world war, islamist extremists and the fight for cyber supremacy. on saturday, just computer with her book no man land, surviving america in the 21st century. on sunday december 301st chris whipple with the gatekeepers how the white house chief of staff defined every presidency. washington journals other series for the next week at 8:00 a.m. eastern on c-span, c-span .org and c-span radio. the assistant secretary for health and substance abuse testified regarding funding for calm batting the opioid programs. lamar alexander is a chair of the committee.

>> the senate committee on health education labor and pensions book please come to order. this morning were holding a hearing entitled implementation of the 21st century act responding to mental health needs. senators cassidy and murphy were the leaders in this committee on mental health form and in the senate. those reforms were included in our 21st century act. senator murray is not here today so she has asked senator murphy to fill in for her. i've asked senator cassidy to chair most of this hearing or at least until 11:45. i will come back and attended but i think it's appropriate that senators cassidy and murphy chair the hearings especially given their extensive work in the area in the leadership in enacting the legislation last year. after our witness testifies senators will have five minutes of questions.

sean is by all accounts a temple busy nashville young adult with a full-time job also attends college. in june 2, 0142 days before his 2025th birthday he experienced his first schizophrenic experience. since then sean has been admitted to the vanderbilt psychiatric council five times. spending ten weeks receiving psychiatric treatment sean recently wrote me saying this may seem slightly depressing but my story does not end there. the doctors and staff i encountered at the hospital and at the clinic taught me to live productively again in society. i've been free of the hospital for over a whole year now and during that time is taking medication and return to work and even paid off a car. i'm currently enrolled in tennessee state university is a junior pursuing a degree in psychology. sean is one person out of nearly 10 million in the united states with a serious mental health condition and without treatment history could have had a very different outcome.

in tennessee about one in five adults have a mental illness according to the tennessee department of mental health and substance abuse and that is more than 1 million tennesseans. in over 230,000 of them have what is considered a serious mental illness. over the past few years the committee has worked in a bipartisan way to update parts of the mental health system including programs of the substance abuse and mental health services administration which we call [inaudible]. this effort was championed by senators cassidy and murphy as well as senator collins and other members of this committee. the reforms part of the mental health act passes committee on march 16 of 2016 and were included in the 21st century cures act which the majority leader mcconnell called the most important legislation in congress passed last year. today marks the third hearing on implementation of the cures

legislation. we hope the updates in this loss will help more americans access quality, evidence-based mental health care. as i said when we began hearings on every student succeeds act a law is not worth the paper it is printed on if it is not implemented properly. i intend to ensure the 21st century cures act is fully and properly implement it as well. our focus today is to hear how samsara is implementing cures. of the 10 million americans with a serious mental health illness that includes severe schizophrenia, bipolar disorder, major depression, billions go without treatment as family struggle to find care for loved ones. most of the services and treatments for those with mental illness are provided by the private sector such as vanderbilt or through programs run by the state. the largest role in the federal government is the amount of

money spent through medicaid in partnership with the states. the federal government also plays a role through samsa which while relatively small compared to medicaid in responsibilities dates have is critically important to a improve the availability and quality of screening, early intervention and recovery services. tennessee received over 80 million in samsa grants last year. fire to our work on cures federal mental health programs have not been updated in over one decade in the coordination between federal agencies is not as effective as it could have been. i hope today we will learn more about implementation of those provisions is going, how his coronation improved among federal agencies on the best way to assist those with mental illness for example. we hope that promising research and early intervention programs at the national institute of health would translate into clinical applications for patients and we also included

updates to the samsa block grants to the states to ensure the funding is best meeting the needs of those suffering from mental illness. in addition to improve the care patient receives we encourage the adoption of proven scientific treatment so i would like also to hear how the agency started to incorporate more evidence-based approaches between mental health and we also hope the reforms would help increase integration between primary care and mental health care and ensure that insurance coverage for mental health disorders is comparable to insurance coverage or other medical conditions and strengthens suicide prevention efforts. doctor mccance is our witness today serves as the first assistant secretary for mental health and substance abuse, a position we created in the 21st century cures act. she is authorities to work with states and federal agencies to help more americans receive the treatment they need. i look forward to hearing about

the progress being made to ensure more people can receive the help they need and a positive outcomes like sean's. i would now like to turn the chairing of the hearing over to senator cassidy and senator murphy will make an opening statement and then senator cassidy will make a statement and then senator cassidy even take it from there. thank you very much. >> thank you very much chairman alexander. thank you for holding this important hearing. thank you for senator murray for allowing me to sit in her place and senator cassie four years of our partnership on this issue. it is indeed fitting that we are holding this hearing on the one-year anniversary of president obama's signing the legislation of that established this new position at the department of health and human services. this is the first assistant secretary for mental health and substance abuse position that is long overdue. it is also almost five years to the day since the terrible tragedy at sandy hook elementary

school were a young man with serious mental illness killed 20 first-graders and six adults. now let's be clear there is no inherent connection between mental illness and violence. america has no more mental illness than any other country and yet we have a gun violence rate that is 20 times higher than comparable nations. we also know that when people fall through the cracks of our fractured mental health system it can have a devastating impact. in the aftermath of that tragedy publicans and democrats were able to come together to pass the mental health form act which was part of the 21st century cures act and represent the first comprehensive overhaul and reauthorization of our nation's mental health laws in a generation. supported by the mental health community regarding equal support from both parties and it couldn't have happened without bipartisan support of this committee which is of course a testament to chairman alexander and ranking member murray. i think the legislation most

important provision is the part the build upon the mental health parity and addiction equity act by strengthening and enforcement of that loss and making it more transparent for americans. still there are two recent reports that illustrate how far we still need to go to fully achieve that vision of parity. a couple of weeks ago miami released its third nationwide parity report which found that more than one out of three respondents with private insurance had difficulty finding a mental health therapist compared with only 13% reporting difficulty finding a medical specialist. similarly, a study and found primary care providers 20% more for the same types of care that they pay addiction and mental health specials including psychiatrist. in many states the disparities in payment rates were two or three times greater in rates higher for medical doctors for people practicing medicine below the neck than those who were practicing medicine above the

neck. fortunately the 21st century cures law provides additional authority to the trump administration on parity and i hope it will begin to see these provisions implement it soon. they also created the position of assistant secretary as i mention this is important step to make sure there's one person at the top of the leadership department who is solely focused on these issues and we codified the roles of the chief medical officer within samsa to work closely with you. other provisions include several grant programs to include coordination of mental health treatment and accretion of a first-ever infant in early childhood and mental health grants and there's a section of the bill that through its workforce development and after hearing from consumers and providers about how there was confusion around hipaa and when

it was allowable to share personal health information we included new authorization for age-adjusted [inaudible]. there are other elements of the bill that will likely come up today but we have to remember that none of the programs that we authorize in this bill matter if we don't fund them. congress has an awful habit of talking a really good game on mental health and addiction but then never being willing to meet our rhetoric with resources. the current labor appropriations bill doesn't yet include funding for the new programs in the bill we passed last year and even worse the health repeal bill that would publicans try to pursue the senate earlier this year would have cut medicaid funding over time by $800 billion and that is of course the nation's primary health payment treatment. the legislation we pass as part of the 21st century cures act is still groundbreaking and properly funded it will save lives. i'm deeply thankful again to the committee for their work in making this bill possible and calling this hearing and lastly i'd like to ask unanimous consent that senator murray's opening statement be placed in the record. >> without objection. >> thank you.

>> many of you know i'm a position work for 25 years in louisiana and i learned a couple of lessons. one when the patient is the power the system lines up to serve the patient when she or he gets the heat that she or he needs. what i also observed is that those with mental illness have no power. they are just -- their ability to act upon the resources that are available are lost by the disorder which is in their minds. this is not just an experience for a fellow who's worked in a public hospital for the uninsured but the experience of assault whether it's a family member and associate, someone we went to high school with. we all know someone seem to have such a promise and that promise was snuffed out by a serious mental illness. their ability to execute power totally lost because of that. government has a role in government has the role to help those who are most vulnerable.

there's been a tangle of efforts for government to attempt to help those who have serious mental illness. what i was so privileged to work with senator murphy and others on this committee for the mental health bill of 2016 and we created the position that doctor mccants to create the authority to untangle this mess. and to somehow take this will miss mash, some would not be affected in some would be ported and line them up to help those with serious mental illness. we are now about the one-year anniversary of that bill's signing and this is a hearing to look at the effectiveness of this and let me say sometimes these committees are connotative and this is about collaboration and cooperation and how do we work together with his newly created position so that we can better serve those folks who

have lost their power for almost anything because of serious mental illness. my goal is that when that 24 -year-old has her first psychotic episode it is her last psychotic episode and when she's 50 years old she does not look back upon that single event is a life defining event leading up to breakup of her marriage, lost of her children, loss of her health but rather she looks back upon as a distant memory from which she grew and became a better person. that is the goal of all of us who look forward to your destiny today to ultimately restore wholeness and return the power to that patient. you for being here and now i will make your introduction. very pleased to welcome doctor eleanor mccann katz today hearing. you can the doctor is a assistant at the substance abuse

and mental health services administration. the 21st century cures act created the office of assistant secretary for mental health and substance abuse replacing the role of samsa administered her. the doctor formally served as the chief medical officer for the rhode island department of behavior healthcare developmental disabilities and hospitals. before that she served as chief medical officer for samsa. welcome again. you have five minutes to give your testimony and we shall hear from you. >> thank you so much. thank you senator cassidy and senator murphy and the members of the health education labor and pensions committee. thank you for inviting me to testify at the support hearing today. one year ago today the 21st century cures act was signed into law in the substance abuse and mental health services administration has been actively implementing its provisions in concert with her colleagues at the department of health and human services, state and local governments, tribal entities and other key stakeholders. for over 25 years i have served

people with serious mental illness and serious substance use disorders. it is such a privilege for me and an honor for me to serve as the first assistant secretary for mental health and substance abuse. as assistant secretary take my duties seriously. the cures act has asked that the assistant secretary look at disseminating research findings and evidence-based programs to treatment programs to ensure that grants are performance [inaudible]. i work actively on that. part of strengthening leadership and credibility at samsa includes a strong critical perspective at the agency. the cures act codified the role of the chief medical officer and we've taken this further by expanding the office of the chief medical officer to include

two additional psychiatrist and nurse practitioners. a new component of samsa greeted by the cures act is the national mental health and substance use policy laboratory. policy lab will promote evidence-based practices in service delivery models to evaluating models that would benefit from further development and the expanding replicating or scaling evidence-based practices across a wider area. the interdepartmental serious mental illness coordinating committee will be called [inaudible] and established by the cures act to ensure better coordination across the federal government to address the needs of individuals with serious mental illness and serious emotional disturbances, as well as their families. i was pleased to chair the first meeting in late august which was attended by key leaders and federal government as well as 14 highly qualified nonfederal members. it has been working with in five key areas of focus, strengthening federal protonation to improve care, closing the gap between what works and what is offered and reducing just involvement in improving care for those just

involved making it easier to obtain evidence-based behavior care and developing finance strategies to increase the availability and affordability of care. as required by the cures action the report will be delivered to congress today and i will just show you this. we are very pleased to bring it to congress on time and i hope that you will be pleased with it. >> i will scratch that question off my list. [laughter] >> and we authorize the community block grant and codified the first episode of psychosis and to set aside a vitally important to ensuring that individuals developing timely appropriate treatment and if we can intervene early with social services people are better able to live with their illnesses and avoid other chronic health conditions. i strongly support the reauthorization of the cures act of assistant outpatient treatment. in fiscal year 2015 samsa implemented and grant program and awarded 17 grants. it is partnered with the

assistant secretary for planning and evaluation to implement a cross site evaluation which will assess the effectiveness and impact of this program. one very important that the cures act addresses with suicide prevention. in 2015 over 44000 americans died by suicide and there are over 1.1 million suicide attempts annual in the united states. it authorizes the existing national suicide lifeline and in 2017 the lifeline had already answered over 1.67 million calls surpassing by 100,000 those recorded for all of 2016 and were not done with 2017 yet. suicide remains the second leading cause of death for individuals 15-24 years old and the cure are act preauthorized the memorial act which provides grant to states and tries to reduce youth suicide and youth suicide attempts. at the same time the highest rate of suicide in america is among adults 54-65 and prior to

the cures act there was no authorized suicide prevention program for adults. we are grateful for the authorization of the adult suicide prevention program in cure for congress is funding the program in fiscal 2017 as a result we have awarded grants for zero suicide is the program that implements suicide prevention and intervention programs within the health systems. ensuring that children and adolescents at risk for living with behavioral health conditions receive services in the support they need the key element. the national child traumatic was reauthorized by the cures act and provided resources to communities and individuals and practices with natural disasters and other traumatic events impacting the mental health of all americans. as directed by the cures act for working collaboratively with the hhs office of civil rights on guidance that would clarify committed use of [inaudible] of protected health information by healthcare professionals under [inaudible] to improve communication.

with the passage of the cures act we continue to recognize the critical role of behavioral health parity and ensuring equitable, high-quality health and behavioral health care for all americans. samsa has compared to 30 economies to improve parity information and the commercial insurance and the children's health insurance program. the hhs parity website has been updated to include information from a public listening session as has the insurance parity portal provides information for individuals who have experienced a parity violation. much work has been undertaken at samsa and across hhs to implement the cures act but we know this work is far from over. there are many more individuals and families struggling with mental and substance abuse disorders that need help. i look forward to continuing a strong partnership with congress to help these people in their families and to answer any

questions. thank you. >> senator murphy, would you like to go first? >> thank you, mr. chairman. thank you doctor mccann we are very excited that you are here and doing fantastic work in this position and you have a lot on your plate. we are excited about some of the early deliverables. i wanted to maybe first ask you to talk about more about this question of integration and you referenced it in your testimony but i'd like you to talk a little bit more about the work that can be done at hhs and through cms to try to bring together our behavioral health system and the rest of our healthcare system whether the proper way to do that are state governments or new payment mechanisms we could develop through cms to try to marry together the existence and its one system of health care for your neck down and then we have

to walk across town to find someone that will treat the rest of your body and it's a slow progression to fix that in part because of the way we fund mental health and mental health services. there's at least one grant program that was designed to take the sound but tell me what you been doing since you've been on the job to promote integration. >> thank you for that question. i think we are doing a fair amount. we have funded programs that are bidirectional and that is to the cures act in that behavioral healthcare can be put into primary care settings and primary care into behavioral health settings. we also have a program that again congress brought into being a couple years ago and is now in the process of implementation and that is the certified community behavioral

centers. these are programs that are focused on behavioral healthcare that require that both serious mental illness treatment and substance abuse disorder as well as physical healthcare can be in the same setting for individuals primarily diagnosed with mental disorders. that's very important. we work collaboratively with cms and we work with how they may be able to look at innovations in terms of ongoing funding and i will personally advocate for the continuation of the community behavioral center program because even though we have an evaluation out we know that f2 hc's work very well and they work well because the integrate care and they pay for that care and that's the other thing about the [inaudible] we have cms that is providing the payments for services and i think that will be very important to

establishing these kind of centers. we also work collaborate with samsa and other operating including [inaudible] which is a much larger organization that we are but we provide a lot of technical assistance and training and same with indian health services. i have also had my chief medical officers established a relationship both with [inaudible] and indian health services to ensure that these things move forward. >> often the states regulate behavioral health care centers and their primary care or federally qualified health care centers through different agencies. when they try to combine they often have simple regulatory hurdles like the number of fire drills are different in the two different locations so when they go on to one site they are often

being overregulated and i hope that is something you will help states try to overcome. one final question on hip pa a lot of confusion out there in the community as to what clinicians can share with family members and we gave you the ability to develop new guidance to try to make it clear only to providers about whether they are actually able to share information with a mom or dad or caregiver. i know you're working with the office of civil rights so within hhs on guidance but i wanted you to give us an update on when we might see that come forward and it would be helpful to everybody in the community. >> so, so, yes, i can definitely definitely come in on that. for one thing i think today you will get a series of informational documents from the

office of civil rights that further clarify when information can be shared. we spoke about -- i spoke with him yesterday about it so they told us that would be delivered to congress today just as my report is coming to you today. a few weeks ago the office of civil rights put out a guidance to practitioners about what can be shared in emergency settings. one of the big sources of confusion is when a person comes into an emergency center with an opioid overdose can it be shared with caregivers and loved ones and the answer was not shared because they think it's covered by 42 cfr, federal confidence and this is not substance abuse treatment. this is treatment of a medical emergency and under h i ppi we

are able to share that. it's also ensuring that there are exceptions under 42 cfr and we have had one guy go out to practitioners under about what they can share under emergency situations that went out in november. we are working on another document that will further clarify both hippa and 42 cfr in the same document and i like these to be short and easily digested by practitioners and i can tell you last week i was at a national meeting of a substance abuse treatment providers and the issue of sharing information was one of their main issues and i am really grateful to congress for the direction on this. >> thank you for taking it so fiercely. >> i'm going to ask you to be tight with your answers because i have a lot to ask. let me follow up probably with what senator murphy just asked about. that is great that you're coming out with the guidance and is there any plans and do you have the ability to turn this into a continuing medical education

credit or a legal credit or a nursing credit because i find those were the things that can be useful in the forest but if you make it right before the end of the year and everyone has to get their credits and it has more bang exactly. we have a number of different types of training programs at samsa and the address wide variety of topics and the issue of the sharing information. >> but will these specifically be continuing education credits? >> absolutely. our programs offer this at no cost to providers so we have the providers clinical support system oriented towards positions and nurse practitioners and we have the addiction technology. >> but it will be the lawyer that their calling in middle the night saying can i share

information and if the lawyer says no they will not do it. >> so you are exactly right about that and is somebody who is worked in a hospital setting i can tell you that they can be a very big barrier to sharing information. >> lawyers a problem can imagine. >> our chief medical officer one of the things that she's working on is developing a network with the national hospital association to exactly address the kinds of issues. >> our legislation we have reporting requirements and clearly you got to measure for this could be money is wasted. as samsa put those requirements in place how you measure compliance in terms of the states of reporting and how does samsa look at compliance with reporting session and how will states are performing when they decide to award a grant.

