wednesday podcast to Charlottesville as well. And as always, you can follow more of our work at NPR Politics on NPR.org or our Facebook page or on the NPR One app and, of course, on your local public radio station. Okay, here's the show. Hey there, it's the NPR Politics podcast here to talk a bit about how President Trump is addressing the opioid crisis and to answer some of your questions. I'm Scott Detrow. I cover Congress. I'm Tamara Keith. I cover the White House. And I'm Scott Horsley.

I also cover the White House. All right. It is the end of a week of news, but we are getting ready for next week and pre-taping this on Friday. So we'll see what happens over the next few days. But one big thing that happened this week was that President Trump, speaking from his golf course in Bedminster, New Jersey, said that he is ready to declare the opioid crisis as a national emergency. First, let's listen to what he said, and then we can talk about what exactly this means. So here's Trump

on Thursday afternoon speaking at his golf course. The opioid crisis is an emergency, and I'm saying officially right now it is an emergency. It's a national emergency. We're going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis. The Presser 2.0 But you need emergency powers to address it. The President We're going to draw it up, and we're going to make it a national emergency. It is a serious problem, the likes of which we have never had.

You know, when I was growing up, they had the LSD, and they had certain generations of drugs. There's never been anything like what's happened to this country over the last four or five years. And I have to say this, in all fairness, this is a worldwide problem, not just a United States problem. This is happening worldwide. But this is a national emergency,

and we are drawing documents now to so attest. Okay, so first of all, big picture, Tam, just how bad has the opioid crisis gotten at this point? The last year for which data is available is actually 2015. And that year was pretty terrible. According to the president's opioid commission, which put out a report about two weeks ago, 142 Americans die every day from overdoses. The report puts that in stark terms. That is a 9-11 every three weeks. That's remarkable. And it's not gotten any better in 2016. No.

Or 2017. And in fact, this drug fentanyl and another drug called carfentanil have become more widespread, often mixed in with the heroin that a lot of people are taking. And these drugs can kill people with just like a tiny amount that folks don't even know that they're taking. Yeah. And before we get to what the White House is doing now, this is an issue that President Trump talked a lot about on the campaign trail. It's an issue that, frankly, almost everybody running for president talked a lot about on the campaign trail because so many voters had such deep personal stories. What

generally has the federal government been doing to address this up until this point? Last year, Congress, in a bipartisan fashion, passed major legislation to try to increase treatment and recovery options to push more funding into dealing with this crisis. But members of Congress and the President's Opioid Commission, the former Surgeon General, any number of other experts have been saying more needs to be done. And the Opioid Commission had an interim report that was put out on July 31st. And in that interim report, it said, this is urgent. We're getting you a final report eventually. But here are a bunch of things that you, the federal government, and you, the president of the United States, can do to improve the situation. Top on that list was declare a public

health emergency. So not to make light of a serious situation, but hearing President Trump yesterday, what I kept thinking about was the episode from the office when Michael Scott declares bankruptcy by yelling, I declare bankruptcy. And someone's like, no, you can't just say it. It's a formal legal process. President Trump just saying this is an emergency is not an official declaration because that's something that has lots of legal things that click in. But up until this point, there has been no official paperwork signed. Right. Right. And the president said we're drawing up the papers. So I got in touch with the White House immediately and I was like,

who is drawing up the papers? What kind of emergency declaration will this be? There's a couple of different options for a formal declaration. And one reason you had questions is earlier in the week, Health Secretary Tom Price had suggested that he didn't think an emergency declaration was necessary. We believe that at this point that the resources that we need or the focus that we need to bring to bear to the opioid crisis at this point can be addressed without the declaration of an emergency, although all things are on the table for the president. Then Trump comes out a couple of days later and changes course. And we should say that when President Trump came out and made this announcement, it was not a formally planned announcement. He was coming out to talk to reporters in advance

of a security briefing. And a reporter asked a question. He said, is the opioid crisis an emergency? And why haven't you declared it as such, more or less? And that's where the president's response came from. So early this morning, I got a note from the White House that said, on background, the president is considering not just the emergency authorities outlined in the report, that would be the Opioid Commission report that recommended declaring emergency, but other potential options as well to ensure we're doing all that we can to tackle this crisis head on. Which is to say, based on the questions that I had asked that got that response, they're probably not drawing up the papers. And the challenge here is, you know, the president has been on vacation. He's at his

golf course in New Jersey, and the White House has gone out of its way to emphasize this is a working vacation. He's still doing things. I was up in New Jersey when they were kind of laying out their roadmap for all the cabinet secretaries that would be coming in. And the very first item they teed up for this president to look busy during his working vacation was a meeting. Oh, my gosh. That was a golf course pun. Subtle Scott Horsley pun. They just fly right by. The very first item they've teed up is this briefing on the opioid epidemic. And yet they haven't done the sort of basic blocking and

tackling to say, OK, what are we going to do? What's going to be our point? What is the ideal world thing that the federal government could do to lower the number of people dying, lower the number of people facing addiction? One of the things that this report says the federal government could do is use its powers to negotiate prices on this drug naloxone. Now, that is the life-saving rescue drug that they can give people to reverse an overdose. The commission wants that drug to be in the hands of every single law enforcement officer in the United States of America. Right now it's not. And the drug is expensive. And the federal government doesn't typically negotiate drug prices, but they could, the commission argues, with an emergency declaration.

Another significant thing is that currently under Medicaid rules, there is a cap on the number of people who can be treated in inpatient treatment programs. It's capped at 16. This argues that the Health and Human Services Secretary should grant a waiver in all 50 states to allow doctors and these facilities to see more people. And there are a ton of other recommendations too, but those are two major ones. Certainly you want to make sure that anyone who is trying to break an addiction to opioids and who is seeking treatment can get treatment. And one of the complaints about the unsuccessful Republican bill to repeal Obamacare was that the

cuts to Medicaid would have actually restricted the access to treatment for some people suffering from addiction. All right. Well, in addition to that, we do have a bunch of questions on a whole range of topics to dig into. So let's shift gears and go to the mailbag. The first question comes from Jesse in Milwaukee. Jesse writes, I am the education coordinator at a small nonprofit in Milwaukee. My position is dependent upon a community development block grant. In Trump's original proposal, all CDBG funds were cut. I know this is just a starting point, but since then I haven't heard much of anything about the budget. What is going on?

I'm currently working on a proposal for 2018 funding, and I don't even know if it will exist. Thanks. So what is going on with the budget? How can we help Jesse in Milwaukee here? Well, Jesse's problem is widespread because there are an awful lot of small and not so small nonprofits that depend on community development block grants. And everyone who relies on a CDBG is getting the heebie-jeebies because they don't know what's going to happen. Your work here is done. And I'll pass off to Tam to handle the real question.

Tam, generally, this is one of the many big picture things that are going to be figured out in September as a wave of deadlines start hitting us. And it seems like you start with the big picture and you get down to the specific budget lines pretty late in the game. Yeah, I mean, I wouldn't focus with any specificity on anything in a presidential budget. That is a vision document. And then Congress says, actually, we have the power of the purse strings over here. And it's not clear how that's all going to shake out. But the process is underway. But in the end, you know, it'll probably come down to some sort of a late night scramble and fight. And then suddenly there will be a budget.

Basically, Congress and the White House deal with their budgeting the polar opposite way that a small nonprofit deals with its budgeting, in that that is something that's worked out months in advance and planning often, often that is not how Washington rolls. Right. All right. Next question is from Carlos, who asks, I recently read an article about the average age of senators being 63 years old and how long some of these senators have been serving as public elected servants. Just like the president, how come there are no term limits for other elected officials? Should there be term limits? What would be the ideal term limit? How come there are not that many younger elected officials? Thanks for your input, Carlos. So a couple different questions

