Health Policy Reporter

THE PROGNOSIS

June has unofficially become opioids month for lawmakers and policymakers in Washington who are gearing up to pass legislation and run ads targeted at the massive and growing problem of opioid addiction and overdose in the United States.

While there are recent, encouraging indications that opioid prescriptions have declined, government data shows drug overdose deaths rose 12 percent between 2016 and 2017 – keeping the issue a top concern as politicians look ahead to their election battles this summer and fall. And the problem isn’t just with prescription opioids, as Americans have increasingly turned to heroin and the highly lethal synthetic opioid fentanyl as well.

House Republican leaders announced this week they plan to bring opioids-related legislation to the floor next week, culminating an effort over the past few months by the House Energy and Commerce Committee to pass nearly 60 bipartisan bills making mostly modest, incremental changes to how prescription opioids are distributed and how people can access addiction treatment.

The committee’s top Republican, Rep. Greg Walden (R-Ore.), told me yesterday to expect House votes on many of these individual bills, but also some kind of larger, streamlined package on which he hopes the Senate might act (although the Senate’s Health, Education, Labor and Pensions Committee has passed its own bundle of bills already, which is more likely to advance in that chamber).

Committee staff confirmed at least three of 57 bills passed in committee that are expected to get votes next week. They include measures from Reps. Bob Latta (R-Ohio), Debbie Dingell (D-Mich.) and Tim Walberg (R-Mich.) aimed at improving doctors’ access to patients’ history of addiction, giving the National Institutes of Health new authorities to research responses to the opioid epidemic and creating a public database tracking federal efforts to stop the crisis.

Like most of the bills passed by Energy and Commerce, the measures don’t make any big, sweeping changes – or deliver big new funding — to the U.S. health-care system, which has come under heavy criticism for failing to deliver science-backed, medication-assisted treatment to far too many people struggling with addiction.

But Republican leaders, eager to show voters they’re responding to the problem, are arguing their inexpensive, somewhat piecemeal approach will still have ripple effects . They argue – and many experts agree – this batch of legislation at least goes further than a 2016 bill making some small policy changes and provided $1 billion to fight opioid addiction.

Walden said his two key priorities are to expand access to treatment and to try to stem the flow of fentanyl into the country. “That’s probably No. 1 – treatment,” Walden said. “No. 2 is trying to figure out how to turn off the illegal fentanyl, cause that’s what is getting mixed in with the heroin.”

One of the bills with the potential for the greatest impact to come out of Walden’s committee would lift a longstanding ban on Medicaid paying for substance abuse treatment at facilities with more than 16 beds. There’s been some controversy around the measure – even though many agree this “IMD exclusion” is an old-fashioned rule no longer necessary for ensuring patients aren’t stuck in mental institutions. But Walden said he believes lawmakers have found a bipartisan way forward on it.

House votes may extend through next week and the following one, Majority Leader Kevin McCarthy (R-Calif.) told reporters on Wednesday.

“This epidemic is destroying America, the fiber of who we are…but at the end of the day we’ll continue to make America safer and more secure and more prosperous,” McCarthy said.

There’s a parallel effort on the other end of Pennsylvania Avenue. Yesterday, the White House launched its first public service campaign against opioid addiction with a series of ads warning young people about its dangers. The four ads feature actors playing out the true stories of young people who crashed their car or broke their own arm to gain access to painkillers:

The ad time is donated, but administration officials said they expect it to be worth at least $30 million.

“Our goal is to show young Americans the dangers of misusing opioids and how quickly one can become addicted to opioids — as short as five days — also the extreme lengths to which one can go to feed this addiction,” said White House counselor Kellyanne Conway, who Trump has appointed to head up his anti-opioid efforts.

Expect much of the floor discussion next week to center on the need for more medication-assisted treatment, an approach science has shown works but which is sadly under-covered by insurers and under-offered by treatment facilities.

Along those lines, the National Institutes of Health says it’s pursuing more research on medicines that help people overcome addiction, at the request of top Energy and Commerce Democrat Frank Pallone (D-N.J.). Pallone released a letter from NIH yesterday outlining its intention to conduct a review of the role these medications play in treating opioid use disorder.

“The National Institutes of Health and the rest of the U.S. Department of Health and Human Services (HHS) are in full agreement about the importance of and continued need for aggressive research and dissemination efforts about Medication Assisted Treatment,” NIH Director Francis Collins wrote to Pallone.

— Breaking this morning: World-famous chef Anthony Bourdain has died at age 61 from an apparent suicide. Bourdain died in France, where he was working on an episode of his CNN show, “Parts Unknown.”

“It is with extraordinary sadness we can confirm the death of our friend and colleague, Anthony Bourdain," CNN said in a statement. "His love of great adventure, new friends, fine food and drink and the remarkable stories of the world made him a unique storyteller. His talents never ceased to amaze us and we will miss him very much. Our thoughts and prayers are with his daughter and family at this incredibly difficult time."

AHH, OOF and OUCH

AHH: The Trump administration said last night it won't defend the Affordable Care Act against the latest legal challenge to its constitutionality in a dramatic break from the executive branch’s tradition of arguing to uphold existing statutes, The Post's Amy Goldstein reports.

In a brief filed in a Texas federal court and an accompanying letter to House and Senate leaders of both parties, the Justice Department said it mostly agrees with the 20 Republican-led states bringing the suit. These states are pointing to a major 2012 case where the Supreme Court upheld the ACA's constitutionality by saying the law's penalty for being uninsured fell under the government's power to tax.

Now these states are arguing that the law is no longer constitutional without the penalty, which Congress repealed as part of its tax overhaul. They say that as a result, consumer insurance protections under the law won't be valid either. Yesterday's three-page letter from Attorney General Jeff Sessions begins by saying DOJ adopted its position “with the approval of the President of the United States.” The letter acknowledges that the decision not to defend an existing law deviates from history but contends that it is not unprecedented.

A group of 17 Democratic-led states that have won standing in the case also filed a brief last night arguing for the ACA’s preservation. “The Texas lawsuit is based on a dubious legal claim with the sole goal of stripping Americans of their healthcare," California Attorney General Xavier Becerra said in a statement. "The Trump administration won't defend the law of the land and 133 million Americans with preexisting conditions like asthma and cancer. Shame on the administration for gambling with the healthcare coverage of 20 million Americans.”

OOF: Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a CDC report released yesterday. In North Dakota, the rate jumped more than 57 percent, but in the most recent period studied (2014 to 2016), the rate was highest in Montana, The Post's Amy Ellis Nutt reports. Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

"Increasingly, suicide is being viewed not only as a mental health problem but a public health one," Amy writes. "Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death. Overall, the most common method used was firearms."

“The data are disturbing,” said Anne Schuchat, the CDC's principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

OUCH: An investigation from the Chinese government has shed no light on the mysterious illness that struck a U.S. diplomat at the consulate in Guangzhou, China after he heard unusual sounds, The Post’s Simon Denyer and Carol Morello report.

On Wednesday, the State Department said it was evacuating additional Americans from Guangzhou after initially evacuating the government employee “who had reported hearing strange noises in his apartment and was exhibiting symptoms of brain injury,” Simon and Carol write. The Chinese Foreign Ministry said investigators were reviewing the case.

“Last month, Secretary of State Mike Pompeo told Congress that the case in Guangzhou was medically similar to the ones seen in Cuba last year, when a large part of the American Embassy staff was withdrawn after many complained of symptoms that included hearing loss, dizziness, tinnitus, visual difficulties, headaches and fatigue,” our colleagues report.

They added: “The latest round of evacuations, which began Wednesday in China, was the first sign that the unexplained ailments have now broadened and threaten to become a full-blown health crisis like the one that affected at least 24 diplomats and their families in Cuba.”

Earlier today, the U.S. Embassy in China sent its second alert to its citizens in two weeks over the unexplained illnesses, urging Americans to seek medical attention if they experience “unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns,” the Associated Press’s Kelvin Chan and Dake Kang report.

AGENCY ALERT

— HHS Secretary Alex Azar said the agency won't block insurance companies from using a workaround to buffer steep increases in health premiums for consumers, a practice known as "silver-loading" that had the effect of making subsidies more generous. Federal officials previously signaled they may prohibit the practice for next year's Obamacare plans. But at a Wednesday hearing before the House Education and Workforce Committee, Azar said doing so “would require regulations, which simply couldn’t be done in time for the 2019 plan period."

"Silver-loading" evolved when the administration halted extra payments to Obamacare marketplace insurers to cover cost-sharing discounts they must offer the lowest-income shoppers. By loading all of the funding loss onto mid-level silver premiums, on which subsidy levels are based, insurers were able to help consumers get larger subsidies they could then also apply to gold or bronze-level plans.

HEALTH ON THE HILL

— If Democrats win back control of the House this year, top House Democrat Nancy Pelosi (Calif.) says the "Medicare for All" proposals that many candidates are backing should be evaluated. These proposals represents a range of approaches, but they all involve more government backing of health insurance options for Americans. The statement is a shift for Pelosi, who suggested last year that these ideas have insufficient support from a majority of the public.

“I've always been for a public option so I'm always eager to talk about that," Pelosi told reporters yesterday during her weekly media briefing, when asked if Democrats would advance such legislation if they win the House. “Some of the other issues that have been proposed have to be evaluated in terms of the access that they give, the affordability of it and how we would pay for it, but again it's all on the table."

— Colorado Republican Sen. Cory Gardner believes Trump will support a bipartisan congressional effort to give states autonomy over their marijuana laws, even though it would put the White House in direct conflict with its Justice Department, our colleague Colby Itkowitz reports. Gardner, along with Sen. Elizabeth Warren (D-Mass.), introduced legislation that would protect the nine states and the District that have legalized marijuana from any federal interference. This would allow businesses that sell marijuana to operate without fear of prosecution by DOJ.

Gardner said he spoke with Trump earlier in the day and was confident the president would sign the bill if Congress passed it. “I have talked to the president about this bill,” Gardner said at a news conference. “In previous conversations he talked about the need to solve this conflict. He talked about his support for a states’ rights approach during the campaign. Not putting words in the mouth of the White House, but I think this will be an opportunity for us to fulfill what is that federalism approach.”

INDUSTRY RX

— Food companies are timing advertisements for soda for the days states distribute food stamp benefits, a new study finds. Shoppers are two to four times as likely to come across soda displays in the store when food stamps go out, our colleague Caitlin Dewey reports. The research is “the latest to suggest there’s more to America’s nutrition gap than a lack of healthy choices or health education,” Caitlin writes. Low-income Americans drink far more soda than wealthier people, according to the CDC. Some are calling on the federal government to ban soda purchases using food stamps.

“People will argue that individuals are ultimately responsible for their choices, but we know that the environment in which we make choices matters,” said study author Alyssa Moran, an assistant professor of health and social policy at the Johns Hopkins Bloomberg School of Public Health. “This study is another example of industry targeting sugary beverage marketing toward lower income families.”

STATE SCAN

— Want to keep track of proposed Obamacare premiums for 2019? The Kaiser Family Foundation has released a handy online tracker showing data from nine major cities in eight states plus D.C. The tracker includes preliminary premium information for the lowest-cost bronze plan and "benchmark" silver plan, which is used to determine the size of premium subsidies.

The tracker also shows how those premiums are changing from 2018 and what a 40-year-old enrollee making $30,000 annually would pay before and after available tax credits. Based on insurers’ requested premium increases in the states available, benchmark premium increases before tax credits range from 7 percent to 36 percent in the cities included. The average increase in the benchmark silver premiums is 2 percent after tax credits for a 40-year-old enrollee with a $30,000 annual income. Check it out.

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

Virginia Politics
Northam celebrates bipartisanship at bill signing. But Republicans, wary of political fallout from Medicaid vote, mostly stay away.
Laura Vozzella
The Bill and Melinda Gates Medical Research Institute has a $273 million, four-year grant to help nurture ideas developed by academic labs or held in the portfolios of other biotech firms.
Stat News
Wonkblog
Dozens of companies increased drug prices in May
Carolyn Y. Johnson
MEDICAL MISSIVES
PostEverything
Providers nearly go out of business trying to cut costs.
Anne Kim and Ricky Carioti
True Crime
Stephen Koch pleaded guilty to child porn and drug charges — as well as attempting to expose another person to HIV.
Lindsey Bever
OPIOID OPTICS
National
Law enforcement officials are using statutes that were once rarely employed, treating overdose deaths as homicides and seizing enormous quantities of the drug.
Katie Zezima and Sari Horwitz
Wonkblog
According to new research, a staggering 1.5 percent of all American deaths in 2016 was attributable to opioids.
Keith Humphreys
DAYBOOK

Today

  • The Bipartisan Policy Center holds a discussion with HUD Secretary Ben Carson.
  • The CATO Institute holds an event for the book “Overcharged: Why Americans Pay Too Much for Health Care.”

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on prescription drug costs on June 12.
SUGAR RUSH

House Majority Whip Steve Scalise (R) returned to the baseball field nearly a year after he was shot during a practice:

Four times Trump got history a little wrong: 

The Washington Capitals won the Stanley Cup. Here's what D.C. looked like during the final game: