THE PROGNOSIS

House Republicans consider it one of the most significant proposals of the dozens of bills aimed at addressing the opioid epidemic. Democrats say the policy is racially biased. 

At issue is an obscure, decades-old rule known as the Institutions for Mental Diseases exclusion rule, or "IMD exclusion," prohibiting federal Medicaid reimbursements for inpatient treatment centers with more than 16 beds whose patients are mainly suffering from severe mental illness. President Trump and congressional Republicans have highlighted repealing the rule as a cornerstone of their effort to address the nation's burgeoning opioid crisis. (The Health 202 previously explained this issue here).

During remarks in New Hampshire on the White House plan to tackle opioid abuse, Trump called rolling back the rule “an important factor.” But Democrats charge the GOP's proposal is needlessly exclusionary by limiting the Medicaid coverage at mental health facilities to opioid users and not all types of substance abuse.

The House this month is quickly moving dozens of narrowly-focused bills aimed at confronting opioid addiction, which killed 42,000 Americans in 2016, according to the Centers for Disease Control and Prevention. Last week, more than 30 bills passed in the House and this week another 20 will receive votes. Republicans are eager for a win before the November midterm election on an issue that most Americans believe is worth the government's attention. 

Democrats have supported almost all of the bills despite complaining the GOP effort doesn't do enough to make a real dent in the epidemic. But when the House takes up the issue of repealing the IMD exclusion rule this week, expect some serious pushback from the minority party.

The opioid crisis has hit white populations hardest. Democrats say that by limiting the Medicaid reimbursement to opioid users, it ignores people with other addictions, particularly those that affect minority communities. This is, of course, part of a larger criticism of the opioid debate. Cocaine use, which is more prevalent among African Americans, has not generally been treated as a public-health crisis but rather as a crime that sends people to jail rather than providing treatment. 

“We cannot let this legacy of treating those with crack cocaine-use disorder differently than those with opioid use disorders to continue,” said Rep. Jan Schakowsky (D-Ill.), during the House Energy and Commerce Committee markup of the bill last month. 

Moreover, the Trump administration currently allows states to request a waiver of the IMD rule. In practice, that means states are not only able to get the waiver for opioid patients but also those with other addictions -- meaning Democrats contend changing the rule is a solution in search of a problem. 

Here's some background: the "IMD exclusion" rule was originally part of a 1960s effort to deinstitutionalize mental-health treatment and shift care to community-based facilities.There is a strong correlation between mental illness and substance abuse, so people with addictions also benefit from mental-health treatment. 

Democrats say a full repeal of the "IMD exclusion" could makes states more reliant on inpatient medical settings and discourages states from investing in community-based programs, which were never adequately funded and remain starved for resources. (Last year I wrote about the success of one such program in Frederick, Md. Read that here.

Republicans maintain the proposal is simply removing one roadblock to a treatment option for a vulnerable population dealing with opioid addiction. During a committee markup, Rep. Greg Walden (R-Ore.) said the GOP's plan to lift the IMD rule "gives [states] certainty for beds that can't be used that are in desperate need by people who have this addiction and need this help."

But public health advocates say real change will require a financial commitment that Congress might not be willing to make. The federal budget set aside $6 billion over two years to pay for new opioid prevention and treatment initiatives, but Daniel Raymond, policy director for the Harm Reduction Coalition, told Kaiser Health News in March that  “to have a fighting chance, we need a long-term commitment of at least $10 billion per year.”  

For now, Republicans are just hopeful they'll have something opioid-related to send to President Trump's desk before they hit the campaign trail this fall. As Politico astutely noticed, "11 of the 17 GOP incumbents the nonpartisan Cook Political Report classifies in toss-up races are primary sponsors” of opioid bills. 

Ultimately all of those piecemeal bills will be wrapped up into one neat package to be sent to the Senate. But all of those vulnerable lawmakers will be able to claim some ownership of it. 

AHH, OOF and OUCH

AHH: The World Health Organization is now saying video game players can actually become addicted. Today, “gaming disorder” will appear in a new draft of the organization’s highly regarded list of medical conditions in the International Classification of Diseases, the New York Times reports.

"Concerns about the influence of video games are dovetailing with increasing scrutiny over the harmful aspects of technology, as consumers look for ways to scale back consumption of social media and online entertainment," Tiffany Hsu writes. "The W.H.O. designation may help legitimize worries about video game fans who neglect other parts of their lives. It could also make gamers more willing to seek treatment, encourage more therapists to provide it and increase the chances that insurance companies would cover it."

“It’s going to untie our hands in terms of treatment, in that we’ll be able to treat patients and get reimbursed,” Petros Levounis, the chairman of the psychiatry department at Rutgers New Jersey Medical School, told Tiffany. “We won’t have to go dancing around the issue, calling it depression or anxiety or some other consequence of the issue but not the issue itself.”

OOF: Twenty-four-year-old Taylor Weyeneth was one of the fastest-rising political appointees of the Trump administration, an unpaid campaign intern with no professional experience who soared into a top job with a six-figure salary at the White House’s drug policy office. But two months after a January front-page Washington Post story cast doubt on his ­résumé and qualifications, ­Weyeneth was gone — demoted, told not to speak publicly and finally fired as the political fallout spread.

The Post's Robert O'Harrow Jr. has the inside account of the young political appointee’s time in Trump’s Washington, after Weyeneth agreed to talk about his experiences in the administration and the unusual circumstances that enabled him to climb through the ranks and into the White House, providing emails, texts and other documents to back up his account.

“It’s the story of a young operative whose central qualification was loyalty and whose responsibilities included furnishing the White House with intelligence about career employees at a time when the administration distrusts the standing bureaucracy to an unusual degree,” Robert writes. “In just over a year, Weyeneth received six promotions in the campaign and administration. They culminated with his appointment as deputy chief of staff at the Office of National Drug Control Policy, where he oversaw veteran employees and helped steer an operation that was supposed to lead the fight against the opioid epidemic.”

OUCH: Elizabeth Holmes, founder of blood-testing start-up Theranos, was indicted Friday by a federal grand jury on charges of defrauding investors, patients and doctors. She and the company's former chief operating officer, Ramesh “Sunny” Balwani, were charged with two counts of conspiracy to commit wire fraud and nine counts of wire fraud, our colleague Carolyn Y. Johnson reports. Before questions arose about whether its technology worked, Theranos was valued at $9 billion and featured on the covers of magazines and backed by a formidable board of elder statesmen and former military leaders.

The company had promised to disrupt medicine by selling blood tests directly to customers, but fell from grace after scrutiny from federal agencies and an investigation by the Wall Street Journal. "The indictment alleges that the pair used marketing, press interviews and financial statements to defraud potential investors on behalf of their company," Carolyn writes.

"Holmes and Balwani knew that Theranos’ proprietary analyzer had accuracy and reliability problems, performed a limited number of tests, was slower than some competing devices and could not compete with larger, conventional machines in high-throughput, or the simultaneous testing of blood from many patients,” the indictment says.

INDUSTRY RX

— The three Obamacare insurers on D.C.'s Obamacare marketplace are looking to increase rates at an average of 14.9 percent, while all of Minnesota’s five Obamacare insurers have proposed rate reductions of 3 to 12 percent, reflecting the variance in rate changes across the country (although we should note the rate adjustments in both states are not yet finalized, and will be finalized in the fall following negotiations).

In Minnesota, Medica Insurance will propose a 12.4 percent decline, Blue Plus a 11.8 percent decline and PreferredOne Insurance will look at a rate decline of 3 percent, per the Washington Examiner. But in D.C., CareFirst Blue Cross Blue Shield is looking to increase rates nearly 10 percent, Kaiser Foundation Health Plan of Mid-Atlantic is proposing a 20 percent hike and Group Hospitalization and Medical Services is seeking a 16.7 percent increase.

OPIOID OPTICS

— Pharmaceutical companies selling legal drugs have contributed to the current weight of heroin and fentanyl and other illicit opioid-related deaths, Keith Humphreys writes for The Post. “In the 1990s, when the industry began aggressively marketing prescription opioids such as OxyContin...the heroin market was small and in decline,” Keith writes. “However, as the number of annual opioid prescriptions in the United States nearly quadrupled beginning in the 1990s to the point that U.S. per capita consumption far exceeded that of any other nation in the world, millions of Americans became addicted to prescription opioids.”

Heroin traffickers used the opportunity to push their business, setting up shop where prescription opioid addiction was high. And users were quick to pick up the cheaper, more potent heroin after already using and being addicted to legal prescription opioids. "Once heroin markets became reestablished around the country, more people had the opportunity to use heroin without starting with legal opioids first,” Keith continues. “Thus, even heroin overdoses of people who were never prescribed a legal opioid are part of downstream consequence of opioid manufacturers’ conduct.”

AGENCY ALERT

— Banks are making a lobbying push to loosen federal restrictions on the legalized pot industry, a move at odds with the views of Attorney General Jeff Sessions. Top banking trade groups want their members to be able to serve the growing number of marijuana businesses in states like California and Colorado where pot is legalized, and have found support from the president and from Sen. Elizabeth Warren (D-Mass.), Politico’s Zachary Warmbrodt reports.

“The unresolved legal questions have been heightened by Sessions’ public campaign against legalizing marijuana,” Zachary writes. “That’s left many banks on the sidelines and forced pot businesses to carry out transactions in cash, making them a target for theft and violence.”

"The time has come for Congress and the regulatory agencies to provide greater legal clarity to banks operating in states where marijuana has been legalized for medical or adult use," a spokesman for the American Bankers Association told Politico.

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

HEALTH ON THE HILL
The quiet surrender comes as new projections show Medicare’s trust fund in its worst shape since the recession.
Politico
STATE SCAN
Doctors in Puerto Rico say they are seeing an alarming rise in the number and severity of asthma cases that they attribute to the aftermath of the deadly hurricane that walloped the island in September.
AP
MEDICAL MISSIVES
Health & Science
After age 65, most people will have more than a dozen years of good cognitive health.
Judith Graham
Health & Science
I chose aggressive, experimental treatment, and I had to be my own best advocate.
Susan Lisovicz
DAYBOOK

Coming Up

  • The House Homeland Security Subcommittee on Oversight and Management Efficiency holds a hearing on opioids on Tuesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Pricing Program on Tuesday.
  • The Senate Special Committee on Aging holds a hearing on Alzheimer’s on Tuesday.
  • The Bipartisan Policy Center holds an event on “Introduction to CBO’s Updated Health Insurance Model” on Tuesday.
  • AHIP’s institute and expo begins on Wednesday.
  • The American Medical Association holds a webinar on health literacy on Wednesday.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Examination of the GAO Audit Series of HHS Cybersecurity” on Wednesday.
  • The House Armed Services Subcommittee on Military Personnel holds a hearing on “Military Health System Reform: Pain Management” on Wednesday.
  • The House Veterans Affairs Subcommittee on Health holds a hearing on VA hiring authorities, recruiting and retention on Thursday.
SUGAR RUSH
Father's Day brings protests of separating migrant families
Congress remains at odds over family separation at border
Watch Trump’s ‘Fox & Friends’ interview, annotated: