THE PROGNOSIS

Congress is poised to write the U.S. government its largest-yet check to fight opioid abuse — but the next thing to watch is how the funds will be spent.

Activists and lawmakers — particularly those from states hit especially hard by the drug epidemic like West Virginia and Ohio – were excited but somewhat muted by the inclusion of $6 billion for addressing opioids in the sweeping budget deal announced yesterday by House and Senate leaders, stressing they want to see exactly where the money will go.

“This is a small step but an important step in the right direction,” said Grant Smith, deputy director of national affairs for the Drug Policy Alliance. “If, in fact, it’s going towards boosting our treatment capacity, that is certainly a welcome development.”

The deal, which has strong support in the Senate but may have a harder time passing the House today, would add more than $500 billion in federal spending over the next two years, delivering the military funding boost sought by President Trump alongside the increase in domestic programs sought by Democrats, The Post's Erica Werner and Mike DeBonis report. With a government shutdown deadline looming at midnight, the accord holds the promise of breaking a months-long partisan standoff centered on federal spending, though roadblocks remain, they write.

The measure's modest sum for opioids, to be spent over two years and allocated by congressional appropriators, is nonetheless Congress’s largest investment yet toward fighting opioid addiction and overdose, a problem now so massive that it claims the lives of more Americans every year than car accidents.

Two bipartisan bills lawmakers passed in 2016 — one aimed at speeding the discovery of medical cures and another aimed at addiction — tossed a little more than $1 billion toward the problem. Congress didn’t provide any additional funding last fall after President Trump declared opioid abuse a public health emergency, much to the chagrin of health advocates who have been highlighting major shortcomings in the health-care system’s ability to help addicted Americans.

In that context, this new $6 billion infusion is the best indication yet that lawmakers and policy wonks are serious about making opioid abuse a top issue.

Senate Majority Leader Mitch McConnell (R-Ky.):

Senate Minority Leader Charles E. Schumer (D-N.Y.): 

Sen. Robert P. Casey Jr. (D-Pa.): 

Sen. Amy Klobuchar (D-Minn.): 

Sen. Sheldon Whitehouse (D-R.I.): 

“Every day approximately 11 Ohioans die from unintended drug overdoses,” Sen. Rob Portman (R-Ohio) said in a statement. “This crisis is overwhelming Ohio and our country. The funding in this proposal would be another important step in the fight against this epidemic.”

The text of the spending measure includes "enhancements to grants to improve well-being of families affected by substance abuse." It would be up to members of the House and Senate appropriations committees to more specifically direct the dollars through the regular budget process. 

Some lawmakers and activists stress the importance of spending the money in smart ways by sending it to the highest-need areas and investing in evidence-based practices proven to help those struggling with drug addiction.

A spokesman for Sen. Joe Manchin told me that while the West Virginia Democrat is pleased with the new funding stream, he’s concerned with making sure his state gets a fair share of the dollars give it has the highest rates of drug abuse in the nation. Manchin, up for reelection this year in a state won by Trump, is also well-placed to weigh in, as he sits on the Senate Appropriations Committee.

“We still don’t know how much West Virginia is going to get,” Manchin spokesman Jonathan Kott told me. “He is going to make sure West Virginia gets as much as possible.”

Manchin would also be more enthused if lawmakers would dedicate a permanent funding stream to opioid abuse, as he’s proposed in a bill dubbed the LifeBOAT Act, which would extract fees from the makers of prescription opioids to pay for substance-abuse treatment.

Addiction experts also say they’re worried about ensuring the money is directed to treatment supported by evidence – like medications helping those addicted wean off drugs paired with counseling – instead of pouring more money into law-enforcement tactics favored by Attorney General Jeff Sessions, many of which appeared to be ineffective during the war on drugs of the 1980s and 1990s.

And, of course, advocates feel that $6 billion isn’t nearly enough to address the crisis fully – although convincing a GOP-led Congress to provide the hundreds of billions of dollars some have suggested would be a tall order.

“It’s too vague and it’s not enough money,” said Andrew Kolodny, a professor at Brandeis University, who says he thinks Congress should spend at least $12 billion over two years.

“Even if they want to spend it exactly as I think they should, it wouldn’t be enough,” he said.

Some Democrats also urged more must be done. Sen. Jeanne Shaheen (D-N.H.):

HEALTH ON THE HILL

--We're keeping our eyes on the House today, where it's still unclear whether Republicans can pass the spending agreement without any help from Democrats. The measure would increase what’s called discretionary spending — areas such as scientific research, education, roads and health care that are funded year-to-year by appropriations — by 21 percent over existing budget caps, irking some conservatives who are warning it would set up trillion-dollar-a-year deficits. 

Opioid funding is just one bullet point in a list of health-care priorities included in the potential deal. A few of the other biggies:

—Extending the Children's Health Insurance Program for an additional four years (on top of the six years Congress authorized in its short-term spending deal last month, making for a total of 10 years before the issue must be dealt with again.)

—Boosting National Institutes of Health funding by $2 billion.

—Funding community health centers for two years (we have written extensively on this issue, most recently here.)

—Repealing the Affordable Care Act's Independent Payment Advisory Board, a Medicare cost-cutting board that has never actually been implemented but which Republicans have slammed for years.

—Closing the Medicare Part D “doughnut hole” for seniors in 2019.