there. And I think first of all, something that Sue Davis pointed out in the newsroom a couple of weeks ago is that by this point, usually you have a couple senators who are saying, I've had enough of this. I'm ready to retire. I'm not running again. And up until this point, no senators have said, I'm retiring. I'm stepping down. And that includes people like Dianne Feinstein on the Democratic side and Orrin Hatch on the Republican side who have been in the Senate for a lengthy amount of time. And who are both in their 80s. Yeah. And it's a six year term. Yeah. So if they're running for reelection, that means they're signing up to be pushing 90. And as for term limits, it gets more complicated. But we are the people to talk to you because all of us covered at one point a state that does have strict term limits in place that really profoundly changed the way that legislating was done there. And that's the state of California. Yes, we all lived in the Petri dish of California at various points. Some of us lived in coastal San Diego. Others lived in, you know, inland Sacramento.

And Fresno. But so what I saw covering the California legislature, which when I was covering it had strict term limits, is that there were a lot of new people around and there was not a lot of institutional knowledge. And what that led to was certain staff who had an incredible amount of power because they had the institutional memory. They knew how to make things happen. And lobbyists had more power. Yeah. And one thing that struck me was that everyone would be very straightforward of saying, yes, this lobbyist wrote this bill and I'm introducing it. And not only a lot of turnover, but often the way that the classes of lawmakers would come in, big chunks of the assembly at any given time would all be freshmen together. And I think a lot of people say that legislating is something that takes a while to figure out how it works. And that's the argument for not having term limits, because you stay in

the job, you get better, you learn the rhythms, you learn the deliberations. There's a strong argument for term limits, too, though. Obviously, the downside of term limits is that you do lose institutional memory. The proponents would argue you bring in fresh blood, you bring in new ideas. And we have all covered congressional hearings where you see some lawmakers who look like they need fresh ideas. And of course, you don't have to have term limits to do that. Voters can at any time decide that their lawmaker has been around too long and needs to head for retirement. In most cases, they don't. So the voters apparently think it's okay to have a Senate with an average age of what it is. So last thing you asked about is the ideal length of term limits. We were talking about California. So I should point out that they actually recently tweaked their term limits there before it had been a set amount of time you could serve in the assembly, that a set amount of time you could serve in the Senate. And that created these situations where you had large gulfs of people coming in and out. But they changed it so that there's a set amount of time you could serve in the Senate. And that created these situations where you had large gulfs of people coming in and out, but they changed it so that there's a set amount of time

that you could serve in both, but you could spend all that time in one chamber or the other. And that's created a situation, the drafters of that language hope, where people can build up a little more seniority and you don't have an entire legislative body of newcomers who don't know which way the bathroom is. Okay. All right. We are sticking to a theme today. You know, I guess with Congress being off for a month, everybody's really just thinking about Congress and missing it. Next up is... We lined up two White House reporters, so let's get all the congressional questions from the mailbag. Keeping you on your toes. It's a recorded question from Amy in Maine. The Senate Intelligence Committee seems awfully important these days. And my own

Senator Collins of Maine is seriously considering running for governor. So she might leave the Senate. And who would decide who fills her seat? Does McConnell just pick somebody? Do the Republicans vote? How do they decide how many Democrats and how many Republicans are on the committee? I'm just really confused by the whole committee thing. And it's always seemed not that important. But nowadays, it seems really important. So I hope you can figure it out. I learned a lot from you guys. Thanks for all your great work. So I think there's two different seats here. Amy was mostly talking about Collins' seat on the committee, but her actual Senate seat, if she or any other senator leaves before a term is up,

it depends on the state on how that's filled. Right. And in the state state on how that's filled. Right. And in the state of Maine, it's one of something like 36 states where the governor chooses who would serve out the rest of the Senate term. So right now, the governor in Maine is Governor LePage, who is a Republican. He would presumably pick another Republican, maybe not one as moderate as Susan Collins. So that senator would then be the lawmaker representing the people of Maine, but would not necessarily take over Collins' seat on the all-important Intelligence Committee. That seat would be filled by the GOP leadership? Yeah, I think that's right. And there are some committees that are very high profile and

desirable, and lots of people want to sit on them. And that's a seniority issue. And other committees that not as many people are interested in that often go to lower ranking freshman lawmakers. But yeah, that's something that Democratic and Republican leadership decide. One interesting committee jostling thing that happened at the beginning of this term was that you saw a lot of the Democrats who were thinking maybe they want to run for president in four years, suddenly end up on committees that had foreign relations or armed services or topics that somebody would like to know a little more about and have voters know they know more about if they're running for president. Yes. But basically, there's no guarantee that the next senator from Maine would be on the Intelligence Committee. That's right.