>> we have a required government reporting system that is used to buy all of our grants including the states and the block grants funding. i will tell you that i am not satisfied with the data as it currently collected. i think that we could do a much better job of getting information and that requires a certain set of steps we need to go through but i will tell you since i started we have made good progress on that and we will be approaching omb to further hone those questions that will be more informative. >> let me ask as well because i've spoken to colleagues about this and medicaid is not required to robustly report data. i understand when it comes to mental health there's the sam's samsa block with all put together with package and cms has one set of reporting requirements and samsa has another and has there been any

initiative between samsa and cms to coordinate these reporting requirements perhaps to unlock some of which see ms holds but you can see where i'm going with this. >> i do see where you're going with it but what i can tell you is this. part of the role of the assistant secretary position is to reach out to other divisions and other agencies of the department and i have asked for a meeting with cms that will be happening soon and this is one of several topic areas that will be addressing. i have talked to folks at samsa about this and they say this is a big hurdle and they do not know a way that we could right now. those data because i do understand what you're getting at but i'll be talking with cms about that and see if can bring people together to look at that. >> let me also say this is about collaboration and i would suggest or suspect that my staff would love to meet with your staff as to how the facility

that is right now paying a lot of money with the federal government for medicaid with some pretty poor outcomes. when you control for everything still have poor outcomes and so we need to have better reporting requirements and if it takes a statute to happen or oversight and sometimes that makes it work better at least murphy and kassie staff would like to meet with -- >> got it. >> i think i now go to senator franken. >> thank you, mr. chairman. good to see you again doctor. when i meet with people in minnesota who are sternly with mental illness and substance use disorders are often here about the stigma people experience, mental illness are often not regarded as physical conditions rather sometimes seen as moral feelings. we know that is not the case. my predecessor, senator paul

made his life's work to fight for people with mental illness pushing seriously for those with mental health parity in one of my growth greatest honors has been to carry forward his work, to help. help the affordable care act carried these protections to those who don't have employer-sponsored coverage and secured to the individual market in the 21st century cares bill extend these efforts by calling on the federal government and key stakeholders to generate an action plan to improve enforcement of mental health parity loss. doctor mccann in your testimony referred to the listing sessions that the administration held this past july patients, advocates and providers explained that many times people cannot find in that providers about high pocket costs and

fight with interest of these just to get services covered. stakeholders called for more enforcement, transparency from insurance companies, and agency guidance. the actions of the ministries taken thus far fall short of these demands and will you do or commit to doing in your new role to improve transparency from insurance companies and transform the parity portal into a meaningful resource for consumers? >> thank you, senator franken. that is a work in progress. one of the reasons i agree to come back into federal service is because i want to advocate for people living with mental and substance use disorders. i will be an advocate for long-term in this position. one of the things i think is very important is for people to be able to get access to care and when they have barriers that are put in place by arbitrary

insured limits i'm working with people with hhs working around the parity portal to make sure it is something that will be more functional for consumers right now and it has been updated so that at least people will be shunted to either department of labor. what their problem is but i would like to see this be something much greater and something that consumers can actually use to get information but it will take time. >> i'm so glad to hear you say that. for years we have heard growing energy cry from tribal leaders about the opioid epidemic and in particular the impact on the country and in the affairs committee i asked indian health services acting director how the

administration could address this issue in the opioid epidemic in indian country more broadly. he recommended that we first bring tribes to the table and second to consider community and culturally specific drug abuse treatment programs and i push for language in the 21st century cares act to ensure that leaders samsa consider the unique needs of vulnerable subpopulations including native americans. what are you doing to support and expand culturally -based treatment programs for individuals and especially those suffering with opioid addiction and other substance disorders and is part of your answer can you describe how you are engaging with tribal communities and working to develop and implement these culturally specific programs? >> yes. we have an ongoing and we actually have a office of tribal affairs. we have ongoing meetings with

tribal leadership. when i came to samsa i had learned that one of the addiction technology transfer centers that was specifically put in place was going to end and that is now a funding announcement out and we will choose a grant e who will work with tribes and meet their cultural needs as well to meet their substance abuse needs as well and i will work with the indian health insurance and we have our chief medical officers meeting with theirs and working with them around what kind of technical assistance and training what they recognize and that samsa can help with. i won't take a lot of time but we have a lot of training programs that are quite good. >> thank you. i am out of time and before the

hearing i spoke to you also about supportive housing and i want to continue that conversation with you even as i leave this body is i think it's very important that people with mental health disorders and with addiction get supportive housing and wraparound services so thank you for engaging the conversation for the hearing. >> thank you, sir. >> senator whitehouse. >> thank you chairman. i appreciate it. doctor, welcome and good to see you before the committee again. in the negotiations and the cares act got a commitment bipartisan commitment for an extra billion dollars to be spent on opioid treatment. the first half of that was already distributed and we hope and expect the second half of it will come through in the end of

this year funding measure whatever that ends up looking like. we are very much counting on that. and the last one the measure by which the funding was distributed to states didn't correlate to the rate of the opioid epidemic and the intensity and severity of opioid epidemic in that state. nor did it connect to the recently passed [inaudible] bill. i am hoping that as we move forward on this you will be in a position to structure the grant process for that second half billion in such a way that it more accurately addresses the high impact states and that it better connects to the [inaudible] bill. i thank you can probably do that in the terms of the grant application request that you

structure from samsa i just wanted to hear from you where you plan to go with that because the high impact states kind of got not treated so well. >> so, my understanding of the situation is that if we make any kind of changes to the previous funding announcement then all states would have to reapply for the money. i can just tell you that we've been hearing from lots of states about their concerns about having to reapply for the money and the decision was made to not have any substantive changes for those two years of the billion dollars. >> so for the sake of the process convenience for all the high-intensity states are going to be the price? >> so, i would say a couple

things. one when that decision was made i did go back and we looks very hard and we did find money we put a new funding announcement out that does prioritize the states that have been hardest hit by the opioid epidemic and i will can continue to do that. in addition, the other thing that i've been able to do is to reallocate funding so that we are building a new technical assistance program that will be individualized to every state so to the states that are hardest hit that certain types of special needs we will have local technical assistance available to them that we think will be important to helping them implement as efficiently and effectively as possible. going forward from that two years of funding whatever congress and the president decide upon we will look at that and very much aware of the kind of issues people just raised. >> please also be an advocate

for additional spending in this area in the care of programs in particular. i think we were able to get $170 million in the last funding measure and that is 2% of the $8.6 billion that the pharmaceutical industry makes selling just the prescribed opioid products setting aside the substance that comes over the border. 2% up against the devastation that we are seeing in the context of a multibillion-dollar industry and i would consider a beachhead not a victory. i hope you agree. >> yes, sir. >> last quick thing and this is a rhode island specific thing. the health insurance commissioners you know in rhode island has taken a look at the parity compliance of the insurance companies in rhode

island and i know you're looking at that at the national level. can i just make sure you got someone on your staff coordinating with rhode island to make sure that you are supporting their work and everything is going smoothly together on parity disclosure in enforcement. >> yes. two things. one seems samsa has developed a parity toolkit that we've made available to all the states and to we have an office of around health care reform issues and that we have a person who worked individually with the states and insurance commissioners within the states. we will make sure that happens. >> perfect. thank you. appreciate it. >> chairman alexander. >> thank you doctor. welcome. i want to follow up senator whitehouse russian because if i remember right it was his language that we put into the cares act to try to make sure

that the money distributed took into account high impact states, am i correct about that? at least i remember. >> the problem is that it was based, as i understand it, on the number of opioid deaths among -- >> but you have a big number but it doesn't necessarily mean it's a big impact. >> so our intention, doctor, was to recognize the importance was to distribute money to high-end impact states and that was our and i believe senator whitehous- >> that was not accomplished. >> so what do we need to do to accomplish our intention? you are saying that it will be impractical to cause all the states to reapply again. i can see that but there will be more money coming for opioids and we don't yet know when or

where or how much but is it the language about the difference between high impact states -- i mean, the number of protests and the number. capita deaths and is that the issue or what language would you recommend that we include in any new funding and that we direct money with a particular sensitivity to high impact states. >> senator alexander is not here in the previous administration when the position was made however my guess would be that they were trying to implement as congress directed and i don't know that -- >> i'm not trying to criticize them but i'm trying to say if you're doing it today how would you do it? >> yes, and so, for the new funding announcement that we just put out what we said was we were looking at the rate of

opioid overdose deaths within the states and the rate of increased year-over-year. that tells you how hard estate is being hit. >> will that affect the second round of funding? >> when the second round of funding comes forward absolutely we will be looking at -- >> does that require reapplication. >> yes, if it's a new source of funding, no, everyone would have to apply for that funding and. >> wait a minute, the second round is -- >> sorry. >> doesn't apply to the second half? >> so, no. >> but you would recommend that what you just said would apply to any new money. >> exactly. >> when you work with our staff so that we write that properly and our intention is to recognize high impact states that we do it in the correct w way? >> i absolutely will do that. yes. >> in 2014 congress required

states and i remember the discussion with senator whitehouse and i want to see that his and we tried to implement his intention and we can keep working on that. >> we are just so grateful that you followed up that way. >> congress required states to set aside 5% of community mental health block grant funds for serious mental illness. the cares act increase the requirement to ten and that sounds good but that reduces the flexibility states have to address what might be different in rhode island and california and what is your opinion about the increase from five-10% and does that help or hurt the ability of states to respond to the needs of those with serious mental illness? >> the vast majority of payment for the services delivered to people with serious mental illness is not samsa. the block grant having that

increase of 10% causes a focus on something that is extremely important and that is early identification of first episode psychosis. we know that the longer a person goes without having their psychotic thinking detected and treated the more refractory their illness becomes overtime. that 10% and that block grant does a tremendous amount of good in terms of raising awareness of this important issue. >> how does that encourage early prevention? the language just focuses on serious mental illness or does it say something about early? >> it talks about early identification. >> early identification of serious mental illness. >> yes. >> so it's not serious but the early that's the key to effective treatment. >> but we consider psychosis to

be serious and indicative of serious mental illness. >> so you think the 10% helps. >> i absolutely -- >> because of the push toward early -- >> yes. we know that the onset of the most psychotic disorders is in adolescence and transitional age groups. this is important to the lives that these folks will be able to live going forward. >> thank you, mr. chairman. >> thank you very much, senator cassidy and mr. chairman, thank you for holding this hearing. and doctor, thank you so much for being here and for the work you do. i want to follow up on the conversation we were just having about funding for those of us who have been incredibly disproportionately impacted by a horrible epidemic that has taken lives across our country but in new hampshire are sentinel and opioid epidemic is referred to

that way because of sentinel that is killing people in my state at one of the highest if not the highest. per capita death rate in the country and we have been targeted by the steelers and i was added funeral saturday were our family buried their second daughter from an overdose. a person who had been in recovery and had been working really hard at it and this disease is taking all of our efforts and i am very grateful for those on the committee but i will add my concerns and frustrations to what you heard from senator whitehouse. i have expressed directly to the secretary and i think the fact that states were uncomfortable about reapplying is not an excuse in terms of the decision that was made with the second round of this funding. toward that end, senator alexander, senator coons, myself and senator mansion have this bill in called the targeted opioid funding that would change the formula and make clear what kind of priority we should give

to. per capita death rates and i would love the committee's attention and collaboration on the bill. even if we fix this formula under the cares act we know the cares act money right now is only for two years and we know that there is no quick fix for this epidemic. we desperately need funds and we need tell us what supplemental and resources that we can have so it turns the time. when the president declares this a public health emergency but so far we haven't seen a follow-up to that decoration and we see no proposal from the administration for the funds that we need to tackle this epidemic and an epidemic that is not only taking lives but it cost us over $2 billion in our economy.

doctor mccann, have we had conversations about additional funding with hhs in the white house and why hasn't this and ministration called for additional funding or proposed additional funding so we can get the dollars and the resources to the front lines. so needed? >> there are many conversations going on about what the needs are and lots of efforts to look at the data available in the information available and it's my understanding that the administration is very interested in working with congress on developing those ideas that might be something that both the president and congress can agree upon. >> this congress has made clear that we support additional funding but we really need a partner in the industry ministration to stop talking and

to start funding. i would look forward to continuing those conversations and i also want to follow up with another question because we know how complex the opioid use disorder is. it's often accompanied by a variety of mental health disorders including, for example, posttraumatic stress disorder. this leads to complex and sometimes very dangerous outcomes. veterans and other populations with ptsd are often prescribed higher doses of opioids putting them at a greater risk for accidental overdose index. twenty-one disorder obviously does not address a symptom of the other and it's imperative to work to ensure that patients have access to copies of treatment to address both substance use disorders in mental health needs. doctor, has the mental health provisions in the 21st century cures act helps samsa enhance the availability of evidence-based treatment programs for dual diagnosis and

mental health disorder? >> yes, i believe they have. specifically i can speak to the issue around department of defense and veterans affairs which cures addresses. it is also developed a strong relationship where samsa works collaboratively in an ongoing way and we specifically address the issues of mental disorders and opioid epidemic as well as suicide. those are the big issues that we are working on right now. and we also can use the information that we learn from the va which actually does a lot of research of its own and we share this and we obligated to communities. >> i thank you for that and i thank you for the vision of integrated healthcare of this area. i am most concerned that we are delaying some of our work that would be made possible with

extra money because of the stigma attached to many of the other speakers and the senators have reference. i appreciate your efforts. >> thank you. >> doctor, good to see you. i read a book some months ago by sebastian, small little book called tribe and he discusses in the book the challenges our veterans face as they try to reintegrate into society and makes the point from an evolutionary standpoint we are more comfortable tribal societies like military platoons. embedded in the military structure and then we are in the current atomized society where people tend to feel lonely. there are challenges of reintegration and adaptation and we turned on its head the challenges veterans are facing but the problem is not. se with the veteran but maybe with an interesting read and

when i lay that line of argument in that analysis on top of the study and the depths of despair study that indicates increased rates with mobility among middle aged men, white men in this country and the reason for the death is heightened suicide alcohol use and so forth and i start to see that loneliness is thriving so many of mental health issues in our country. give me your assessment of that perhaps popular reading of literature. >> so i do think that those are important points and i think that actually there is research data that says that people who are isolated and will endorse

loneliness and feeling ostracized within their communities have diet much younger ages. that is an important issue. >> it's a driver is what i'm hearing. are there evidence-based approaches to intervening in this problem? if not solving it, then mitigating the challenges and if so, what is that evidence-based? what interventions work? >> so, senator young, i think this is a topic in evolution. but i do think there is some accumulating evidence for the value of recovery support as they relate not only to substance abuse disorders but mental disorders and so one of the things that i'm working on and this is one of my priorities actually is to bring psychiatric

medicine into closer contact and collaboration with communicating support. ... >> port assisting people to live the fullest life. >> it seems consistent with common sense but there's more needed than medicating these problems away. people need genuine human contact. they need relationships that are meaningful to them and they need to feel part of a broader community, a meaningful part. so i just have a couple minutes left. if we could turn to how the federal government

incorporates or fails to incorporate feedback loops in terms of addressing mental health and the policies we have. there's a recent governing magazine article on this written by health economics professional at harvard medical school and a former obama administration official and the authors advocate for including a tiered evidence approach with tourist dollars to allow for scaling up of evidence-based approaches while concretely supporting the old generated innovations. have you considered including a tiered evidence approach and some of your programs? say, the national mental health substance abuse policy lab? >> thank you for that question senator and we spoke about this a little when i was going through the confirmation progress i want to publicly speak about it . >> the answer to your question is yes, we are.

i'm happy to tell you the policy lab is being stood up now. we hired a director who is very experienced and knowledgeable who is going to do exactly that kind of work. >> great. i continue to have great interest in thisand i'll be following up with you and your staff to see how it might be supported from a legislative standpoint . >> senator franken. >> thank you mister chairman. i was glad to hear you talk about recovery support. we had rebecca voss from rhode island, i know you're from rhode island. >> i use to work for him she's doing unbelievable work and in rhode island they have recovery coaches is what they're called to do exactly what you're talking about is getting into the community. one of the things that we put in to 21st-century and the cures act is more crisis intervention training for police. we talked before the hearing about judge whiteman and miami who has implemented a

system where people with mental illness and substance abuse who get arrested instead of going to jail which they used to do and which costs a tremendous amount of money are going to emergency rooms which also cost a lot of money is getting them housing and getting them wrap around services. that is something that i think talking about evidence, i know that they are young and i talked about housing as a way. we've done this in allen county in minnesota as well. but that's something that i want senator young and others on this committee to keep advocating for and keep thinking about. keep bugging you even from outside. i want to, and i want to talk

about indian country again. and senator hassan talked about trauma. and we see a tremendous amount of trauma in the indian country. not just the historical trauma but the trauma of the extreme poverty, of domestic violence. and of drugs and sexual abuse and all of those things. and so we see that's why we see such high incidents of opioid deaths in the indian country. i went to a rehab for teenagers in northern minnesota acouple years ago . and i've visited a number of rehabs and i had never seen such hopelessness from the

rehab. usually when you go to rehab there's people feeling hope at a certain point and what i got was that most of them had started with their parents. and the hopelessness that i saw was what they were going back to. they seemed to be going back and this is true also not just in that country. i was in rock had minnesota and we had an open table on opioids and woman's daughter who had gotten treatment, went back, fell in with the old crowd and is now gone. one of the things that i was thinking of again was housing is a model of and maybe piloting this, a sober living housing in the indian country. where instead of going back to where you were living,

going to a facility that has people like you and it can be very close to the reservation or on the reservation but where you are getting continuous support and you are being tested and you have a fellowship of people there who are living sober to because especially with opioids, this is a long-term thing. it isn't five days of detox and then 28 days. it's a much longer thing than that so that's something that i would really like to advocate for. and going forward. so one last thing about culturally specific in indian country, it's important but i did a roundtable in minneapolis and one of the providers there or the

counselors said to me what does that mean, hopefully specific? she said when an indian woman sees me as a counselor, because i'm indian she knows that i know what she's been through. so i think that culturally specific means more than just a cultural, i think it means actually in indian country making sure that we train the providers so thank you. >> and i agree with you. that's quite right. >> senator warren. >> thank you mister chairman. mister mccann, one of the most important things we did in cures was to create an office of the assistant secretary of mental health and substance abuse which is now what you've been nominated to head off. we need to wrap up our opioid

epidemic and that means using every single tool in the toolbox. and one tool is to put more resources into mental health. so can i ask you to tell us why it is so important that we address mental health if we want to beat back the opioid crisis? >> yes and thank you for that question. because there is such a very high rate of co-authoring mental disorders with substance use disorders.and the genesis of these mental disorders often predate the substance abuse disorder itself so andwe also know that if we donot address both disorders , treating one does not treat both . >> that's a very six-inch way to put it, i appreciate that. it's clear that making progress on the opioid crisis means putting resources into treating mental health disorders. medicaid is the largest

funding source for mental health services but since i have a number of other problems. it helps services that are not covered from public or private insurance. mental health services block grant and a group of other grant programs call the programs of regional and national significance are senses made mental health programs providing funding for all 50 states and supporting the work of mental health agencies. of local governments and nonprofits who are working in this area. these programs are absolutely critical to improving mental health in this country and they serve millions of americans let me ask you doctor mccance-katz, is everyone who needs mental health care able to get help right now? >> i'd say the short answer to that is no. >> and why not?

>> there are a variety of reasons. one thing we know is a lot of people who we would say need this kind of assistance don't want it. but then there are also barriers that prevent people from getting the care and treatment they need. it would be very difficult to access care. >> you have an estimate on how many people need mental health treatment who are able to get it? >> i think the data told us somewhere around 13 million people. >> that's really a stunning number. and now the mental health services block grant and the programs of regional and national significance are the two largest mental health programs. combined, we spent less than $1 million a year on those programs. so let me ask you, the white house council of economic advisers released a report last month estimating the cost of the opioid crisis to this country. you know what figure they came up with? >> i'm guessing it was high when it was i hundred and $4

billion. but think about that. the cost of to this country annually of the opioid crisis is more than half $1 trillion. that's in 2015 alone where we have the most recent data and we are investing only one fifth of one percent of that amount in helping us tackle the mental health piece of this problem. i think we need to do more and that's why i called for an additional billion dollars in funding in next year's budget that would double the budget and let them double what they put into the two largest mental health programs. yesterday, the national

council was representing 2900 mental illness and addiction organizations. they wrote me a letter and i want to quote it. it said now is the time to support the highest possible levels of funding for health care programs in the federal budget and today, this morning the massachusetts association for behavioral healthcare sent me a separate letter requesting that congress double these funds. i could not agree more that doubling the funds for these programs would give millions more americans access to the treatments that they need and it would start making a dent in the astronomical cost that the opioid crisis is imposing on our country. thank you. thank you for being here, thank you mister chairman. >> thank you mister chair and it's good to have you with us. i want to ask about the issue that i hear about all the time in virginia from my law enforcement community and at the intersection between mental health and people who are in jails and prisons who should be. i have a lot of top law enforcement sheriffs and police chiefs who lament the fact that their jails are filled with people who have diagnosed an untreated or

sometimes never diagnosed mental health issues and they feel these people shouldn't even be in jail but if they're not treated there going to do something to harm themselves. they feel like they are being asked to be the mental health provider for society and mental health services and they feel both sort of a compassion and anger about that but also a resource challenge that makes it harder for them to do their job. so i want to ask about that. i also talk to police chiefs sometimes after highprofile incidents , a policeshooting at somebody and i'll say bottom , some of this was the police approached somebody a mental health field and i'm not completely trained on that and it spiraled into something worse and that can often become a flashpoint for community anger but at the bottom of it, there was an untreated mental health issue that's what i want to talk about. >> the 21st century cure has been an important provision

around mental health and criminal justice. including and a departmental serious mental health coordinating committee. and a provision that called for the attorney general to establish a pilot program to determine the effectiveness of diverting eligible offenders from the federal court system , federal courts and prisons . can you tell us a little bit about work with the bargaining committee in conjunction with the criminal justice system and has the attorney general and the department of justice been supportive in these efforts? >> so a lot of questions there. but yes. so we call it the is nick, the interdepartmental coordinating committee includes the department of justice. they have been good partners with us and we expect that to continue. this is a five-year process. you will be getting that report from the committee today. and the issues around the

interface between serious mental illness and the justice system is one of the primary areas of focus in that report. and so, i will tell you also we have programs that are dedicated to divergent, mental health courts. we have programs for offender reentry so they don't get lost in the cracks because my own experience having run state hospital systems in rhode island where we worked with the department of corrections was we really would get back because they didn't get into appropriate outpatient care at the time they were leavingand even though we might provide treatment to them while they were incarcerated , the is make has addressed this. i hope you will be pleased with some of the recommendations that we will be working on. >> i look forward to reading it. the thing i'm most familiar with at the state level is

the use of mental health courts which are significant. can you talk about how the mental health court system is working and the federal level, some of the things we might be reading in the report? ask what you will be reading is that we need more. more of these types of programs and these programs can be very, they are very effective and in diverging people away from incarceration and into treatment, appropriate care including medication because a lot of these individuals need medication and have not gotten it and don't continue to get it. also part of what the is nick committee has recommended, that the issues around civil commitment laws being looked at to try to maintain a person and in care once they leave. also the other thing that we talk about in the report is the crisis center. the use of a crisis center that is specifically geared to the treatment of people

who have substance abuse and mental disorders rather than going to an emergency department which is not an appropriate placement and where law enforcement often get stuck. these kindsof interventions can be very helpful in freeing up law enforcement and giving people the care they need . >> one more question if i can ask but if others want to jump ahead for a second round, should i just go ahead? i'm going to ask about prescription of naloxone. i worked with colleagues to introduce a coproducing save lives act which was incorporated in trenton and i was pleased to see that was a nonpartisan effort. how much progress has been made in terms of making naloxone more available to at-risk populations question mark can you the ability of prescribing guidelines? >> prescribing guidelines, we have an opioid overdose prevention toolkit that

speaks to the use of all the available formulations of naloxone in the process of being updated because there have been recent fda approved formulations so that is available. we also encourage co-prescribing. we train on cobra's writing and we have through kara and cures we have programs available that train first responders and also provide for funding or proper purchase of naloxone and distribution ofnaloxone . >> miss mccance-katz, i have a follow-up. and it's a follow-up not only to what i asked earlier but to a previous hearing where you work . in my previous line of question is asking about how to monitor outcomes? last committee hearing i asked how do we monitor a specific program. if we have treatment program

a and treatment program b and treatment program a has a hybrid recidivism rates with a lot of folks being perhaps overdosing in emergency rooms two weeks after discharge and we have program the weather have a more effective approach and we don't see that sort of thing on building data orhowever , i ask you last time if samsara was instituting thosereview processes and the answer i got was probably not at this point . in relation to what i asked earlier, is it possible for samsara to do that without a cooperative agreement with cms to look at billing data to see if there's a marker or recidivism. for example, billing for an emergency room visit a week after discharge.what i'm trying to get at is how do we effectively look at programs treating folks for addiction to know whether or not those programs are effective and the taxpayer gets the best deal for his or her dollar but more importantly the patient gets the best outcome relative to recovering from their addiction. >> so the issue around cms

and their billing data is one that we have to work on. but we are, yes, i am reviewing all of the data collection programs right now. and we are going to be making that data more available publicly so it's not just a matter of due program, these would be our programs that we are funding but it's not just a matter of collecting the data so that we can see whether the programs are good but making it available to the public and so you are working with our center for behavioral health institute quality to look at means by which we can make that data more available. the other thing that we do is i will tell you that for the sgr program, and the clinician. sdr is a targeted, there's a 500 million a year. i'm a clinician and i love clinical work. i am meeting with my staff about every single, we are

looking at every single program to see how the states are using their money.also using it differently. >> and follow-up, the states are using it differently, is there a common way where you can say this is how we wish you to evaluate because asset billing data, apparently it's only available from cns, it would be difficult to evaluate recidivism rates. is somebody moving to another location, many of these treatment will get programs are a geographic distance from the state. so if there is a way to evaluate without billing data, one that exists and two is cms promulgating this as we want you to evaluate and this is how we wish you to do so? >> the answer to your question is we have several evaluations ongoing. and we are monitoring to make sure they are using evidence-based practices. we have one evaluation done by cdc, another being done by a contractor and with that data will be made available publicly so that is an

ongoing project. >> i don't personally think the data should be used putatively. it could be quality management. >> the other thing that we do is cause we are working so closely with the state and because we have a new program with technical assistance we will also be asking the states to bring forward data on their programs because they have abilities to see. >> is that data available for the public or congress under review? >> i don't know the exact answer to that but i will find out and get to you on that. >> thank you very much. a follow-up question. i wanted to ask on the challenge of running our mental health workforce, senator kane accurately talk about converting individuals out of the criminal justice system. your first interaction happens at school often. many kids with mental illness will misbehave at school, run

into a police officer and be sucked into the criminal justice system, never to emerge. we talk a lot about mental health first aid training. shouldn't, to the extent that schools havethese officers , on site, should every single school-based resource officer have some asic training in identifying mental illness so that they can diver kids away from jails and into treatment if they present with symptoms? >> yes and with out endorsing aparticular program , i believe that is the best way to approach the issue, absolutely. >> and then tell me about senses work to develop more. capacity. peers occupy a very specific and useful role in treatment. a lot of emerging data is telling us that for many people in recovery that year

connection is what matters most. give me initiative that samsara is working on to broaden and improve the quality of peers in our system today.>> samsara has had a substantial role in the development of the year workforce. however, it's my view that samsara, no government agency should be in the business of trying to figure out how to credit a particular type of workforce. what we are doing is we have an office for consumers and families that is working with some national organizations on developing criteria for accreditation of peers. the states all do it differently but we are working with states and with the stakeholders to move that process along.

i believe that peers need to be integrated into the healthcare team because it's so important to not just give medical care but also the recovery services so that's what we are working towards. >> one last question, a follow-up with senator cassidy. you mentioned you were not satisfied with the data you were receivingfrom states. i think that's in relation to the block grant . can you tell us why you are not satisfied with the data you are getting? is it the amount of data or the quality of data? what's the problem you are seeing? >> because the data does not tell us anything about diagnosis and it doesn't tell us anything about basic standard of care issues like did a person get medication assisted treatment? how do i know if the program is working if i don't even know if they got the standard of care? >> what are you getting right now we are getting number of

people served. we're getting things that approximate certain types of diagnosis . did you feel sad? do you use certain substances? that is not enough to tell us what these programs are doing or who and what doesn't work. >> thank you for your focus on data and i agree with senator cassidy to that to the extent we can avoid duplication, that's something we should work together on. and i would echo that and i think thank the administration for appointing you because you. irritated about the same things i am irritated about and they are good things to be irritated by. i want to finish by thanking senators alexander, murray and murphy areconvening and participating in this . i also thank you doctor mccance-katz for an excellent

testimony. the hearing record will remain open for 10 days. members may submit additional information for the record within the time if they would like. thank you for being here today and the committee is adjourned. .. [inaudible conversation]

>>. [inaudible conversation]

>>. [inaudible conversation] this weekend on book tv on c-span2, saturday at 8:40 5pm eastern, rachel bachman talks about the impact technology has had on trust in her book who can you trust . >> is technology making us smarter about who we trust or is it encouraging us to place our trust in the wrong people and the wrong places. >> sunday at 4:45 pm, jamie goldstein talks about the closing of a general motors

assembly plant in janesville during the great recession. >> the core of my story is about the dislocated workers themselves. dislocated as a government term that means you've lost their job and it's not likely it's going to come back. as a set of social policies we call these people dislocated workers and i decided what i wanted to illustrate was as i came to think of it , what choices people make when there are no good choices left. >> and it 7:30, scientist gerard lanoir on the connection between the brain and the world in his book on a new everything. >> for more of this weekend's schedule, go to booktv.org. >> saturday night on c-span, victims of sexual harassment telling their stories. we will hear from fox news anchor gretchen carlson. me to movement founder toronto park, a group of military cadets. >> take us inside that day. >> so sunday morning.

picture it. >> sunday morning i started having notifications on my phone. not a lot. and i checked one and a friend sent me a message that said did something happen? what are you doing? and i said doing day. >> nothing in particular. and she said you need to go online, there's people talking about me too. i'm like okay. i had those out and i've been doing it for a long time but when i went, i looked on twitter and it wasn't, but there was an awful lot of post. i kind of panicked.i said this is weird. i work in a specific way and honestly in a very specific audience and that wasn't the audience that i was seeing. i also had tackled actual harassment in the workplace. and in schools yet.

and so i went through a range of emotions. i think by the late afternoon i was more panicked about the idea that there was mass disclosure happening in such a public way so while me too is obviously about people disclosing and telling their stories i was worried about people not having containment on the process. it's a big deal. i think we lose the idea that social media is the world. once you put it out there, it's in the world and there was like, what are these people going to do. there's a wave of emotions that happens that's so personal. so then i was like okay. i need to figure out how to insert myself in this conversation to get context. it's not just two words. it's a declaration and a disclosure that has an impact. and we use it, there's empowerment.

>> victims of sexual harassment and abuse telling their stories saturday night on our companion network c-span starting at eastern. >> for the next week washington journal is featuring authors of key books published this year. at 8 am join us for our live conversation with authors about their popular books. on saturday, fh buckley with his book republic of virtue. how we tried to ban corruption and failed and what we can do about it. michael dyson talks about his book tears we cannot stop: a sermon to white america and on christmas day monday author henry olson with the working-class republican. ronald reagan and the return to blue-collar conservatism. can stern with republican like me. i left the liberal bubble and learn to love the right and on wednesday angela j davis at her book policing the

black man. thursday, former representative cliff stearns with his book life in the marble palace. in praise of folly. also on friday, december 29 author and installer all with digital world war. islamic extremists and the fight for cyber supremacy and then on saturday, december 30, jessica bruder with her book no bad land. surviving america in the 21st century and on december 31 author chris whipple with the gatekeepers. although white house chief of staff define every presidency. washington journals author series for the next week at 8 am eastern on c-span, and c-span radio. >>. >> the senate judiciary recently held an oversight hearing on the insuring patient access and effective drug enforcement act. law-enforcement officials say the 2016 law undermines efforts to control the distribution of dangerous drugs as part of the opioid epidemic. >>