DAVID GREENE, HOST:
So this is a question that people have been asking for weeks now - a very long time. We know that the nation's opioid crisis is deadly serious, but is it officially a national emergency or not?
STEVE INSKEEP, HOST:
President Trump has talked of making it one. Here he is back in August.
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PRESIDENT DONALD TRUMP: It's a national emergency. We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.
INSKEEP: OK, now, using the word emergency is one thing, but officially declaring an emergency is another with a lot of implications. The president has yet to take that step, although he plans an announcement of some kind on opioids today. As he does that, let's recall the scale of this problem. In 2015 alone, opioids killed more than 33,000 Americans. So how would an emergency declaration address this?
GREENE: Well, Noam Levey is here. He writes about health care policy for the LA Times.
Noam, good morning.
NOAM LEVEY: Good morning.
GREENE: So Steve mentioned possible implications here. If the president does speak about this - we don't know what he's going to declare - but could he change the war against opioids in some fundamental way?
LEVEY: Certainly, I think there's an - there's a hope among people on the front lines that the president and his administration will do that. We don't know, as you suggested, what a national emergency technically would mean.
But the president himself sort of alluded, I think, to one of the main issues here, which is an extraordinary demand for treatment and the huge numbers of people facing addiction, yet very limited resources in many parts of the country for people who need treatment for substance abuse disorder. By one estimate, just 1 in 10 Americans with an opioid addiction are getting the kind of treatment that the medical community feels works pretty well.
GREENE: One in 10 - so 9 of 10 people with an addiction are actually getting inadequate or no treatment. That's incredible.
LEVEY: It is incredible. And I mean, there are some pretty good reasons for this. Part of it is money. Part of it is, there's been a terrible stigma attached to substance abuse for decades. But one of the, in some ways, encouraging - if there is an encouraging storyline, I think, in the opioid addiction crisis, it is that the medical community has found some pretty effective ways to help people who are suffering from a heroin addiction.
There are treatments like methadone and other medication, medications that can allow people who have suffered in a substance abuse disorder to get back to learn - living normal lives. But that...
GREENE: So they know how to treat this. I mean, it - but the resources are a big problem. Would a national emergency, in theory, change that, help get the resources to states that they really need to bump up those numbers and get more people treated?
LEVEY: It really depends. It could. It certainly could. It certainly could. But one of the big issues here that I think really has to be addressed is that many people who have a substance abuse disorder don't have health insurance, and that's part of the big problems that fits into the larger health care debate we're having right now about getting Medicaid coverage around the country. That's probably the biggest thing that folks in the medical community say would really make a difference in confronting the epidemic.
INSKEEP: It's a big deal, and as we travel in communities from time to time, just talking with voters, asking them about their concerns, this is frequently one of the first things that comes up. And that 33,000-death figure is, of course, just the beginning - many, many more lives affected in terrible ways by this.
GREENE: Yeah, there's no doubt about that. Noam Levey of the LA Times, thanks for the time this morning. We appreciate it.
LEVEY: Good to be with you.
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GREENE: OK, Steve, so the House is going to be voting today on a budget plan.
INSKEEP: Yeah, it's a key step toward a tax bill. It would create a framework that would allow for a tax cut, and that's a goal that President Trump says brings Republicans together.
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TRUMP: We're really unified on what we want to do. We want tax cuts for the middle class. We want tax cuts for businesses to produce jobs. There's great unity.
INSKEEP: Notice the word choices - unified, unity. Republicans keep saying that they need to. They are fractured on many issues from what to do on health care to what to think of President Trump, but they at least agree on tax cuts. Or do they? Some worry about expanding the deficit.
GREENE: All right, NPR's Mara Liasson is here.
Mara, are Republicans unified? Is there unity, as the president is talking about?
MARA LIASSON, BYLINE: Well, there's some unity. I think the budget does have support, but because it's the last vehicle, the last prerequisite for passing tax cuts with only 51 votes in the Senate - that's what's known as reconciliation - a vote for the budget is the last point of leverage that members have to make sure their priorities are protected for tax reform. And the latest sticking point for the budget was this idea that tax cuts would be paid for by limiting the deductibility of state and local taxes, or SALT.
And Republicans who come from high local, state and - local-and-state tax states - generally, bluer states like New York and New Jersey, states that pay a lot more to the federal government in taxes than they get back in services - they don't like this idea. And they wanted some assurances before they vote for the budget that their taxpayers won't be disadvantaged when the Republicans unveil the details of their tax plan next week. So that's just the latest hang-up. Republican tax writers are trying to figure out a compromise on that.
GREENE: So it's so interesting. Republicans were looking at this issue as the one where maybe they could show unity. But you're picking tax cuts as the issue to try and show unity. That is always difficult because you have all of these elements in it. Some people are going to be opposed to something, and this is their moment.
LIASSON: Right. And on the general concept of cutting taxes, the president is right. Cutting taxes is like mother's milk for Republicans. And there's a real sense of political urgency - some would even call it desperation - to pass the tax bill so they don't go home to voters next year completely empty-handed. But the details of the tax cuts, Republicans are not unified on.
And the biggest problem is what's called pay-fors - how to pay for the tax cuts so they don't balloon the deficit. And this is where there's a lot of disagreement among Republicans. And even when Republicans come up with ideas for pay-fors, the president's - shoots a hole in it. Just an example - this idea of whether there should be big reductions in tax-free contributions to retirement accounts.
GREENE: Mara, let me just ask you this. Speaking of the question of Republican unity, you had Trump's former adviser Steve Bannon declaring this war on the Republican establishment. It sounds like there is now a big counterpunch coming from the establishment.
LIASSON: Yes. And this is where the real civil war in the Republican Party is right now. You know, no other Republican senators are joining this small band of outspoken Trump critics, like Jeff Flake, Bob Corker, Ben Sasse and John McCain. But the establishment is going to go toe-to-toe to defeat Steve Bannon-backed candidates who the establishment Republicans say, in many cases, can't win general elections.
And we have seen this plan - this play play out before. In 2010, the Tea Party candidates won a lot of primaries, lost general elections. Then in 2014, Mitch McConnell fought back and won. This is not an ideological fight, not even about pro-Trump versus never Trump. This is about mainstream Republicans versus insurgents. Steve Bannon says he wants to have a challenger for every single Republican incumbent except Ted Cruz.
GREENE: All right, NPR's Mara Liasson. Mara, thanks, as always.
LIASSON: Thank you.
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GREENE: OK, Steve, here's some news we reported back in August. Kenyans are going to the polls.
INSKEEP: That was true in August. It's true again today - a redo of a contested election, which is not going smoothly. Police fired tear gas at protesters in the capital, and some polling stations were closed because of security concerns. A candidate challenging the president in Kenya has urged people to boycott this rerun, so are Kenyans taking his advice?
GREENE: Well, let's ask NPR's Eyder Peralta, who is in Nairobi.
And Eyder, where exactly are you now?
EYDER PERALTA, BYLINE: So I'm in Kibera, which is an opposition stronghold here in the capital, Nairobi.
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PERALTA: And, you know, what we're seeing here right now...
GREENE: What is that sound behind you?
PERALTA: ...Is complete chaos. I'm at a polling station, and it's surrounded by protesters, by rioters who are throwing rocks at the polling place. The polling place is officially open. I spoke to one of the elections officials who says that they haven't had a single voter.
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PERALTA: But, you know, you can probably hear the rocks.
GREENE: Wow.
PERALTA: ...Right now coming through. And police are firing and also firing tear gas. Right now, what I'm watching right now is, they're throwing rocks at a police officer who was pointing his weapon at them. So they are trying desperately to keep protesters out of this place, but they've breached the wall. And you'll hear me sniffle here because there's a lot of tear gas in the area.
GREENE: Yeah, well, be careful.
PERALTA: That - they've breached one of the walls, and they're trying to come into the polling - I'm in a safe area here. But basically, stuff is tense here. And, you know, the government has said that voting will go on. But protesters have said they will not allow this to continue. I spoke to one woman who was trying to vote.
GREENE: And why is that? Can you just remind us why the opposition - go ahead. Go ahead.
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PERALTA: Yeah, yeah, I mean, you know, the opposition basically says that not enough changes, not enough reforms have been made to this election systems. And they say that these elections will be rigged once again. They said that the first ones were rigged, and the Supreme Court did agree with them and threw out the case - threw out the results of the first elections. Of course, the opposition leader lost it - during the first elections.
GREENE: All right, well, it sounds like an incredibly tense scene. Again, the opposition does not want people to vote today in Kenya. And that's our colleague, Eyder Peralta - NPR's Peralta in Nairobi in what sounds like a tense scene where no one has voted yet. We'll certainly be following that story. Eyder, thanks very much, and stay safe.
(SOUNDBITE OF HAFUSA ABASI & SLIM ALI & THE KIKULACHO YAHOOS BAND SONG, "SINA RAHA") Transcript provided by NPR, Copyright NPR.