And Amy asked about the partisan breakdown on that committee. The Intel Committee is less partisan than some, so it is fairly even. Of course, all the Senate committees are relatively even now because the breakdown in the Senate is fairly even. But the Intel Committee strives to be fairly nonpartisan. We've seen the good working relationship between the chairman, Richard Burr of North Carolina, a Republican, and Mark Warner of Virginia, a Democrat. So it's been a fairly apolitical committee. Yeah. All right. We're going to take a quick break. We'll be back with a couple more questions. Support for this podcast and the following message come from ZipRecruiter. ZipRecruiter is committed to helping employers build great companies by making it easy to find

and hire top talent. Using advanced matching technology, ZipRecruiter actively connects employers with qualified candidates in any city or industry nationwide. In fact, 80% of jobs on ZipRecruiter get a qualified candidate in just one day. Try it for free. Go to ZipRecruiter.com slash quick takes. I'm Linda Holmes. And I'm Stephen Thompson. There's more stuff to watch and read these days than any one person can get to. That's why we make Pop Culture Happy Hour.

Twice a week, we sort through the nonsense, share reactions, and give you the lowdown on what's worth your precious time and what's not. Find Pop Culture Happy Hour on the NPR One app or wherever you get your podcasts. All right, we are back. Our two White House correspondents have done a great job answering questions that they do not cover on a daily basis. So I guess we were kind of like, wait, wait, don't tell me there for a little bit. Tam at least used to be a congressional reporter. But now we are in your wheelhouse. We are in your zone. We are going to talk about the White House for a couple of questions. All right. Nicole writes,

my husband and I enjoy listening to your podcast together and learning more about what is going on in our government. All right. Lately, we've been surprised by how often we hear about Donald Trump holding campaign events. Is it normal for sitting presidents to hold this many campaign events when they are less than a year into office? How does the time he spends campaigning compare to that of recent presidents? Thanks, Nicole. Well, it's definitely unusual to see a president campaigning in the way that Donald Trump has. But then, you know, Donald Trump filed his reelection papers on Inauguration Day. So that was also unusual. He's held seven campaign-style rallies around the country since taking office. The first was just over a month after he got in.

I think, Tam, you were at his most recent in West Virginia. In West Virginia, yeah. Two weeks ago. They still play the music from the campaign. Tiny Dancer. Backstreet Boys. I wasn't there very long because I came in with the president, so I did not hear Backstreet Boys.

However, I did hear Tiny Dancer twice. But these are a chance for the president to sort of recharge his batteries, surround himself with people who really support him and his policies. It's not that unusual to see presidents in the past go out and hold campaign style rallies on behalf of some piece of legislation or some program. And Trump did, I think, talk about the health care bill at one of his rallies. But they've really been more amorphous than that. They've really just been sort of Donald Trump rallies as opposed to health care rallies or aimed at promoting a particular part of his agenda. Yeah. I mean, what's interesting about this is President Obama went out and held events that looked kind of like campaign events early in his presidency. He had rallies. He had town

halls, which is something he did a lot of when he was a candidate. The difference is President Trump is calling these campaign rallies. They are being organized by his campaign, whereas President Obama was campaigning for policy and put it on the White House dime. It was a White House event, whereas these are actually technically campaign events. And the longer that we have gotten into Trump's first year in office without his big ticket agenda items being passed, the louder the argument is that maybe if he helped focused rallies all about health care in specific states where senators were on the fence, that might be more effective than just kind of generally campaigning.

Now, the White House has said he's going to do that when it comes to tax reform. He's going to be out there campaigning. But we'll see. We haven't we haven't seen that happen yet. I think they said that about health care, too. Yeah, I think they did. All right. Our last question of the pod is from Andrea, who writes, My question is regarding the White House positions that have remained unfilled by Trump. Is there any sort of timeline or action that Congress can take if key positions remain unfilled? Lastly, how many positions remain to be filled by this administration and how does that compare to past administrations? Andrea, thank you for asking. We have the answers.

We called up the Partnership for Public Service. They track these things. And here are the basic numbers. There are about 600 positions that are seen as sort of critical positions to be filled. And at this point, President Trump has nominated 279 people. Now, actual confirmations, people who've gone through the Senate process, the Senate has voted and been confirmed, is only 124. Now, compare that to President Obama at the same point. President Obama had nominated 433 people and had 310 confirmed.

And the numbers are basically roughly similar for other past presidents. So what's happening here is both President Trump has been slow to nominate people and the Senate has been, relatively speaking, slow to confirm them. The White House has blamed a lot of Democratic obstruction, and those numbers show that there's only really a handful of Trump nominees who've been rejected by the Democrats. They don't have the votes to actually block a nominee, but they do have an opportunity to sort of slow walk it through the process, and they've certainly done that. So on the one hand, Trump's been slower than his predecessors in nominating people, and the Senate has been slower than its predecessors in confirminginating people, and the Senate has been slower than its predecessors in confirming them. And given the way that the filibuster rule for executive nominees has dwindled and the minority party has lost a lot of power, slow walking things,

making it take several days to get through the Senate instead of happening in an hour or so, is one of the very few areas where Democrats can affect the Trump agenda. So they definitely have been doing that. But I think the one department where you've seen this the most, where the president just simply has not nominated that many people, is the State Department, where it's like the majority of key positions just haven't been nominated. It's hollow. It's a real variation.

If you look at Homeland Security, if you look at HHS, most of those positions have been filled by the president. But the State Department, only about a third have been filled. It's even less in the Agriculture Department, which was, I think, the last to get a secretary, and the Labor Department, where only about one in five top positions have been filled. So you can sort of see where this president's priorities are and where he's content to leave vacancies. Remember when the president was asked last week about Putin expelling diplomats from the U.S. embassy in Russia, he said, I'm grateful. We're trying to cut headcount over there. Just one more thing to add on this. The Partnership for Public Service

is still hopeful that many of these positions will be named and confirmed. They really feel that these positions are important. However, one of the people I was talking to said there are career people sort of filling in right now. But the question is, like, does the president want his own people there or does he want career people? One carve out from this is judicial nominations. The president has been pretty aggressive in filling vacancies on the federal bench. Of course, the big one, Neil Gorsuch, on the Supreme Court, but also at the appellate court level and the district court level. There were an awful lot of vacancies for this president to fill because Republicans in the Senate held up a lot of nominations in the Obama

era. So Trump came in with a whole lot of vacancies on the bench, and he is moving quickly to fill those. The only power Democrats have there is sort of a traditional power where if there's a Democratic senator in the state that the judge would be representing, either on the district court or on the appellate court, there's a tradition where the Democrat can... Or in the past, a Republican, where a senator of the opposing party can sort of exercise a veto power by not returning what's called the blue slip. But I suspect if Democratic senators try to use that in any large numbers, that genteel tradition of respect for the opposing party will go away. And it'll be just like another version of the nuclear option. It's not been a good last few years for genteel traditions, has it?

No, no. But seersucker is still around on Thursdays. There's one tradition that ought to be term limited. All right. That teases us up to end the show. A reminder to write with your questions or record them and send them to nprpolitics at npr.org. We read them all. That is also the address to send your timestamp to if you want to record one of those from a fun place like Springfield, Illinois, home of Abraham Lincoln.

I'm Scott Detrow. I cover Congress. I'm Tamara Keith. I cover the White House. I'm Scott Horsley. I also cover the White House. Thank you for listening to the NPR Politics Podcast.