with Paulina Firozi


Here’s an irony as Capitol Hill Republicans consider how to tackle the nation’s opioid crisis: Doing it through Medicaid – the low-income health insurance program they spent last year attacking in Obamacare repeal efforts – is probably the quickest way to expand help to those who need it.

The health insurance program for low-income individuals covers a whopping four in 10 non-elderly adults with opioid addiction, according to the Kaiser Family Foundation. That’s why experts and dozens of activist groups agree that expanding counseling, medication-assisted treatment and other crucial addiction interventions for Medicaid patients would go a long way toward countering the country’s sweeping struggle with opioid overdoses.

“We hope as Republicans are thinking through their next steps on the opioid epidemic, they’re thinking about how Medicaid can reach these individuals,” Rebecca Farley, vice president of policy for the National Council for Behavioral Health, told me on Friday.

“From our perspective, Medicaid is clearly the best tool to expand access immediately through this existing infrastructure,” Farley added. “It’s so logical that Medicaid is the program used.”

The council and a bipartisan group of lawmakers are pushing hard for a bill doing just that. Last year, health clinics in eight states were allowed to access higher Medicaid payments in return for supplying a broad range of mental-health and substance-abuse services.

By meeting the requirements, those facilities could be designated as certified community behavioral health clinics. They could be compared to the popular community health centers Congress recently funded, which are also certified. Only these clinics would be focused on mental health and addiction services and existing community health centers could also add these services to offer a whole range of care.

To advocates who have long worried about a shortage of substance abuse services in the United States, these centers could fill a longstanding hole in the health safety net for low-income Americans. Of about 23 million Americans suffering from drug and alcohol disorders, just 11 percent get treatment at a specialty facility, according to the National Survey on Drug Use and Health.

“In the community, there is a huge disparity between physical health and mental health and addiction,” Sen. Debbie Stabenow (D-Mich.) told me last week. Stabenow sponsored the 2013 Excellence in Mental Health Act, the measure that created the two-year pilot program.

Now Stabenow, Sen. Roy Blunt (R-Mo.), a co-sponsor of her measure, and the House sponsors — Reps. Leonard Lance (R-N.J.) and Doris Matsui (D-Calif.) — are trying to convince their colleagues working on opioids legislation to expand the Excellence Act by adding clinic certification in 11 additional states that originally applied but were excluded from federal funding because of a lack of it.

The measure "would be a very helpful thing for people trying to deal with the opioid challenge,” Blunt told me.

Stabenow has her eye on $3 billion in opioid funding expected to be made available via the spending bill Congress must pass by March 23. It’s still unclear exactly how that funding will be divvied up, but some of it could go toward an opioid package being worked on by Rep. Greg Walden (R-Ore.), chairman of the Energy and Commerce Committee.

“The fastest way to get comprehensive services out to patients would be to fully fund these 11 states who put together plans, who are ready to go,” Stabenow said.

But lawmakers and lobbyists told me privately they’ve run up against some GOP opposition to tackling opioid abuse through Medicaid, despite how well suited the program is for the task.

Medicaid was last year at the center of deep controversies over repealing and replacing the Affordable Care Act, as several GOP health-care proposals would have scrapped the law’s Medicaid expansion and enacted further changes to the program.

A Senate committee has even held a hearing to blame Medicaid, at least in part, for the opioid crisis. In January, Homeland Security and Governmental Affairs Committee Chair Ron Johnson (R-Wis.) presided over a panel focused on whether the program gave more Americans access to opioid painkillers that were then distributed on the streets.

Johnson raised the issue to the Department of Health and Human Services last summer, writing in a letter to the agency that “the Medicaid expansion may be fueling the opioid epidemic in communities across the country. Because opioids are so available and inexpensive through Medicaid, it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits and stay hooked.”

Stabenow said she’s hoping Republicans view these new certified behavioral health centers in the same way they see community health centers, which enjoy broad bipartisan support, even though Congress took an unusually long time this year to extend their funding.

She also pointed to evidence of the program’s success in the eight participating states. The newly certified behavioral health centers reported they’ve been able to hire 1,160 new staffers including 72 psychiatrists and 212 employees with an addiction specialty or focus, according to NCBH.

Sixty-two percent of the clinics trained staff or community partners in administering naloxone, an overdose-reversing drug, and 81 percent either began offering medication-assisted treatment or expanded existing programs.

“People don’t think of [community health centers] as Medicaid,” Stabenow said. “We want them to think of behavioral health clinics like health clinics and really focus on the fact that we need a permanent way to deliver services in the community.”


AHH: On Friday, a federal judge sentenced former Turing Pharmaceuticals executive Martin Shkreli to seven years in prison. Skhreli, known as the “Pharma Bro,” was convicted last August for defrauding investors after lying about the performance of his hedge funds and for conspiring to manipulate the stock price of drug company Retrophin.

U.S. District Judge Kiyo Matsumoto struck a middle ground between the 15 years prosecutors requested and the up to 18 months urged by Shkreli’s defense team, our colleague Renae Merle reports. The former executive is known for increasing more than 5,000 percent the price of an antiparasitic medication Daraprim, used primarily to treat newborns and HIV patients.

“In pleading for a short sentence, Shkreli’s defense attorney, Benjamin Brafman, portrayed Shkreli as a misunderstood genius suffering from depression and anxiety conditions,” Renae writes. “Usually boisterous and defiant, Shkreli spent most of the three-hour hearing, dressed in a dark prison uniform and black glasses, staring down into his lap.” Skhreli cried once he was given a chance to address Matsumoto, saying “poor judgment led me here. … The only person to blame for me being here is me.”

OOF: Veterans Affairs Secretary David Shulkin, a favorite of Trump’s who by most accounts tallied multiple wins in the president's first year, is fighting to regain his standing amid a staffer mutiny. It has become clear that one side — whether it’s Shulkin, who is the only Obama administration holdover in Trump’s Cabinet, or his estranged management team — is unlikely to survive the standoff, The Post's Lisa Rein reports based on interviews with 16 administration officials and other observers.

“It is an extraordinary state of affairs at the massive federal agency — only the Defense Department is bigger — whose mission is etched outside its headquarters a block from the White House: 'To care for him who shall have borne the battle,'" Lisa writes. “Some of the secretary’s aides, many of whom spent decades following orders in the military, have for weeks openly defied their VA chain of command."

“The rift has simmered for months, driven by personality and policy differences over shifting more health care for veterans to the private sector," Lisa continues. “It exploded into public view in February with the release of an inspector general report admonishing Shulkin and his staff for missteps surrounding a 10-day business trip to Europe. The report so outraged veterans that some threatened Shulkin. ... Shulkin continues to have Trump’s confidence, the White House says, but the impasse has compelled the secretary to seek support from those closest to the president."

OUCH: A long-established San Francisco fertility clinic experienced a liquid nitrogen failure in a storage tank on March 4, jeopardizing tissue hundreds of women had stored in hopes of having children, The Post's Amy Goldstein reports. The incident at Pacific Fertility Clinic, which the facility’s president acknowledged yesterday, followed a similar malfunction the same weekend at an unrelated clinic in Cleveland. A spokesman for the American Society for Reproductive Medicine said such large-scale incidents appear to be unprecedented.

Officials at Pacific Fertility said it was discovered during a routine check that the level of liquid nitrogen in one of the clinic’s steel storage tanks had fallen too low. Too little liquid nitrogen causes the temperature in the waist-high tanks to rise, risking damage to tissue housed in vials called cryolocks. Each vial can contain as many as three eggs; embryos — fertilized eggs — are stored individually.

The clinic declined to say how many eggs and embryos had been affected but said the malfunctioning tank contained “several thousand” eggs and embryos. Clinic spokesman Alden Romney said that represents as much as 15 percent of the total stored at the facility.

President Trump suggested that drug dealers get the death penalty for killing people with illegal drugs. "I don't think we should play games," Trump said. (The Washington Post)

--Yesterday the White House rolled out several policy proposals that focus largely on mental health and school safety initiatives as a response to last month's gun massacre at a Florida high school, The Post's Philip Rucker reports.

The administration is calling for “rigorous firearms training” for some schoolteachers and a bill to tighten the federal background checks system, but it backed off Trump’s earlier call to raise the minimum age to purchase some guns to 21 years old from 18 years old. Instead, the president is establishing a Federal Commission on School Safety, to be chaired by Education Secretary Betsy DeVos, that will explore possible solutions, such as the age requirement for purchases. The administration also wants to better integrate mental health, primary care and family services programs, and the president has ordered a full audit and review of the FBI tip line.

--The administration is also considering supporting the death penalty for drug dealers as a response to the opioid crisis, our colleagues Katie Zezima and Josh Dawsey scooped late last week. A final announcement on the new policy could come within weeks, as the Domestic Policy Council and the Department of Justice continue discussions and study the potential policy. 

Trump, who has expressed interest in Singapore's policy of executing drug dealers, also pitched the idea to a Pennsylvania crowd over the weekend. During a rally for a struggling Republican candidate, he said allowing prosecutors to seek the death penalty for drug dealers “is a discussion we have to start thinking about. I don’t know if this country’s ready for it," according to our colleagues Philip, Seung Min Kim and Jenna Johnson.

Even though the president is now setting up a commission on school safety, he mocked the idea of commissions to solve the nation’s drug epidemic. “Do you think the drug dealers who kill thousands of people during their lifetime, do you think they care who’s on a blue-ribbon committee?” Trump said. “The only way to solve the drug problem is through toughness.”


--HHS Secretary Alex Azar has vowed to advance such health-care innovations as computerized medical records and savings on drug costs, which he says Trump has endorsed. Kavita Patel, a health policy expert at the Brookings Institution and a veteran of the Obama administration, told the Associated Press the ideas are “taking a page out of a smart policymaking 101 and hitting on themes that everybody cares about,” though she noted it’s not clear how the administration will execute their ideas.

Here's a review of the agenda Azar has rolled out over the past several weeks, as detailed by the AP:

  • The administration wants to implement new standards to computerize medical records, which would allow patients to use an app to access their claims information and other medical details.
  • Azar is pushing more ways to fast track generic drugs to the market and enacting polices to discourage drug makers from raising prices.
  • Azar also wants to increase transparency in medical pricing, using Medicare, Medicaid and federal-state collaboration resources to get “true prices for health care goods and services in front of consumers."
  • The administration wants to use the Centers for Medicare and Medicaid Innovation to ensure Medicare’s payment system rewards quality over quantity of tests and procedures.
  • The administration’s overall goal is still to repeal the Affordable Care Act.

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



  • The Bipartisan Policy Center will hold an event on using the Supplemental Nutrition Assistance Program to promote better health.
  • The Kaiser Family Foundation holds an event on global health security.

Coming Up

  • The American Enterprise Institute holds an event on the opioid crisis with Sen. Mike Lee (R-Utah) on Tuesday.
  • The Senate Indian Affairs Committee holds an oversight hearing on opioid in the Indian community on Wednesday.
  • The Patient-Centered Outcomes Research Institute and the American Heart Association hold a briefing on cardiovascular disease on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Discount Program on Thursday.
  • VA Secretary David Shulkin testifies before the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies on Thursday.
  • HHS Secretary Alex Azar testifies before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on Thursday.

Watch a recap of President Trump's stump speech in Pennsylvania: 

President Trump played up his steel and aluminum tariffs in Pennsylvania steel country, while stumping for Republican Rick Saccone, who faces a tight race. (Reuters)

Saturday Night Live spoofs the "Bachelor" finale starring special counsel Robert Mueller: