May 08, 2019

Warren, Cummings, and More than 95 Colleagues in Senate and House Reintroduce Comprehensive CARE Act to Combat the Opioid and Substance Use Epidemic

Endorsed by over 200 organizations, the CARE Act is the most ambitious legislation of its kind in Congress and would allocate $100 billion over 10 years

Read Letters of Support from Labor, Health Advocacy, and Tribal Organizations (PDF)

View Full List of Endorsements (PDF)

View Updated State-by-State Funding Chart (PDF)

 View Targeted Programs for Tribal Nations (PDF)

 Bill Text (PDF) | Fact Sheet (PDF) | Section-by-Section (PDF)

 Video (YouTube)

Washington, DC - Senator Elizabeth Warren (D-Mass.) and Representative Elijah E. Cummings (D-Md.), Chairman of the House Committee on Oversight and Reform, today led over 95 of their colleagues in the Senate and House in reintroducing the Comprehensive Addiction Resources Emergency (CARE) Act, the most ambitious legislation ever introduced in Congress to confront the opioid and substance use epidemic. Endorsed by over 200 organizations, Senator Warren and Representative Cummings’ CARE Act would provide state and local governments with $100 billion in federal funding over ten years, including more than $800 million per year directly to tribal governments and organizations.

The legislation is cosponsored by U.S. Senators Edward J. Markey (D-Mass.), Tammy Baldwin (D-Wisc.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Kamala Harris (D-Calif.), Tom Udall (D-N.M.), Bernie Sanders (I-Vt.), and Chris Van Hollen (D-Md.), and over 85 members of the House of Representatives.

Originally introduced last year, the updated CARE Act of 2019 includes new provisions to strengthen standards for services and recovery residences and establish a new grant program that would help workers who are at risk of, or struggling with, addiction to maintain or find employment while in treatment and recovery. The bill would also incentivize states to cover the full range of addiction services in state Medicaid programs.

“The opioid and addiction crisis touches all communities, regardless of geography, income, or racial makeup,” said Senator Warren. “The federal government has waited far too long to address this crisis. It’s long past time to enact comprehensive legislation to make sure everyone who needs treatment for a substance use disorder is able to get it.”

“Families across this nation—in red states, blue states, and purple states, in big cities, suburbs, and rural areas—are struggling with the devastating consequences of this generational crisis that claims 190 lives every single day,” said Chairman Cummings. “I am proud to introduce the CARE Act with Senator Warren to finally get to the heart of this problem by providing stable and sustained funding for states and local communities to expand access to evidence-based treatment.”

“I’ve met with local health officials, law enforcement and those who have lost loved ones throughout Wisconsin, and it’s clear Washington must do more to be a strong partner in supporting local prevention, treatment and recovery efforts,” said Senator Baldwin. “We need a bold, long term commitment to addressing this public health crisis by providing local communities the tools they need to save lives.”

“Families and communities on the frontlines of the opioid epidemic in Connecticut all tell me the same thing: We cannot win this battle without substantial and sustained resources from the federal government. The CARE Act answers that call by providing states with the significant funds needed to treat and prevent substance use disorder. It is past time for the federal government to act boldly and put its money where its mouth is to confront this deadly public health crisis,” said Senator Blumenthal.

“We need to treat the opioid epidemic as the national health crisis that it is. And that means we need more, not less, funding for treatment, recovery, prevention, and research. This bill will provide struggling communities across the country with the money they need to help their residents affected by this epidemic," said Senator Sanders.

“For too long, the opioid epidemic has left its mark on too many communities – and New Mexico and Indian Country have been among the hardest hit,” said Senator Udall. “We urgently need strong, sustained funding for evidence-based treatment and recovery services that will help individuals get on the road to recovery, especially in rural and Native communities that have been devastated by the opioid crisis. This vital legislation will funnel critical resources on the scale we really need to the frontline communities battling this deadly public health crisis, and enable them to confront it head on. As a senior member of the Appropriations Committee, I’ll keep fighting for the resources our communities need to combat this epidemic and connect people with the help they need.”

