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The Health 202: HHS chief pushes Trump opioid commission's top recommendation

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with Paulina Firozi


President Trump’s top health official wants everyone to know that he is pushing forward with a key recommendation for helping states combat the opioid epidemic.

Health and Human Services Secretary Alex Azar said yesterday at a White House summit on opioids that he’s willing to exempt more state Medicaid programs from a long-standing restriction that severely limits where those struggling with addiction may get treatment – all states have to do is ask, he said.

“We’re open for business,” Azar said, speaking in the East Room of the White House, where top Trump administration officials spent several hours Thursday afternoon touting their strategies for combating the national plague of drug abuse and overdose.

Although President Trump has been heavily criticized over the past several months for doing little about opioid addiction — despite declaring it a public health emergency in October — the administration has sought to change that narrative in recent weeks.

Trump’s budget proposed an additional $13 million to expand addiction treatment, Attorney General Jeff Sessions announced a new opioids task force this week and Azar said he told state governors at their meeting last weekend that he is prioritizing Medicaid “waivers,” making it easier for states to provide substance abuse treatment.

There are several levers these waivers can pull to expand treatment, but a chief way is through removing what’s known as the “IMD exclusion” — a federal law banning facilities with more than 16 beds from providing substance abuse treatment.

Treatment advocates, governors and medical providers have lobbied heavily to remove this exclusion, which has been in place since the Medicaid program was created half a century ago. Back then, there was a big push to deinstitutionalize mental-health patients in favor of integrating them into communities.

Trump’s opioid commission, led by former New Jersey governor Chris Christie (R), last August identified removing the IMD exclusion as the top way to make treatment available to patients immediately. “This is the single fastest way to increase treatment availability across the nation,” the report said.

Azar is apparently taking that recommendation to heart. While he can’t permanently reverse the policy, since it’s written into law, he can excuse states from it. He said HHS has granted five states such waivers – including West Virginia and Kentucky, two states with huge rates of addiction — and he wants to see many more apply.

“I berated the governors, saying, 'Why have we gotten only five of these [waiver requests] so far?' ” Azar joked yesterday.

Azar said he even encouraged governors who are seeking multiple changes to Medicaid to separate out their request for ducking the IMD exclusion — that way, the agency could expedite it and start expanding access to treatment sooner.

“I’m hoping we’ll see a faster clip,” Azar said. “We can handle those quite quickly.”

Arkansas' Attorney General Leslie Rutledge: 

From the group Students for Opioid Solutions: 

Azar appears to be striving overall to remake HHS’s image as an agency grounded in research and evidence-based practices, after it was criticized in recent months for appearing to censor certain language. Multiple times in the past few weeks, he has emphasized viewing those addicted to opioids not as morally corrupt but as people in need of medical help.

“We need to treat addiction as a medical challenge, not as moral failing,” Azar said.

President Trump on March 1 said countries where drug dealers face “the ultimate penalty” have “much less of a drug problem than we do.” (Video: The Washington Post)

Azar’s emphasis on medication-assisted treatment for opioid abuse also stands in stark contrast to Trump, his boss, who typically focuses heavily on law enforcement whenever he’s addressing the epidemic. That’s the approach Trump took yesterday, telling summit attendees that cracking down on drug dealers is a key to solving the problem — and even suggesting that imposing the death penalty on them would be helpful.

“Some countries have a very, very tough penalty — the ultimate penalty,” the president said. “And, by the way, they have much less of a drug problem than we do. So, we’re going to have to be very strong on penalties.”

Trump added that he planned to roll out additional policies in the coming weeks to address the crisis. And the White House is considering whether to make trafficking in fentanyl, a synthetic opioid many times more deadly than heroin, a capital crime, per my colleague Katie Zezima.

“If you shoot one person, you get life in prison,” Trump said. “These people kill 1,000, 2,000 people, and nothing happens to them.”

Trump tweeted this morning in support of Eric Bolling, who spoke at the summit about his 19-year-old son who overdosed last year. Bolling was ousted by Fox News in September following allegations of sexual misconduct: 


AHH: Uber and Lyft are ready to give you a ride to your doctor’s appointment. Yesterday, Uber announced the launch of Uber Health, a dashboard to let health-care providers schedule rides for patients. It’s just the latest example of tech companies plunging into the health-care space, our colleague Carolyn Y. Johnson reports. Over the last few years, ride-share rival Lyft has established partnerships with health insurers, hospitals, and medical transport services to help people get to medical appointments for nonemergencies.

One potential hiccup: A recent study in JAMA Internal Medicine found the availability of ride-sharing services did not decrease the number of no-show patients -- which is a big problem in medicine. "A study of nearly 800 Medicaid patients in West Philadelphia found that offering to schedule free Lyft rides to and from primary care appointments didn't decrease the number of missed appointments compared to a group of people not offered the service," Carolyn writes. "That work...calls into question whether simply expanding the availability of ride-sharing services would help solve the problem."

But individual companies have reported benefits, with the services providing cheaper transportation alternatives and reducing patient complaints. "CareMore Health System found in a pilot study in 2016 that using Lyft was cheaper than other forms of transportation and patients spent less time waiting for a ride," Carolyn writes. "American Medical Response, a leading medical transportation company, has reduced complaints by 50 percent since partnering with Lyft."

OOF: Some states are working on ways to respond to the Trump administration’s proposed expansion of short-term health insurance plans, a move criticized by ACA advocates who note these plans wouldn't have to offer the benefits required under the health-care law. The proposal would allow people to gain short-term coverage for 364 days. But some states could outright ban short-term plans or could restrict them by limiting the length an individual could be covered or imposing certain rules, CQ Roll Call’s Mary Ellen McIntire reports.

