Patrick Kennedy sounds off on alcohol’s dangers

The ideas and innovators shaping health care

Nov 30, 2022 View in browser   By Ruth Reader , Ben Leonard and Grace Scullion AROUND THE NATION Patrick Kennedy is critical of moves to loosen alcohol regulation. | Getty Images During the pandemic and in its wake, alcoholism has soared. Alcohol use is up, too, and alcohol-related deaths jumped 26 percent between 2019 and 2020. As state governments locked down in 2020, they loosened alcohol regulations so restaurants could sell beer, wine and cocktails to go and delivery services could bring booze to your door. Many of those changes remained after lockdowns ended. Informed by his own struggle with addiction, former Rep. Patrick Kennedy (D-R.I.) wrote the 2008 Mental Health Parity and Addiction Equity Act, which requires insurers to reimburse for mental health care, including substance abuse treatment, as they would physical health care. Ruth talked to him about the state of addiction in the country, the connection between mental health and addiction and how public policy decisions can both hurt or help sufferers. The interview is edited for length and clarity. Is expanded alcohol delivery having an effect on alcohol abuse in the U.S.? We know not everybody becomes an alcoholic. But even if 10 to 15 percent of the population has that predisposition, that's 15 percent of a couple 100 million. That's what we're looking at. So we have to understand that the more that people gain access, the more people that are vulnerable are going to tip over. I was such a confirmed alcoholic and drug addict that I couldn't get my hands on enough. And I had to really scheme and manipulate and cajole and hide. Today, I wouldn't have to worry about all those things. I'm sure my life was spared to some degree because it was harder for me to get alcohol. What can policymakers do? You address it with data-driven solutions. We know that access correlates to much higher levels of usage. With tobacco, we did a lot of things to rein it in. So we've always got to be vigilant. We really need to have a public health approach, and the best way to do that is to go through public education and really strengthen the skills of our young people to understand how to self-modulate. In other words, have problem-solving skills and coping mechanisms. President Kennedy had a presidential physical fitness program, and we need to do mental fitness. What about social safety-net programs? If we don't pay for things like clubhouse models [that provide community-based services to aid] recovery that's both for mental illness and addiction, and if we don't get people trained to have purpose and socialization and places to stay like sober housing, you're just going into battle with a hand tied behind your back. We need to know what we are organizing ourselves to do. Say, reduce alcohol deaths by 20 percent. It's going to include raising taxes. It's going to include greater regulations. You're going to have to allow hospitals and Medicaid to sue alcohol distributors and manufacturers for the collective harm their product causes. Should law and regulation treat alcohol more like it does tobacco?  Why not? I mean, alcohol has probably a worse public health impact than tobacco. We've totally lifted the ceiling off of the sales on alcohol. We used to have rules — you couldn't advertise hard liquor. And we haven't increased the taxes on alcohol and beer to the same degree.   POLITICO APP USERS: UPGRADE YOUR APP BY DECEMBER 19! We recently upgraded the POLITICO app with a fresh look and improved features for easier access to POLITICO's scoops and groundbreaking reporting. Starting December 19, users will no longer have access to the previous version of the app. Update your app today to stay on top of essential political news, insights, and analysis from the best journalists in the business. UPDATE iOS APP – UPDATE ANDROID APP .     WELCOME TO FUTURE PULSE Monhegan Island, Maine | Shawn Zeller This is where we explore the ideas and innovators shaping health care.  It's the holiday season, which means it's time to turn to anti-anxiety meds for more than a third of Americans who want stress relief from being around their family, according to new data from iPrescribe. Somehow that still seems low. Just sayin'. Share news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Grace Scullion at gscullion@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, Daniel Payne talks with Lauren Gardner about how rural health care providers are trying to convince lawmakers to extend the telehealth rules passed during the pandemic — which would expire after the lifting of the Covid-19 public health emergency. Listen to today's Pulse Check podcast FOLLOW THE MONEY A 2020 law saved people in high-deductible health insurance plans money on telehealth visits. | Sarah Blake Morgan/AP Photo Some of America's most prominent companies want Congress to extend a rule allowing high-deductible health plans to cover telehealth for subscribers who haven't hit their deductibles. The Connected Health Initiative, whose steering committee includes Apple, Microsoft, the American Medical Association and UnitedHealth Group, wrote to House and Senate leaders this week, asking them to extend a provision stemming from a 2020 law that allows high-deductible health insurance plans to pick up the tab for virtual visits. The provision, which Congress initially passed to help patients access care during the Covid-19 pandemic, will expire on Dec. 31 if lawmakers don't act. Big firms care because they have encouraged employees in recent years to sign up for high-deductible plans that: Reduce companies' insurance costs because high-deductible plans are cheaper than plans that offer more coverage Cover preventive care but require subscribers to pay the insurers' negotiated rate for sick visits, emergency care and hospitalizations until patients reach a deductible that's at least $1,400 for an individual or $2,800 for a family, but those deductibles are often much higher.  More than 30 million Americans are enrolled in the plans, for a number of reasons: They pay low monthly premiums and are eligible to invest in health savings accounts.  They can invest in an HSA with pre-tax dollars in stock and bond mutual funds and tap those funds to pay health care bills tax-free. Contributions are capped at $3,650 for individuals and $7,300 for families this year but rise each year with inflation. Beginning at age 65, people with health savings accounts can withdraw funds to pay nonmedical expenses. Those withdrawals are taxed as regular income. The big firms in the Connected Health Initiative say patients would suffer without the provision going forward. Health insurers are on board because they want to encourage telehealth use that's less expensive than in-person doctors' visits and offers the prospect of long-term savings if it helps patients stay on track with preventive care. Background: Congress previously allowed the high-deductible-plan rule to expire at the beginning of 2022 but extended it through Dec. 31 in March.   TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO's must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING .     WASHINGTON WATCH Army Sgt. Travis Snyder gets his first Pfizer Covid shot in December 2020. | AP Covid-19 vaccine mandates have fallen all over the country this year and the military's could face a test in the Senate this month. Thirteen Republican senators wrote to their party's leaders on Wednesday to say they would oppose moving forward with the annual defense authorization bill if they are denied the opportunity to vote on an amendment to end the military's mandate. Background: The armed services have discharged 8,000 active-duty troops since Defense Secretary Lloyd Austin ordered servicemembers to get vaccinated against Covid-19 in August of 2021. Up to 9,000 National Guard members face discharge due to vaccination status if the mandate stays in place, the deputy chief of the Army National Guard Strength Maintenance Division told Federal News Network. The troops forced to leave amount to less than one percent of each service branch. Upwards of 98 percent of active-duty servicemembers are fully vaccinated. However, the senators cited the military's recruitment challenges and the cost to recruit and train a servicemember in their letter. The Army missed its recruitment goal by almost 10,000 soldiers for fiscal year 2022, and the Navy and Air Force spent millions on enlistment bonuses to meet their targets. What's next: Congress has passed a defense authorization bill for 61 years in a row. It sets Pentagon policy and appropriatiors usually accept its guidance on how much money to give the military. If the senators do get a vote on the vaccine mandate, most Republicans are likely to support ending it. And Democrats could be divided. Earlier this month, 12 Democratic senators joined Republican colleagues in voting for a resolution to end the Covid-19 national emergency.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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