936: Reducing Opioid Overdoses, FY26 Budget Breakdown

JANSON SILVERS: 

This is the award-winning Public Health Review Morning Edition for Friday, June 27, 2025. I'm Janson Silvers. Now, today's news from the Association of State and Territorial Health Officials.

KELLY DOUGHERTY: 

At this point, with fentanyl implicated in 93% of our fatal overdoses in 2024, I just, I'm always saying, just assume that your drugs contain fentanyl, because it's it's just so prevalent.

SILVERS: 

A recent report from the state of Vermont showed a decline in the number of annual opioid overdose deaths. Kelly Dougherty, with the Vermont Department of Health, explained how her department utilized a variety of public health strategies to reduce opioid deaths across the state.

DOUGHERTY: 

Starting in 2019, we started distributing fentanyl test strips for people as we started to see fentanyl become more prevalent and the drug supply. And then, I think it was two years ago, we also offer xylazine test strips.

SILVERS: 

According to Dougherty, Vermont has seen success when employing a number of strategies that include increased naloxone distribution and varied drug testing approaches.

DOUGHERTY: 

We funded a drug testing it's almost like a pilot program, but one of our syringe service programs in the state has a spectrometer, and people can come in and bring their drugs and have them tested to see what all is in there.

SILVERS: 

You can read the full report from the Vermont Department of Health now by heading to the link in the show notes.

It seems like every week we are flooded with public health news from Capitol Hill. Luckily, we have ASTHO's senior director for government affairs, Jeffrey Ekoma, here to break it all down in this week's View from Washington, D.C. report.

It's a Friday morning, which means we are lucky enough to be joined by Jeffrey Ekoma, how are you this morning?

JEFFREY EKOMA: 

I'm doing well, good morning.

SILVERS: 

Terrific. And I know that there is a lot happening in Congress right now that either directly or indirectly, impacts state and territorial health departments. Let's start with the administration's FY26 budget proposal. Can you first of all, describe new information that was released, and then what is next with respect to FY26 appropriations?

EKOMA: 

Lots of things are co-occurring right now. In the past couple of weeks, the Administration released congressional justification documents for various agencies, and one of note is a justification document for the Administration for Healthy America, or AHA, which is a proposed agency that would consolidate chronic care and disease prevention programs across the Office of the Assistant Secretary of Health, or OASH, HRSA, SAMHSA, the National Institute of Environmental Health Sciences, and several centers and programs under CDC. Overall, the budget proposes $20.6 billion for AHA, and additional information on the agency can be found in our team's most recent Legislative Alert that's on our website.

SILVERS: 

Those Legislative Alerts are always very helpful, and I know that there were also a couple of hearings of note for the listeners. Who exactly was on the Hill and what themes were explored in each of those hearings?

EKOMA: 

Yes, the Secretary of HHS was on the Hill earlier in the week before the House Energy and Commerce Committee- Subcommittee on Health, discussing HHS' FY26 budget proposal. Themes of the hearing included a discussion about ACIP and recent changes made to the council, the quote "Defend the Spend" initiative and the Secretary's awareness of the new process across HHS, Pandemic Preparedness and the strategic national stockpile, potential changes to Medicaid that are currently being discussed in Congress through reconciliation and the opioid epidemic. Later on in the week, the Senate HELP Committee held a hearing to discuss the nomination of Dr. Susan Monarez to be the next director of the CDC. And Dr. Monarez discussed her background, qualifications, and priorities for CDC, which include restoring public trust, rebuilding credibility, improving data transparency, and ensuring that recommendations from CDC are backed by gold standard science. The second being strengthening public health infrastructure, and her interest in working closely with state and territorial health officials on this issue. And last, but not least, using evidence-based measures to inform rapid decision-making. Now, Dr. Monarez' nomination will need to be advanced by the Committee before consideration on the full House floor. The timing of those votes are currently unknown, but we'll be tracking it really closely.

SILVERS: 

And in previous weeks, the government affairs team has discussed the One Big Beautiful Bill Act. We've discussed it right here on this newscast, and that's a reconciliation bill that passed in the House and is currently in the Senate. Are there any updates to share on what has happened and what is likely next?

EKOMA: 

Yes, as you noted, the One Big Beautiful Bill Act, is currently being considered by the Senate, and because of Senate rules that require provisions in the bill to be one directly related to changes in federal spending or revenue, it has to have more than a marginal impact on the budget. It cannot be related to social security in any way, and it cannot increase the federal deficit beyond the timeline, in this case, 10 years, the Senate's bill will be different than what was passed in the House. Now, this process I described is known as what many folks in D.C. refer to as a 'bird bath,' and that's ongoing. And the bill's provisions related to SNAP and provided taxes, which states use to fund their share of Medicaid, are likely to be changed. There are also ongoing negotiations on state-directed payments, which we- which we've been tracking really closely. Now, in terms of next steps, the Senate is still working to meet an internal deadline of passing a bill by the Fourth of July. Now, there's been some public reporting that indicates that there may be some challenges for them reaching that deadline, but we're tracking things really closely, and we also plan to release an updated Legislative Alert in the future, describing the details of what was passed in the Senate.

SILVERS: 

Jeffrey, it's always helpful to have you here explaining all the action from the Hill to us. We appreciate it, and I hope you stay cool this weekend.

EKOMA: 

It's been a pleasure. And yes, please, it's been incredibly hot in the D.C. area. So, please everyone, stay cool and thanks again.

SILVERS: 

Also earlier this week, ASTHO members discussed the importance of local relationships during ASTHO's deskside briefing on the Impact of Nutrition on Chronic Disease [Prevention]. While serving on the panel, ASTHO member, Dr. Ralph Alvarado of Tennessee, received a question on what conversations have taken place with those on the House Agriculture Committee from his delegation.

RALPH ALVARADO: 

I'm actively engaged with our state legislature, with our federal government officials. Just in my previous role, I've had a chance to have relationships with them, to discuss many of the concerns that we've got. So, that's a- that's a constant dialogue that I'm having and expressing on the needs that we have. And I'm also relying also, obviously, on the governor's team, who also conveys a lot of the issues.

SILVERS: 

Finally, an ASTHO blog article sheds a light on certain barriers to vaccine administration among Medicaid providers and members. It also discusses potential approaches to reducing those barriers. Learn more when you click the link in the show notes.

That'll do it for today. We're back on Monday morning with more ASTHO news and information. I'm Janson Silvers. You're listening to the award-winning Public Health Review Morning Edition. Have a great weekend.