HCR24

WHEREAS, opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and prescription pain relievers such as oxycodone, hydrocodone, codeine, and morphine; and

WHEREAS, while opioids are generally safe when taken for a short period of time as prescribed by a physician, regular use of opioid pain killers, even as prescribed by a physician, can lead to dependence; and

WHEREAS, because opioid pain relievers produce euphoria in addition to pain relief, they are prone to misuse and can easily lead to overdoses and deaths; and

WHEREAS, the Centers for Disease Control and Prevention formally declared an opioid epidemic in 2011; and

WHEREAS, according to the American Society of Addiction Medicine, more than 2,500,000 Americans have an opioid use disorder; and

WHEREAS, the opioid epidemic is the deadliest drug crisis in United States history, claiming more than 200,000 lives, or more than three times the number of United States military deaths in the Vietnam War; and

WHEREAS, in 2016 alone, drug overdoses claimed more lives than motor vehicle accidents or gun violence, and every three weeks the opioid epidemic causes about the same number of deaths as occurred in the September 11, 2001, terrorism attacks; and

WHEREAS, Hawaii is also experiencing the effects of the opioid epidemic, with two hundred seventy-five individuals dying from opioid overdoses between 2012 and 2016 and about two thousand more suffering from nonfatal overdoses; and

WHEREAS, at the heart of the opioid epidemic is OxyContin, which is a brand name for the prescription pain killer oxycodone, a dangerous opioid that was developed in the 1990s by Purdue Pharma, a Stamford, Connecticut-based company that is owned and operated by certain members of the Sackler family; and

WHEREAS, the Sacklers are best known as philanthropists whose family name is prominently featured in exhibits at a number of notable institutions, including the Metropolitan Museum of Art, Harvard University, and the Louvre; and

WHEREAS, because the members of the Sackler family who control Purdue Pharma have managed to write their family name out of the history of the family business, most visitors to these establishments are unaware that these family members made their fortune by being one of the prime beneficiaries of the current epidemic of opioid use; and

WHEREAS, as detailed in an article published in the New Yorker on October 30, 2017, Purdue Pharma's OxyContin generated great profits for the company and its owners at the expense of millions of people who fell prey to drug addiction due to OxyContin's intrinsic addictive properties; and

WHEREAS, Purdue Pharma was well aware of OxyContin's addictive potential, but denied any knowledge and launched OxyContin with a marketing campaign that misinformed doctors about the dangerous risks of opioids; and

WHEREAS, in September 2017, the attorneys general of forty-one states banded together to investigate the role that deceptive marketing campaigns by opioid manufacturers and distributors, including Purdue Pharma, had in the current crisis of opiate addictions and overdose deaths; and

WHEREAS, meanwhile, Congress in April 2016 yielded to pressure from the drug industry by passing a law that effectively stripped the federal Drug Enforcement Administration of its authority to freeze suspicious shipments from drug distribution companies, which was its most effective weapon against large drug companies suspected of spilling prescription narcotics onto the nation's streets; and

WHEREAS, the passage of this law has severely undermined the Drug Enforcement Administration's previously aggressive enforcement efforts; and

WHEREAS, in this regulatory vacuum of ineffective law enforcement efforts, states must increase their own efforts to combat the opioid epidemic through a multi-faceted approach, including requiring insurers to provide health care coverage and benefits for a minimum of six months of inpatient and outpatient treatment for opioid dependence; and

WHEREAS, section 23‑51, Hawaii Revised Statutes, requires that "[b]efore any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, there shall be concurrent resolutions passed requesting the auditor to prepare and submit to the legislature a report that assesses both the social and financial effects of the proposed mandated coverage"; and

WHEREAS, section 23-51, Hawaii Revised Statutes, further provides that "[t]he concurrent resolutions shall designate a specific legislative bill that:

(1) Has been introduced in the legislature; and

(2) Includes, at a minimum, information identifying the:

(A) Specific health service, disease, or provider that would be covered;

(B) Extent of the coverage;

(D) Limits on utilization, if any; and

(E) Standards of care.

For purposes of this part, mandated health insurance coverage shall not include mandated optionals"; and

WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the Auditor's report; and

WHEREAS, the social factors that section 23-52, Hawaii Revised Statutes, requires the Auditor to examine include:

(1) The extent to which the treatment or service is generally utilized by a significant portion of the population;

(2) The extent to which the insurance coverage is already generally available;

(3) If coverage is not generally available, the extent to which the lack of coverage results in persons being unable to obtain necessary health care treatment; and

(4) If the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial hardship on those persons needing treatment; and

WHEREAS, anecdotal evidence have suggested that patients currently face a variety of gaps and barriers when seeking insurance coverage for opioid dependence treatment; and

WHEREAS, the Legislature is concerned that these gaps and barriers may prevent patients from receiving necessary opioid dependence treatment, resulting in those patients relapsing and suffering fatal or near fatal overdoses; and

WHEREAS, the Hawaii Opioid Initiative found that, in addition to being deadly, opioid overdoses can be very costly, with each emergency department visit costing an average of $4,050, and each hospitalization costing an average of $40,100; and

WHEREAS, these high medical costs could be avoided if patients are able to receive drug treatment before overdosing; and

WHEREAS, House Bill No. 1603 (2018) mandates health care coverage and benefits for a minimum of six months of inpatient and six months of outpatient treatment for opioid dependence, beginning after December 31, 2018; and

WHEREAS, the Legislature believes that mandatory health insurance coverage specifically for opioid dependence, as provided in House Bill No. 1603 (2018), will prevent the loss of precious lives, ensure that those addicted to opioids receive needed treatment, and help to eradicate the current epidemic of opioid overdoses in Hawaii; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-ninth Legislature of the State of Hawaii, Regular Session of 2018, the Senate concurring, that the Auditor is requested to conduct an impact assessment report, pursuant to sections 23‑51 and 23‑52, Hawaii Revised Statutes, of the social and financial impacts of mandating health care coverage and benefits for a minimum of six months of inpatient treatment and six months of outpatient treatment specifically for opioid dependence beginning after December 31, 2018, as provided in House Bill No. 1603 (2018); and

BE IT FURTHER RESOLVED that the Auditor is requested to submit findings and recommendations to the Legislature, including any necessary legislation, twenty days prior to the convening of the Regular Session of 2019; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and to the Insurance Commissioner, who in turn is requested to transmit copies to each insurer in the State that issues health insurance policies.

	OFFERED BY:	_____________________________

Report Title:

Mandated Coverage; Addiction Treatment; Opioid Dependence; Auditor Study

HOUSE OF REPRESENTATIVES	H.C.R. NO.	24
TWENTY-NINTH LEGISLATURE, 2018
STATE OF HAWAII