Senate Democrats:

Larry Levitt, a senior vice president at the Kaiser Family Foundation, noted Congress doesn't seem terribly concerned with policies to help rein in health-care spending. The deal repeals IPAB and and delays the "Cadillac tax" on high-cost health plans (two parts of the ACA intended to do just that):

Politico's Jennifer Haberkorn noted a glaring omission in the budget deal: Neither of the bipartisan marketplace stabilization measures to help insurers lowers the cost of Obamacare premiums.

AHH, OOF and OUCH

AHH: Obamacare enrollment went significantly better in the 11 states plus the District of Columbia that run their own marketplaces, the National Academy for State Health Policy finds in a new report. The Post's Amy Goldstein reports overall signups stayed essentially level from the year before -- while enrollment fell by an average of 5 percent in the states using the federal-run Healthcare.gov website. And who did best of all? The five states with hybrid federal-state marketplaces.

Overall enrollment was surprisingly resilient despite the Trump administration's rollbacks of advertising for the marketplaces. The report shows that almost 11.8 million Americans chose ACA health plans for this year — just a half-million fewer than for 2017 and about 900,00 fewer than in 2016, Amy notes. But there are several reasons why state-run marketplaces tended to fare better than the federal ones: Some of them extended enrollment beyond the federal six-week sign-up season and some states chose to run robust advertising programs.

“The states live in a period of uncertainty, so when you see stable enrollment, it’s good,” said Trish Riley, NASHP's executive director. Despite repeated assertions by Trump that the marketplaces are essentially dead, “the message is, people want coverage, and they came and got it,” Riley said.

OOF: Robin Williams’s suicide in August 2014 appears to be linked with a nearly 10 percent spike in the number of suicides in the United States in the following five months. Our colleague Amy Ellis Nutt reports on a study finding the increase was especially marked among men ages 30 to 44, whose suicide rate rose nearly 13 percent. Even more notably, there was a more than 32 percent spike in the number of suicides by suffocation, which is how Williams died. 

"Analyzing monthly mortality statistics from the Centers for Disease Control and Prevention, researchers at Columbia University estimated that the number of suicides from August to December 2014 should have been 16,849," Amy reports. "Instead, the number was 18,690, representing an additional 1,841 cases."

Lahrs Mehlum, the director of Norway's Centre for Suicide Prevention, said the media's portrayal of Williams’s death may have played a role. “Sadly, there were all too many examples of unfortunate presentations of the case of Robin Williams' suicide,” Mehlum said. “Many journalists failed to mention the huge health problems Williams struggled with (both mentally and physically), but rather portrayed a glorified version of the event. This is not according to international guidelines for media reporting of suicide.”

OUCH: Republican lawmakers are threatening to withhold U.S. funding for the World Health Organization's cancer-research program, charging that its 2015 finding that Monsanto's herbicide Roundup could cause cancer in humans is flawed and biased, the AP reports. House Science Committee Chairman Lamar Smith (R-Tex.) said yesterday the finding is fundamentally flawed, relying on cherry-picked science and demonstrating anti-industry bias, citing a separate EPA review in December that glyphosate, the active ingredient in Roundup and other products, is not likely to cause cancer at typical levels of exposure.

"There are real repercussions to IARC's unsubstantiated claims, which are not backed by reliable data," Smith said at a hearing. "Labeling requirements will drive costs up for farmers and consumers and create unjustified public fear."

TRUMP TEMPERATURE

-- Meghan McCain says Trump told her he will no longer go after her father. McCain told Politico the president called her in the fall to say he would back off Sen. John McCain, who is being treated for brain cancer, following months of criticizing the Arizona Republican for his vote against the Republican “skinny repeal” health-care bill in August.

“I don’t believe he would go there again," Meghan McCain said in an interview for Politico’s Women Rule podcast. “I don’t think at this point in his administration it would be beneficial to him in any way.”

“I don’t think he has obviously attacked him in a while, but when the news came out that he was apparently, allegedly making physical mockeries of my father’s war injuries … I was deeply hurt by it," she added. McCain was referring to a story in Axios from September that reported Trump had physically mocked McCain “imitating the thumbs-down of his historic health-care vote.” 

--A few more good reads from The Post and beyond:

MEDICAL MISSIVES
Inspired Life
It was Lucas's smile that won him the iconic contest. Parents, especially those of special needs kids, celebrated.
Allison Klein
A second patient has been treated in a historic gene editing study in California, and no major side effects or safety issues have emerged from the first man’s treatment nearly three months ago, doctors revealed Tuesday.
AP
INDUSTRY RX
To Your Health
The transplant surgeon turned entrepreneur and philanthropist has been the subject of media investigations.
Ariana Eunjung Cha
Health insurer Humana will be raising its full-time employees' hourly pay to a $15 minimum thanks to the Republican-backed tax bill that President Trump signed into law late last year, the company's CEO announced during its quarterly earnings call Wednesday.
Washington Examiner
REPRODUCTIVE WARS
Journalist Anna Quindlen is leading the search for Richards' replacement.
HuffPost
SECOND OPINION
Wonkblog
It’s in everyone’s best interest for states to harsh the mellow a bit.
Keith Humphreys
DAYBOOK

Today

  • The Senate Health, Education, Labor and Pensions Committee holds an hearing on the opioid crisis.

Coming Up

  • George Mason University’s Law and Economics Center holds an event on generic drugmakers on Friday.
  • Kaiser Health News holds a discussion on living well with dementia on Feb. 13.  

SUGAR RUSH

Watch Nancy Pelosi’s eight-hour speech, in three minutes:

Meet Lucas, the first ever Gerber spokes-baby with Down syndrome: 

Trevor Noah responds to reports Trump wants to throw himself a parade: