THE PROGNOSIS

BREAKING: Ronny Jackson, Trump's pick to head the Veterans Affairs administration, dropped out of the process this morning after a slew of charges about his time as White House physician. Get the details below.

Emerging partisan fights and political considerations are threatening to derail legislation addressing the opioid epidemic, even as both chambers of Congress try to move quickly on the crisis in an election year.

House and Senate panels have passed separate bundles of bills aimed at countering opioid abuse — the Senate Health, Education, Labor and Pensions Committee moved its package on Tuesday, and yesterday evening the House Energy and Commerce Health Subcommittee approved 56 measures. There was lots of fanfare from both sides of the aisle, as lawmakers patted themselves on the back for advancing a bipartisan response to what President Trump has dubbed a public health crisis.

“The epidemic of opioids needs a prompt, bipartisan and effective response, and we gave that today in the Senate Health Committee,” said Chairman Lamar Alexander (R-Tenn.).

But the legislative pathway forward is far from clear.

For one thing, there’s little money to work with, meaning limited opportunity to dramatically expand treatment opportunities for Americans struggling with opioid addiction. Congress provided $4 billion in new opioid-directed funding in the sweeping spending bill it passed last month, but the money was allocated mainly through grants to states and Indian tribes and distributed among federal agencies to strengthen ongoing efforts to address the problem.

And now Democrats are rethinking whether they even want to hand Republicans a win on the hot-button issue, as they face the prospect of taking back the House and gaining more leverage in 2019. If they seize the House majority, Democrats could influence more of the agenda and try to force the hand of Republicans to address opioid abuse through Medicaid.

In a hearing this month, top Energy and Commerce Committee Democrat Frank Pallone (N.J.) said that the whole process felt “more like an opioids media blitz than a thoughtful discussion of our national crisis.” Yesterday the congressman appeared even more critical of his GOP colleagues, accusing them of rushing through the process without deliberating which kinds of policies and programs might work best.

“Taking the wrong action because we are not spending the appropriate amount of time to get these policies right could have the very serious consequence of making things far worse,” Pallone said at yesterday’s hearing.

Energy and Commerce Democrats refused to support a handful of bills the health subcommittee had been trying to advance, including a measure from Rep. Markwayne Mullin (R-Okla.) to revise medical privacy law so doctors can access patients' previous treatment for drug abuse and addiction. The change is widely supported by medical and industry groups, including the American Hospital Association, the American Psychiatric Association and America's Health Insurance Plans. The measure wasn't among the bills passed.

The dozens of bills passed in both the House and Senate committees make small — but significant — changes to the ways federal agencies regulate, oversee and enforce rules on opioid painkillers, and to how states and localities try to mitigate abuse as well as to how Medicaid handles patients struggling with addiction.

For example, language in the Senate package would clarify the Food and Drug Administration's authority to require that companies package certain opioids in smaller dosages and give the National Institutes of Health more flexibility in researching nonaddictive painkillers that could be alternatives to opioid painkillers.

Lawmakers say that these tweaks to public policy could, overall and over time, help tamp down high rates of abuse and overdose. But here’s a broader question to consider: What would Congress need to do to close the treatment gap?

Federal data show a huge number of Americans who need substance abuse treatment don’t get it. Just 11 percent of the people who required such treatment in 2016 actually got it, according to the latest National Survey on Drug Use and Health.

As The Health 202 wrote in March, the most efficient way to tackle opioid abuse is probably through the Medicaid program, since it covers four in 10 non-elderly adults with opioid addiction. But lobbyists say Republicans are reticent to make any big changes to the program for low-income people because it has become so politicized in recent years.

At this point, the House looks more likely than the Senate to pass opioid legislation, as Senate Majority Leader Mitch McConnell (R-Ky.) has not appeared eager to move on any kind of health-care legislation. Energy and Commerce Committee Chairman Greg Walden (R-Ore.) has set a goal of getting a package to the floor by Memorial Day — but it’s still unclear whether things will stay bipartisan until then or devolve into across-the-aisle bickering.

“We’re tinkering around the edges — we’re not tackling this public health crisis,” Rep. Kathy Castor (D-Fla.) complained yesterday.

AHH, OOF and OUCH

AHH: New research shows the surge in marijuana use is driven not by young people but by the gray-haired and balding set, The Post's Keith Humphreys reports. Only two age groups showed a significant rise in use when researchers William Kerr, Camillia Lui and Yu Ye integrated 30 years of survey data from more than 40,000 participants who reported on whether they had used marijuana in the past 12 months. Compared with older Americans 30 years ago, Americans age 50 to 59 and 60 and older today are a remarkable 20 times more likely to use marijuana.

"The researchers noted that people born before World War II very rarely used marijuana at any point in their life, but as this population passed away, the marijuana use of subsequent generations became increasingly felt in greater total population use," Keith writes. "The signature change occurred with the baby boomers who were born from the late 1940s through the early 1960s. ... Just as the boomers engaged in an unusually large amount of crime in their youth and continue to do so far later in life than did their parents, they also have also carried the heavy substance-use patterns of their adolescence into their senescence."

OOF: A British appeals court ruled yesterday against the family of 23-month-old Alfie Evans, preventing the terminally ill boy from leaving Britain to seek medical treatment. The toddler has been in the hospital since December 2016 with a chest infection causing chronic seizures that eventually left him relying on a ventilator, The Post’s Julie Zauzmer reports. His doctors say he suffers from a rare and incurable degenerative neurological condition.

The Italian government had granted Alfie citizenship and set up a plan to have him travel to a Vatican hospital for treatment, but his doctors said he cannot be healed and shouldn't bother making the trip. On Tuesday, a British judge sided with the doctors, and on Wednesday, an appeals court quickly reheard the case and upheld the ruling, saying the family can't accept the offer to travel to the Vatican.

"The little boy’s case has become a subject of fierce concern for some Catholic and other Christian activists, who have protested outside the hospital in Liverpool where the boy is being treated," Julie writes. "Calling themselves 'Alfie’s Army,' the protesters say that the British doctors’ desire to remove Alfie from life support violates the sanctity of life as well as his parents’ wishes to continue seeking treatment to keep him alive."

OUCH: Ronny Jackson withdrew from the nomination process to lead the Department of Veterans Affairs, The Post’s Josh Dawsey, Lisa Rein and John Wagner reports this morning, following allegations of professional misconduct, including that he had wrecked a government car after getting drunk at a Secret Service going-away party.

 “Going into this process, I expected tough questions about how to best care for our veterans, but I did not expect to have to dignify baseless and anonymous attacks on my character and integrity,” Jackson said in a statement. He called the allegations “completely false and fabricated.”

Jackson’s fate was imperiled even before Democrats detailed the new allegations in a two-page document yesterday that summarizes interviews with 23 of Jackson’s current and former colleagues, describing Jackson’s “pattern” of handing out medication with no patient history, writing himself prescriptions and contributing to a hostile work environment with “a constant fear of reprisal.”

“Veteran advocates and many lawmakers also had expressed concerns about Jackson’s lack of management experience, and some have worried that he would capitulate to President Trump’s goal of outsourcing more veteran services,” our colleagues write.

Jackson’s full statement, via The Post’s Seung Min Kim:

INDUSTRY RX

 — Our colleague Carolyn Y. Johnson takes an extensive look at how patients with rare diseases requiring expensive treatment can become human jackpots for drug companies. She describes the case of 44-year-old Loukisha Olive-McCoy who has hereditary angioedema, a life-threatening disease so rare that some doctors have only read about it. The price of just one of the drugs she needs for treatment will cost $600,000 this year. And an attack of HAE can lead to other massive costs, sometimes leading to $1 million in hospital bills.

Olive-McCoy’s rare diagnosis puts her in a “pocket of the health-care system that drug companies use to ensure that rare-disease patients can afford their expensive medicine," Carolyn writes. Drug companies can donate to independent nonprofit charities that will cover drug costs and sometimes health premiums for patients such as Olive-McCoy, who are in need of financial help to get the medication and treatment they need to survive.

“Patients such as Olive-McCoy are extremely valuable to drug companies,” Carolyn writes. “Funding charities that ensure patients get their drugs can quickly pay off. A Citi Research report found that a pharmaceutical company’s $1 million donation to a charity for patients with rare diseases can generate up to a $21 million return in drug reimbursements.”

— A former Obama administration official who oversaw Healthcare.gov and is now an executive at health insurer Centene criticized the health care law’s individual mandate during an earnings call with investors yesterday, Axios reports.

“When I was at [the Centers for Medicare & Medicaid Services], I never really thought the individual mandate was all that powerful, and I'll tell you why,” said Kevin Counihan, the former chief executive of the federal health insurance marketplace. “Because number one, the dollar value for the penalty was not that significant, particularly compared to premium. And number two is, there were so many opportunities for people to appeal.”

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

The Switch
Google will promote a DEA initiative on its homepage to combat the opioid crisis, encouraging people to safely dispose of unwanted drugs.
Hamza Shaban
MEDICAL MISSIVES
To Your Health
Ambien and Provigil are widely used and safe, but should not be handed out indiscriminately, experts say.
Lenny Bernstein
To Your Health
The bacteria can cause serious kidney problems, and at least 42 people have been hospitalized.
Lena H. Sun and Joel Achenbach
REPRODUCTIVE WARS
DAYBOOK

Today

  • The House Ways and Means Subcommittee on Health holds a hearing on health care innovation.
  • HHS Secretary Alex Azar speaks at the 2018 Health Datapalooza, which will be held on today and Friday.
SUGAR RUSH

The issues surrounding Ronny Jackson’s (now former) nomination for VA, explained:

Kanye West shows Trump some Twitter love: 

Trevor Noah on the allegations against Ronny Jackson: