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At the White House

THE 'REASSURER-IN-CHIEF' IS OUT: Just when you thought Washington wasn't capable of making any more jaw-dropping news, Department of Defense Secretary Jim Mattis resigned on Thursday following his clashes with President Trump over his decision to withdraw troops from Syria and plans to do so from Afghanistan. And in the process, he delivered a remarkable repudiation of Trumpism via his resignation letter on the way out the door: 

  • From the letter: “My views on treating allies with respect and also being clear-eyed about both malign actors and strategic competitors are strongly held and informed by over four decades of immersion in these issues. We must do everything possible to advance an international order that is most conducive to our security, prosperity and values, and we are strengthened in this effort by the solidarity of our alliances.”
  • Bottom line: “Because you have the right to have a Secretary of Defense whose views are better aligned with yours on these and other subjects, I believe it is right for me to step down from my position.” 
  • Mattis offered not a word of praise for his boss in the letter. 

Mattis's departure capped a moment of total chaos in Washington as Trump sought to disrupt both the international and national order by making good on campaign promises to bring home U.S. troops from foreign conflicts and obtain full funding for his border wall at the risk of partially shutting down the government at midnight tonight in the midst of the holiday season.

  • Chaos politics: “At perhaps the most fragile moment of his presidency — and vulnerable to convulsions on the political right — Trump single-handedly propelled the U.S. government into crisis and sent markets tumbling with his gambits this week to salvage signature campaign promises,” The Post's Phil Rucker, Bob Costa and Josh Dawsey write
  • Yikes: “There’s going to be an intervention,” one former senior administration official said speculatively to Rucker, Costa and Dawsey. “Jim Mattis just sent a shot across the bow. He’s the most credible member of the administration by five grades of magnitude. He’s the steady, safe set of hands. And this letter is brutal. He quit because of the madness.”

Reaction from all quarters was swift, and not positive:

  • Hill Republicans on Mattis: “Having Mattis there gave all of us a great deal more comfort than we have now,” said Sen. Jeff Flake (R-Ariz.). “He was the steadiest hand in the Cabinet, and we’ve all slept better and felt better that he was there.”
  • Senate Democrats: Intelligence Committee Chair Mark Warner (D-Va.), who helped oversee that panel's Russia probe, called the Pentagon chief's departure “scary,” adding “our national defense is too important to be subjected to the President's erratic whims.”
  • European allies: “A morning of alarm in Europe” said Carl Bildt, co-chair of the European Council on Foreign Relations and formerly prime minister of Sweden. Mattis, he wrote on Twitter, “is the remaining strong bond across the Atlantic in the Trump administration. All the others are fragile at best or broken at worst.”
  • Moscow: “In our times, guessing who restrained President Trump from doing what is the work of political scientists and a rather thankless task,” said Russian Foreign Ministry spokesman Dmitry Peskov.
  • One exception on the shutdown: right-wing commentators like Ann Coulter and Rush Limbaugh and the hard line House Freedom Caucus, spoiling for a fight over the wall before House Democrats regain power in January. “I’m okay with a shutdown,” Trump told House Republicans at the White House yesterday, per Politico's Rachael Bade. “He was embracing it. He was at peace with it,” said one source in the room of Trump’s mood. “I think he was trying to go along with the [Mitch] McConnell- [Paul] Ryan strategy… and it wasn’t natural for him. He is more of a rabble rouser …. We asked him today, ‘Mr. President, are you sure you’re 100 percent committed to this?’ He was a kid in a candy store.”

From McConnell on Mattis:

 

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On The Hill

OH, P.S., THE GOVERNMENT IS PROBABLY GOING TO SHUT DOWN: It's looking increasingly likely we're headed to a shutdown tonight over Trump's 2016 campaign cornerstone: the wall.
Or, as he's been calling it lately, “artistically designed steel slats.” After House GOP leadership visited the White House for an emergency meeting yesterday, Trump said he'd veto a stopgap spending bill that would fund the government through Feb. 8th, 2019  unless it includes billions of dollars to build a wall along the southern border, The Post's Erica Werner, Damian Paletta, and Mike DeBonis report. 

  • Status: "The legislation passed the House on a near-party-line vote of 217 to 185 Thursday night, over strident objections from Democrats who criticized the wall as immoral and ineffective and declared the legislation dead on arrival in the Senate. No Democrats voted for the House measure, and eight Republicans voted against it,” Werner, Paletta and DeBonis report. 
  • Interesting:"Trump spent six to seven minutes in the meeting with [Speaker Paul] Ryan and [Majority Leader] McCarthy talking about “steel slats” and saying the term was preferable to calling the proposed construction a 'wall' as the president has done for more than three years," Rucker, Costa and Dawsey report. 

  • Bottom line: The House bill is dead on arrival in the Senate, where many lawmakers have gone home for the holidays after approving their own version of a stopgap funding bill on Wednesday. Retiring Sen. Bob Corker (R-Tenn.), a frequent Trump critic, reacted by laughing as Trump warned he won't sign that chamber's bill, per Politico's Burgess Everett: “Well, why not?” Corker responded when asked about his laughter. “You can’t make this stuff up. Y’all have fun.”

CNN's Clare Foran broke out who exactly would be effected by the lapse in federal funding if Trump and Congress can't hash out a deal. 

  • Agencies: Department of Homeland Security, the Justice Department, the Interior Department,  the State Department and the Department of Housing and Urban Development. 

  • “More than 420,000 government workers would be expected to work without pay. Some federal employees would be deemed essential and would continue to work, but their pay would be withheld until the shutdown is over.” 

  • Ironically enough: “That would include tens of thousands of Customs and Border Protection agents and customs officers,” Foran reports. 

The People

2018 AND THE OPIOID CRISIS: In a year most notable for its drama and dysfunction, one issue has consistently fostered bipartisan cooperation — enough to pass a massive package to tackle it. And in a White House where the only consistency is inconsistency, the opioid crisis has captured the joint attention of the president and first lady — it’s the only issue on which the two work seem to consistently work together, said observers.

The nation's addiction to painkillers continues to kill over 115 people a day. Power Up talked with Sen. Rob Portman (R-Ohio) — a leading voice in Washington on the issue — to discuss progress in combating the crisis and where improvements still must be made. Portman praised Trump on the topic and said he's shown “a real curiosity on the issue and seems genuinely interested in addressing it.” 

  • Portman said Trump stepped to help secure passage of his bill to help stop the shipment of fentanyl through U.S. postal system.“He said, 'Why don’t you have me tweet, because I have a lot of Twitter followers.' Luckily, of course, we thought about that in advance on what he might tweet and he did it and it really did help. So I would say, to his credit, on this issue, he has managed to keep it away from the politics,” Portman told us.
  • “He goes out of his way to thank Democrats and Republicans alike, so, it’s been maybe a little different than almost any issue I can think of. It hasn't been politicized,” Portman added. 
  • FLOTUS: Portman also praised first lady Melania Trump for her advocacy for babies with neonatal abstinence syndrome. Lawmakers approved language permitting Medicaid coverage of health services for infants born exposed to opioids in pediatric recovery facilities. 
  • Kellyanne Conway, senior adviser to Trump who has led efforts from within the White House to combat the crisis, told Power Up the issue appeals to Trump and Melania's “individual senses of compassion . . . it's a policy issue where neither the first lady or the president have thought, 'Well we can just check a box, deliver a speech, visit a hospital, sign a bill, cut a commercial and then our work is done.'" 

Both Portman and Conway pointed to the sweeping opioid bill signed by Trump into law at the end of October — one of the only comprehensive pieces of legislation signed into law in Washington this year — as a sign of bipartisan success on the issue.

  • “The package of 70 Senate bills costs $8.4 billion and creates, expands and renews programs across multiple agencies. It’s ambitious in scope, aiming to prevent the deadly synthetic drug fentanyl from being shipped through the U.S. Postal Service as well as allowing doctors to prescribe more medication designed to wean addicts off opioids, such as buprenorphine,” The Post's Colby Itkowitz reported

That measure allowed for broader coverage for recovery treatments under Medicaid and Medicare — which may be imperiled in the aftermath of a ruling by a federal judge in Texas who ruled that the entire Affordable Care Act is unconstitutional. 

  • “I think Medicaid expansion in my state has been very helpful in providing treatment options,” Portman told us. “It’s not the only way to do it but just to give you some sense of it, probably half of the dollars in the expansion have gone to some kind of mental health or substance abuse treatment.”
  • Portman and Conway both said that one of the more significant parts of the bill for those in the business of treatment was the partial repeal of a policy limiting Medicaid funding in bigger facilities  for mental health and substance abuse treatment. 
  • “You could get somebody in the treatment world to tell you this is huge in terms of increasing access to treatment. So we’re actually going in the opposite way in terms of providing more treatment for people under Medicaid,” Portman added. 

Some notable metrics from the past year: 

  • Since January 2017, the total number of opioid prescriptions dispensed monthly has declined by almost 17 percent, per an Health and Human Services Department-confirmed analysis of IQVIA data. 
  • According to the Center for Disease Control's Provisional Drug Overdose Death count, there was a 10 percent increase in deaths in 2017 (72,268) vs. a 22 percent increase in 2016 (66,012). In 2015, 54,207 people died from drug overdoses. 
  • And the seizures of fentanyl by border agents increased by 212 percent from 2016 to 2018, according to Customs and Border Protection. 

Outside the Beltway

THE STORY OF THE OPIOID EPIDEMIC is often datelined from rural West Virginia or Ohio or Pennsylvania, a problem endemic to mobile-home parks and suburbs, and the stories are often about members of the white working and middle class. But, as an investigation by Peter Jamison and a team of other Post reporters shows, that picture is dangerously incomplete.

“Almost entirely omitted from their message has been one of the drug epidemic’s deadliest subplots: The experience of older African Americans,” Jamison wrote, “for whom habits honed over decades of addiction are no longer safe.”

More from the just-published, two-part investigation:

  • The problem: “Heroin laced with the powerful synthetic opioid fentanyl has killed thousands of such drug users in the past several years, driving a largely overlooked urban public-health crisis. Since 2014, the national rate of fatal drug overdoses has increased more than twice as fast among African Americans as among whites.”
  • The numbers: “Between 2014 and 2017, the fatal overdose rate among African Americans shot up by 94.1 percent — more than double the 44.6 percent increase for whites. The resulting deaths have disproportionately hit cities and other densely populated areas. … America’s opioid epidemic has changed. And what changed it was fentanyl.”
  • A fierce and surprising killer: “Fentanyl has decimated opioid users of every demographic. But its effects are especially pronounced among older African Americans caught off guard by the sudden lethality of heroin they had learned to use with relative safety. Those veteran, urban users — who typically dread and seek to avoid fentanyl — are still left out of policy discussions about the opioid epidemic.”

IN THE SHADOW OF THE U.S. CAPITOL, just down the street from the seat of national power, where lawmakers, health professionals and advocates debate the best solutions to the opioid epidemic, a city is struggling to combat its largest public-health crisis since AIDS. Fentanyl-fueled drug overdose deaths are ravaging the District and killing hundreds of Washington’s African Americans.

Yet, the city has “consistently fallen short in its response to mounting opioid casualties, misspending millions of federal grant dollars and ignoring lifesaving strategies that have been widely adopted elsewhere,” Jamison’s investigation found.

  • Not enough to go around: “D.C. officials distributed naloxone — an overdose antidote that laypeople can use to prevent deaths — at a far lower rate than other cities with comparable opioid problems.”
  • Missing in action: “The city has also faltered in carrying out a federally sponsored initiative to connect long-term heroin users with treatment. Although D.C. officials in 2017 began receiving what will ultimately total $4 million over two years … many programs the city said it would launch never materialized.”
  • An unequal response: “Few elected officials have taken prompt action to address the crisis. Frustrated advocates and medical professionals say the District’s lackluster response would never have been tolerated in whiter and more affluent neighborhoods.”

In the Media

The opioid epidemic often doesn't get the press coverage it deserves, but here's a selection of 2018 stories — from national and local outlets — that covered the crisis well. 

Viral