“Opioid addiction has wreaked havoc in Maryland and across the country, leaving no community unscathed. To fully combat this epidemic, we must devote more resources where they’re needed. From increasing funding that goes directly to the communities hit the hardest, to expanding research and training—this legislation would improve our response to the crisis dramatically. I urge my colleagues to pass it immediately,” said Senator Van Hollen.

Life expectancy in the United States has now dropped three years in a row—and drug overdoses are the single biggest contributor. In 2017, more than 70,000 Americans died from drug overdoses—the highest rate of drug overdose deaths in the United States.  Opioid-related overdoses accounted for  47,600—or 68%—of these deaths. Yet, only about 10% of those in need of specialty treatment for substance use disorders are able to access it. 

This is not the first time we have faced a public health crisis of this scale.  During the 1980s and 1990s, deaths from HIV/AIDS grew rapidly, and the country’s medical system was ill-equipped to provide effective, evidence-based care. In 1990, Congress passed the bipartisan Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White Act) to provide funding to help state and local governments, and community-based organizations, combat this epidemic.  

The CARE Act is modeled directly on the Ryan White Act, supporting local decision-making and programs to expand access to evidence-based treatments and recovery support services. The CARE Act also recognizes the need for expanded mental health supports, early intervention, and harm reduction tactics.  Finally, this legislation would make it easier to hold corporate executives at pharmaceutical companies accountable for actions that fuel the opioid crisis.

The CARE Act would provide $100 billion over ten years to fight this crisis, including:

  • ·       $4 billion per year to states, territories, and tribal governments, including $2 billion to states with the highest levels of overdoses, $1.6 billion through competitive grants, and $400 million for tribal grants;
  • ·       $2.7 billion per year to the hardest hit counties and cities, including $1.43 billion to counties and cities with the highest levels of overdoses, $1 billion through competitive grants, and $270 million for tribal grants;  
  • ·       $1.7 billion per year for public health surveillance, biomedical research, and improved training for health professionals, including $700 million for the National Institutes of Health, $500 million for the Centers for Disease Control and Prevention and regional tribal epidemiology centers, and $500 million to train and provide technical assistance to professionals treating substance use disorders;
  • ·       $1.1 billion per year to support expanded and innovative service delivery, including $500 million for public and nonprofit entities, $500 million for projects of national significance that provide treatment, recovery, and harm reduction services, $50 million to help workers with, or at risk for, substance use disorders maintain and gain employment, and $50 million to expand treatment provider capacity; and
  • ·       $500 million per year to expand access to overdose reversal drugs (Naloxone) and provide this life-saving medicine to states for distribution to first responders, public health departments, and the public.

The cost of inaction is staggering.  President Trump’s Council of Economic Advisers estimates that the opioid crisis cost the nation more than $500 billion in 2015 alone. In addition, a new study in the journal Medical Care estimates that the federal government lost $26 billion in tax revenue between 2000 and 2016 due to the opioid crisis.  

Under the CARE Act of 2019, Massachusetts would receive an estimated $120.1 million annually over ten years, with $56.6 million allocated to the state government and $63.5 million distributed among the counties. Click here to learn more about how funding would be allocated to each state.

The legislation has been endorsed by over 200 national, local, and tribal organizations. You can view the full list here.

“Modeled directly on the Ryan White Act, the CARE Act of 2019 would provide $100 billion in federal funding over the next ten years to states, local governments, and other organizations and institutions to support federal research and programs to prevent drug use while expanding access to prevention, harm reduction, addiction treatment, mental health services, and recovery support services. This level of authorized funding is critical in order to build comprehensive systems that are both effective and sustainable,” wrote members of the Coalition to Stop Opioid Overdose. Read the full letter, signed by 146 organizations, here.

“The CARE Act would provide critical resources needed now and over the next decade to strengthen our addiction treatment infrastructure and expand access to treatments proven to save lives. ASAM applauds Senator Warren and Representative Cummings for recognizing addiction as the national public health emergency that it is, and for taking bold steps to help ensure current and future generations of Americans receive the addiction treatment they need and deserve,” said Paul Earley, MD, DFASAM, President of the American Society of Addiction Medicine (ASAM).

“On behalf of the AFL-CIO, I write in strong support of the Comprehensive Addiction Resources Emergency (CARE) Act which you have introduced…This bill constitutes a comprehensive public health response the opioid crisis. It provides urgently-needed resources to fill our nation’s yawning gaps in treatment and prevention services, and it recognizes the importance of engaging workers in the workplace to prevent opioid misuse or to help them secure employment when recovering from opioid use disorder (OUD),” wrote William Samuel, Director of Government Affairs at the AFL-CIORead the full letter of support here.

“This legislation, through policy and funding, is a major step forward in addressing the opioid epidemic.  The bill would authorize $100 billion over 10 years, a substantial increase and in keeping with the enormity of the epidemic.  At the patient level, the bill would help remove a common obstacle that makes it difficult to receive treatment for an opioid use disorder.  The bill would do this by giving preference to states that have prohibited prior authorization and step therapy for medication-assisted treatment (MAT) drugs, the gold standard for treating opioid use disorder.  About 90 percent of those needing addiction treatment are unable to get it, and prior authorization and step therapy are partly responsible. We commend Rep. Cummings and Sen. Warren for offering a timely federal response to the opioid epidemic that will immediately benefit patients,” said Patrice A. Harris, M.D., American Medical Association President-Elect and chair of the AMA Opioid Task Force

“North America’s Building Trades Unions applaud the introduction of the CARE Act by Senator Elizabeth Warren and Representative Elijah Cummings. Our nation’s opioid epidemic has caused tragedy in almost every community across the country, and this legislation is an important step forward to mobilize critical infrastructure and resources to effectively address the crisis.  Importantly, this bill will accelerate innovation among especially hard hit industries like ours in collaborative efforts to prevent the development of substance use disorder and help identify treatment resources for workers and their families impacted by these disorders,” said Sean McGarvey, President of North America’s Building Trades Union (NABTU).

“The opioid crisis in our country has reached epidemic levels. Registered nurses are on the frontlines of caring for patients with opioid addiction and other substance use disorders. In order to adequately address this crisis, it is necessary for the federal government to provide adequate financial resources for the dramatic scale-up of prevention, treatment, and recovery services and programs in communities across the country. This is why National Nurses United is proud to endorse the Comprehensive Addiction Resources Act.  We applaud Senator Warren and Congressman Cummings for taking the bold leadership we need to combat this public health crisis, and we urge every Member of Congress to stand with nurses and our patients, and pass this legislation,” said Deborah Burger, R.N., President of National Nurses United.?

“AIDS United urges Congress to pass this critical legislation. We are pleased that the bill’s authors modelled this new legislation directly on the highly successful, landmark Ryan White HIV/AIDS Program, which has provided access to high quality care to people living with HIV for three decades. Like the Ryan White HIV/AIDS Program before it, the CARE Act of 2019 recognizes the severity and urgency of the public health crisis it seeks to address,” said Jesse Milan, Jr., President and CEO of AIDS United.

“AIDS United strongly endorses the CARE Act of 2019 for, among other things, its recognition and inclusion of community-based harm reduction programs as a core component of our nation’s collective response to the opioid crisis. Such recognition is long overdue and is essential if we are to successfully tackle the monumental challenges we face in this current crisis,” added William McColl, Vice President for Policy and Advocacy of AIDS United.

“The Drug Policy Alliance strongly endorses the CARE Act of 2019, a groundbreaking bill urgently needed now to end our nation’s overdose crisis. This legislation presents a bold federal plan of action to address this national emergency of overdose deaths by prioritizing the public health needs of local communities, including long-term investments in effective treatment, harm reduction and supportive services. We applaud Senator Warren and Representative Cummings for their thoughtful leadership in authoring the CARE Act, a bill inspired by the successes of the Ryan White CARE model in mitigating the HIV/AIDS crisis, and we look forward to working with the sponsors to highlight the many ways that the CARE Act would help communities save lives and close enormous gaps in treatment, harm reduction and other critical infrastructure essential to ending this crisis,” said Grant Smith, Deputy Director of National Affairs, Drug Policy Alliance. Read the full letter of support here.

“We must commit to building an addiction workforce capable of responding to the clear demand in our communities for expanded prevention, treatment, and recovery services due to the ever increasing rise of addictive disorders. As the national professional association representing the interests of addiction counselors, educators, and addiction-focused health professionals, NAADAC proudly supports the CARE Act and its bold commitment to addressing substance use disorders for the individuals, families and communities that are so severely affected,” said Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP; Executive Director NAADAC, the Association for Addiction Professionals.

“The proposed CARE act will provide critical and ongoing resources for medication treatment for opioid use disorder, naloxone rescue treatment, and much needed research on opioid use disorders.  The funding for treatment in this legislation will enhance opportunities for first responders to gain access to naloxone to reverse opioid overdose.  This funding for treatment will enable more people with opioid use disorder to be treated with evidence-based medications to reduce opioid overdoses and all-cause mortality,” said Shelly F Greenfield, MD, MPH, President, American Academy of Addiction Psychiatry.

“Families USA is pleased to support Senator Warren’s and Representative Cummings’s legislation, the Comprehensive Addiction Resources Emergency (CARE) Act of 2019. Substance Use Disorder (SUD) is perhaps the most significant public health emergency facing the United State since the first wave of the AIDS epidemic in the 1980s and 1990s. Modeled on the highly successful Ryan White Act, this bill would provide critical funding to state, local, and tribal governments and nonprofits for substance use disorder treatment and services. Additionally, Families USA strongly believes that the Medicaid program is critical in providing comprehensive health care coverage for many affected by SUD. The CARE Act appropriately relies on Medicaid as a primary source of coverage and requires that available grants not displace current sources of coverage, meaning that grants would be available only to patients who lack coverage for SUD treatment from another source,” said Shawn Gremminger, Senior Director of Federal Relations, Families USA.

“The CARE Act of 2019 provides a compelling vision, framework, and level of investment necessary to reverse the course of the overdose epidemic and promote the safety and welfare of people most at risk of overdose…The CARE Act of 2019 represents a vital and strategic response to the challenges of our communities, and Harm Reduction Coalition looks forward to working with your offices, Congress, and our communities to advance this legislation,” said Daniel Raymond, Deputy Director of Planning and Policy at the Harm Reduction Coalition. Read the full letter of support here.

“The AIDS Institute, a national non-profit organization dedicated to supporting and protecting health care access for people living with HIV/AIDS, viral hepatitis, and other chronic and serious health conditions is pleased to offer its strong support of the Comprehensive Addiction Resources Emergency (CARE) Act. This bill would provide much needed resources to state, local, and tribal governments working to improve the nation’s response to the growing opioid crisis,” wrote Franklin Hood, Senior Policy Associate at the AIDS Institute. Read the full letter of support here.

“As an anti-poverty organization, CLASP is committed to ensuring that low-income people and communities of color are included in any proposed legislation that addresses the opioid epidemic…CLASP is proud to endorse the CARE Act and supports its passage through Congress,” wrote Nia West-Bey and Isha Weerasinghe, Senior Policy Analysts at Center for Law and Social Policy. Read the full letter of support here.

“The National Indian Health Board applauds the efforts of the CARE Act to respect the federal trust responsibility and recognize the urgent need for relief from substance and opioid misuse and overdose in Indian Country. We stand ready to work with you as the legislation moves through Congress. Thank you for your continued dedication to meeting the health needs of Indian Country,”wrote Victoria Kitcheyan, Chairperson of the National Indian Health Board. Read the full letter of support here.

“In response to Tribal concerns and priorities, the CARE Act of 2019 would ensure Tribal Nations, like other units of government, are well-equipped to combat the opioid epidemic and other substance use disorders in our communities…This level of funding and its method of delivery are reflective of a strong commitment to recognizing our governmental status and the unique relationship between the federal government and Tribal Nations,” wrote Kirk Francis and Kitcki A. Carroll, President and Executive Director of the United South and Eastern Tribes Sovereignty Protection Fund. Read the full letter of support here.

“The opioid crisis has created the century’s most devastating emergency in a growing and disproportionate substance abuse problem affecting American Indian and Alaska Native (AI/AN) communities…The National Council of Urban Indian Health (NCUIH) appreciates that the CARE Act has detailed specific language that ensures urban Indian organizations are listed as an eligible entity in this important legislative act,” wrote Maureen Rosette, President of the National Council of Urban Indian Health. Read the full letter of support here.

“The opioid epidemic poses one of the most significant public health threats in recent history and has devastated our American Indian and Alaska Native (AI/AN) communities. Addressing the opioid epidemic is a nationwide priority; however, access to critical opioid prevention and treatment dollars are not reaching any of the AI/AN communities that are in serious need of these funds…The CARE Act addresses this problem by providing urgently needed support to tribes throughout the country that have been disproportionately affected by the opioid epidemic,” wrote Esther Lucero and Aren Sparck, Chief Executive Officer and Government Affairs Officer of Seattle Indian Health Board. Read the full letter of support here.

“On behalf of Native American LifeLines, a Title V Urban Indian Health Program serving American Indian and Alaska Native (AI/AN) communities in Baltimore and Boston, we write to express strong support for your legislation, the Comprehensive Addiction Resources Emergency (CARE) Act...We are gratified that the CARE Act intentionally addresses shortfalls that often leave tribal and Urban Indian communities behind,” wrote Kerry Hawk Lessard and Kiros A.B. Auld, Executive Director and President of the Board of Directors of Native American LifeLines. Read the full letter of support here.

“Mahalo to Senator Warren and Congressman Cummings for being steadfast and inclusive leaders in the fight against the opioid epidemic.  We appreciate the incorporation of Native Hawaiian-specific provisions as it ensures the community has a voice and access as it works to improve their overall health and well-being,” said Dr. Sheri Ann Daniels, Executive Director of Papa Ola Lokahi.

“ABH applauds Senator Warren for introducing the CARE Act of 2019 and championing the fight against the opioid crisis in Massachusetts and across the country. This is a massive public health undertaking that requires energy and resources over a long term. Senator Warren has been there from the start, bringing fresh ideas and doing the hard work that is beginning to make a difference as we confront the opioid crisis on all fronts,” said Vic DiGravio, President/CEO, Association for Behavioral Healthcare. Read the full letter of support here.

“The physician, resident and medical student members of the Massachusetts Medical Society thank Sen. Warren for her leadership in recognizing that additional funding and support is needed to help our patients who face a chronic struggle with opioid misuse and substance use disorder. As physicians, we endorse evidence-based measures for prevention and treatment of opioid misuse and substance use disorder. On a daily basis, we have a first-hand view of the pressing needs for additional research, expansion of access to care and for the bolstering of the dangerously shallow pool of health care professionals trained to appropriately screen for, prevent and treat this chronic disorder as we would other crises threatening our patients’ health. Sen. Warren’s CARE Act considers patients, communities and populations most affected by and most at-risk to be harmed by the opioid epidemic, and, as importantly, it considers the future. The passage of the CARE Act would provide a decade’s worth of funding – to increase research into treatment, expand access to care and provide training and depth to the corps of health care professionals dedicated to reducing harm and saving lives. The proposed resources would be a comprehensive investment in long-term solutions that are necessary to mitigate the effects of this chronic illness and reduce harm for future generations of patients,” said Massachusetts Medical Society president Dr. Maryanne C. Bombaugh.

“The Comprehensive Addiction Resources Emergency (CARE) Act sponsored by Senator Warren and Congressman Cummings offers a concrete and panoptic strategy for tackling the opioid crisis. The CARE Act not only provides resources for preventing and treating substance use disorder and overdose, it puts them where they are most needed – in our hardest hit communities. Massachusetts community health centers, which serve more than one million state residents, work on the frontlines of this public health epidemic every day. These long-term investments will help us expand critical treatment, predict and prevent patient risk for addiction, and better support individuals in their ongoing recovery,” said James W. Hunt, Jr., President and CEO of the Massachusetts League of Community Health Centers.