Analysis | Why opioid settlement money is paying county employees’ salaries (2024)

Today’s edition: A powerful House committee is pressing for answers on February’s cyberattack on Change Healthcare. The Supreme Court largely cleared the way for Idaho to enforce its ban on gender-affirming care for young people. But first …

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.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.

Lawmakers continue to press UnitedHealth Group over the February cyberattack on its subsidiary Change Healthcare, with a bipartisan group of House leaders on Monday demanding answers about the nature of the attack, the cybersecurity protocols in place and the company’s response to providers that have struggled to get paid, our colleague Dan Diamond reports.

“It is important for policymakers to understand the events leading up to, during, and after the Change Healthcare cyberattack,” the leaders of the House Energy and Commerce Committee wrote to UnitedHealth CEO Andrew Witty.

Congress has pressed UnitedHealth for weeks, as providers continue to complain about payment disruptions and other problems stemming from the Change cyberattack. More than half of respondents to an American Medical Association survey released last week said they’d had to dip into personal finances. “I have not taken a salary for a month and am borrowing from personal funds to keep practice going,” one comment read.

Who’s on the latest letter: House E&C Chair Cathy McMorris Rodgers (R-Wash.), the panel’s top Democrat Rep. Frank Pallone Jr. (N.J.), and the chairs and ranking members of the panel’s health and oversight committees.

On tap today: The House E&C’s health subcommittee is looking at the health sector’s cybersecurity risks following the Change attack, with a slew of experts set to testify.

On tap in two weeks: Witty is set to face the Senate Finance Committee, where he'll likely be pressed on the cyberattack but also other UnitedHealth issues.

Senate Democrats introduced legislation to boost the direct-care workforce, Dan writes.

The Long-Term Care Workforce Support Act, led by Sen. Bob Casey (D-Pa.) and co-sponsored by 19 Senate Democrats, would increase funding for the field through Medicaid matching funds, grants and other supports. Rep. Debbie Dingell (D-Mich.) introduced a companion bill in the House.

The field has faced persistent staffing woes and other challenges, exacerbated by the pandemic. Three-quarters of direct-care professionals earn less than the average living wage in their state and nearly half rely on public assistance, according to a fact sheet released by Casey.

The legislation also is intended to ensure that “direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation,” according to the fact sheet.

“We cannot claim to be the greatest country in the world if we do not have the greatest caregiving in the world,” Casey, who chairs the Aging committee, said in a statement, calling for more investments.

Experts have urged Congress to focus on the direct-care workforce. “The U.S. long-term care workforce is in desperate need of policy attention,” Harvard's David Grabowski, who has studied the field, wrote in an email. “Caregivers have been historically undervalued in this country.”

Up next: Today’s hearing in the Aging committee will focus on challenges facing the field, with testimony from several workers, a community-college educator and a New York University nursing professor. Expect the new legislation to be a focus of conversation too.

The Supreme Court cleared the way for Idaho to broadly enforce a ban on gender-affirming medical care for minors yesterday, marking the first time the justices have intervened on the contentious issue, our colleagues Casey Parks and Ann E. Marimow report.

The court’s order didn’t address the underlying merits of the constitutional challenge — only whether the law could take effect for now. The state’s restrictions will not immediately apply to two transgender teens who sued the state.

A closer look: State legislators passed the Idaho Vulnerable Child Protection Act last May. The law bans puberty blockers, cross-sex hormones and certain surgeries for transgender adolescents and threatens providers with up to 10 years in prison for violations.

Idaho Attorney General Raúl Labrador (R):

The ACLU of Idaho, which is representing plaintiffs in the case:

Arizona’s Republican-controlled legislature is exploring promoting alternative ballot measures to undercut support for a proposed constitutional amendment that would solidify abortion rights in the state, Alex Tabet and Adam Edelman report for NBC News.

A PowerPoint presentation circulated Monday by a Republican legislative staffer outlines a strategy to present voters with alternatives to the Arizona Abortion Access Act initiative, which backers say has amassed enough signatures for the November ballot. The PowerPoint proposes Republicans introduce two ballot measures that would limit abortions after either six weeks of pregnancy or at the beginning of the 15th week, among other ideas.

The document’s objective is to “Change the narrative — Republicans have a plan!” The effort coincides with increased attention on the abortion access ballot measure following the Arizona Supreme Court's decision to uphold the state's near-total abortion ban dating back to 1864.

The view from Republicans: “The document presents ideas drafted for internal discussion … I’ve publicly stated that we are looking at options to address this subject, and this is simply part of that,” said State House Speaker Ben Toma.

The Post’s Lauren Weber sends us this dispatch:

The Centers for Disease Control and Prevention recently released a report showing no link between the coronavirus vaccine and sudden cardiac death among healthy young people.

The report refutes widespread misinformation that young athletes were dying suddenly at higher rates after the coronavirus vaccine was released, popularized in the wake of NFL player Damar Hamlin's on-screen cardiac incident and amplified by anti-vaxxers and right-wing provocateurs.

A closer look: CDC researchers examined death certificate data in Oregon from June 2021 — December 2022 and found “these data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons.” The report also noted that the risk for cardiac complications was “significantly higher” after covid-19 infection than after covid vaccination for those at or over 5 years old.

The coronavirus vaccine continues to be recommended for those at and over 6 months of age.