To have an effect on the 2019 individual marketplaces, states would have to move quickly if they would hope to block short term plans and potentially deter companies from looking to sell their policies, Georgetown University's Sabrina Corlette told Mary Ellen. Corlette also suggested requiring short-term plans to cover preexisting conditions or spend a minimum on premiums may also be enough to deter companies from marketing their plans.

OUCH: Three federal appeals court judges had an unusually contentious fight yesterday, as they considered whether an undocumented teen immigrant should be allowed to get an abortion after being blocked by the Trump administration, Politico reports.

"The legal fight about the wishes of the 14-year-old girl pitted one of the New Orleans-based 5th Circuit’s most conservative judges, Edith Jones, against two of her colleagues, Patrick Higginbotham and Gregg Costa," Josh Gerstein writes. "The extraordinary, caustic exchange stemmed in large part from Jones’ use of her opinion in the case to attack two Texas attorneys, Myles and Rochelle Garza, who have served as court-appointed guardians for a series of pregnant teens who have sought abortions recently while in U.S. government custody."

Jones also said her colleagues’ “disingenuous” opinion ordering a hearing on the wishes of the girl...was based on “critical assumptions that … but must be exposed in order to prevent the continued sidestepping of [HHS’s] custodial role by advocacy groups seeking to extend abortion rights.” "Despite the nearly nuclear exchange, the appeals judges actually agreed on the immediate outcome of the case," ordering it sent back to U.S. District Court Judge Rolando Olvera in Brownsville, Texas, Josh writes.


--The Trump administration has selected a new assistant secretary of public affairs, recently vacated after Charmaine Yoest was moved to the White House Office of Drug Policy. Multiple sources tell The Health 202 the pick is Judy Stecker, director of media relations at the conservative think tank the American Enterprise Institute. The appointment comes as HHS is trying to remake its image as a more media-friendly agency.


Planned Parenthood's political arm announced plans yesterday to spend $20 million in eight states with competitive races ahead of the 2018 elections. The campaign -- which will be the group's most sizable investment yet in a midterm election -- will mostly target gubernatorial and Senate races in Arizona, Florida, Michigan, Minnesota, Nevada, Ohio, Pennsylvania and Wisconsin. Planned Parenthood Action Fund will also focus on several House, attorneys general and state legislature races, the group's leaders said yesterday.

Planned Parenthood also launched a website, “March. Vote. Win.,” that says it will “educate voters about where candidates stand on reproductive health care issues.” The eight-figure campaign will include digital and television advertisements, and mail programs.  

— The Trump administration isn't banning abortion providers such as Planned Parenthood from applying for Title X family planning grants — as some groups on the left had feared. But in a notice of funding for the program, HHS did include some wording changes that are still raising the groups' ire and could potentially make it harder for certain clinics that provide only limited services to apply for grants.

The funding notice removes prior references to “contraception,” instead referring generally to “family planning” in the details about the types of services Title X grantees must provide. The notice also includes two references to “natural family planning,” a form of family planning supported by the Catholic Church that doesn't involve contraceptives. And it adds that each potential recipient should “optimally” offer primary health services onsite or offer robust referrals to primary health-care providers in close proximity.

In a memo warning lawmakers to closely watch the upcoming season of Title X grant applications, the group Equity Forward writes that the program's “long history of bipartisan, evidence-based work is in jeopardy” considering the antiabortion views of the Trump appointees running HHS. “They are shifting Title X to reflect a far more conservative, limited view of reproductive health,” the memo says.


Yesterday, United Health Foundation released its 2018 America's Health Rankings update on the health status of U.S. women, infants and children — and it showed some troubling trends. The report consolidated all the publicly available health data from the past two years on more than 60 different health measures to provide guidance on where policymakers should focus efforts. Some top findings:

—Maternal mortality has increased 4 percent nationwide. The mortality rate among black women is 2.5 times higher than among white women and 4 times higher than the rate among Asian/Pacific Island and Hispanic women.

—Drug deaths among women ages 15 to 44 have increased 20 percent, and death rates trend higher with age.

—Drug death rates were highest among women ages 35 to 44 compared to ages 15 to 24 and ages 25 to 34.

—The teen suicide rate increased 6 percent for adolescents ages 15 to 19. Suicide rates were highest among American Indian and Alaskan teens.

A few more good reads from The Post and beyond:

C-Sections and Gut Bacteria May Contribute to Overweight Kids (New York Times)


Big pharma, big data: why drugmakers want your health records (Reuters)


West Virginia drops lawsuit against DEA (Washington Examiner)

10 ERs in Colorado tried to curtail opioids and did better than expected (Chicago Public Radio)


Coming Up

  • Brookings Institution holds an event on "What's ahead for the individual health insurance market" on March 6. 
  • The National Coalition on Health Care holds an event on alternative payment models on March 16. 

During the White House summit, Melania Trump shared a letter she received from a mother whose son died from a drug overdose:

During a White House summit about opioids on March 1, first lady Melania Trump shared a letter she received from a mother whose son died from a drug overdose. (Video: Reuters)

Here's how Trump plays good cop and bad cop: 

President Trump surprised lawmakers by backing tougher gun-control proposals on Feb. 28. Here are a few other examples of when Trump has changed his mind. (Video: Elyse Samuels/The Washington Post)

Sen. John Cornyn (R-Tex.) called the meeting on guns with President Trump a "brainstorming session:" 

Senators update reporters on March 1 about the status of the gun debate after members of congress met with President Trump. (Video: Jordan Frasier/The Washington Post)