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In Opioid Crisis, Public Health Emergency Vs. National Emergency


Later today, President Trump is expected to address the nation about this country's opioid epidemic. On average, nearly 150 Americans a week are dying from overdoses, many of them from heroin, fentanyl and other opioids - so safe to say this is a dire situation. Administration officials say the president will direct the Health and Human Services secretary to declare a public health emergency. And to help us sort through exactly what that means, we're joined by NPR White House correspondent Tamara Keith, who has been covering this issue.

Good morning, Tam.


GREENE: So long-awaited decision from the president - sounds like not exactly what some people were expecting. Tell us how the White House reached where they are today.

KEITH: So this began back at the end of July when a commission that the president appointed to study the opioid crisis came back with what it described as urgent recommendations, including the recommendation that the president declare an emergency. They suggested a couple of different kinds of emergency, either the kind that you do under FEMA or a public health emergency.

The White House - the president, about two weeks after that recommendation came out, was asked about it by reporters. He said, it's an emergency; it's an emergency; I'm declaring it emergency; we're drawing up the paperwork now. It's been more than two months since then, and the administration has really struggled to figure out what exactly to do. And now they have settled on this public health emergency.

GREENE: OK, public health emergency - you mentioned FEMA. One option would've been some sort of national emergency, the kind that we would see because of a disaster. Is that - that would've been one option.

KEITH: Yeah. So I was talking to Dr. Bertha Madras. She is a professor of psychobiology at the Harvard Medical School. She's also a member of the president's opioid commission. And she said that they felt that - in their hearts that this was something to do, though they hadn't really thought through all the logistics. Here's a little bit from the interview I did with her.

BERTHA MADRAS: FEMA can declare a natural disaster - hurricanes, tornadoes, floods, what have you. The secretary of Health and Human Services can declare an emergency if you have an infectious disease or poisonings. But this is different. There's no precedent for this.

KEITH: Right. And the administration officials are defending the choice to go with a public health emergency, saying that that will allow them to do this on more of a nationwide basis, that the FEMA-type disasters are more specific to a point in time and a specific location but that this will be nationwide.

GREENE: OK, so let's talk about what this public health emergency will actually mean, what this declaration will do in terms of dealing with this crisis.

KEITH: Yeah, so administration officials say that it will allow - I think the most substantial part of this is that it will allow for standard access to telemedicine services. This opioid crisis has been particularly challenging in more rural areas of Appalachia and the Rust Belt, where there is a shortage of doctors and where - really, the public health community has come around to the view that the best way to help most people is through medication-assisted treatment.

But there aren't doctors to prescribe those medicines and oversee that treatment, and so this would allow telemedicine - people to see doctors virtually to get the help that they need. It also includes some smaller things that the Department of Labor could do - something to do with hiring personnel, reducing some of the bureaucracy, but it - and shifting around existing funding. Also, the administration says an important part of this is just sort of making it a bigger issue, trying to reduce the stigma and bring this issue out of the shadows.

GREENE: Because there are many people who don't come out of the shadows to get treatment because they might not want people in their community, their family, to even know that they're suffering from this.

KEITH: That's right, though there's also serious issues with whether some of these treatments are covered by insurance, whether people have insurance.

GREENE: Tam, you said something that really caught my ear, which was shifting existing funding around. As we were reporting on this leading up in the last days and weeks, many people said, if this is declared a national emergency, it might free up a lot of federal funding to help states. So with this public health emergency, is there new money associated with it?

KEITH: There is a fund associated with public health emergencies. That fund is empty, so Congress hasn't filled it, and Congress will need to fill it if there's going to be an infusion of any new cash into this problem. The White House says they're working with Congress to make that part of any sort of end-of-year budget negotiations or budget deal.

GREENE: Oh, that's interesting. So this might be one of those - another problem that the president has come out and said he wants to address, but it's going to involve a lot of working with Congress to make it actually happen.

KEITH: Yes, absolutely. But Congress is willing, and I know of senators from both parties who will be at the White House today for this announcement. They've been begging the White House, really, to get involved, to help, to do more. They are - they tell me they are ready to be partners on this.

GREENE: All right, Tam, thanks a lot.

KEITH: You're welcome.

GREENE: That is NPR White House correspondent Tamara Keith talking to us about this announcement expected from President Trump addressing the nation's opioid epidemic. Transcript provided by NPR, Copyright NPR.

Tamara Keith has been a White House correspondent for NPR since 2014 and co-hosts the NPR Politics Podcast, the top political news podcast in America. Keith has chronicled the Trump administration from day one, putting this unorthodox presidency in context for NPR listeners, from early morning tweets to executive orders and investigations. She covered the final two years of the Obama presidency, and during the 2016 presidential campaign she was assigned to cover Hillary Clinton. In 2018, Keith was elected to serve on the board of the White House Correspondents' Association.