Health Policy Reporter

THE PROGNOSIS

Health and Human Services Secretary Alex Azar is working hurriedly to put his agency on the good side of an immigration tangle -- and public relations disaster -- created by his boss President Trump. 

Azar has created a task force for reuniting more than 2,000 kids separated from their families. On Saturday, his agency released a statement promising the process is "well-coordinated" and announcing that 522 children had been returned and another 16 were expected to be with their parents within 24 hours.

The statement jointly issued by HHS and the Department of Homeland Security said Immigration and Customs Enforcement will implement a system for tracking separated family members and reuniting them before their deportation as a unit. Parents will begin receiving more information about the whereabouts of their children and telephone operators will provide more frequent communication.

“There will be a small number of children who were separated for reasons other than zero tolerance that will remain separated,” it said. “Generally only if the familial relationship cannot be confirmed, we believe the adult is a threat to the safety of the child, or the adult is a criminal alien.”

But even with those efforts underway, it remains unclear exactly how long it will take for all the families to be reunited, and Democrats and immigration rights advocates are charging the process remains mangled and inefficient. Sen. Elizabeth Warren (D-Mass.), who visited a detention center in Port Isabel, Texas the administration says will act as a reunification site, said she'd seen no evidence the process was underway, our colleagues Maria Sacchetti, Michael E. Miller and Robert Moore report.

Warren, who spent two hours inside the facility speaking with immigration officials and detained immigrant mothers Sunday night, said there were no reunifications to report. She said she spoke with nine women: “In every case, they were lied to. In every case, save one, they have not spoken with their children. And in every case, they do not know where their children are.” “It’s clear,¨ she added. “They’re not running a reunification process here.”

A senior administration official told our colleagues the administration never intended to send busloads of children to Port Isabel for a massive reunion. The official said they plan to reunite families on an individual basis once a parent has lost his or her deportation case. Parents may ask for their children to join them so that they can be deported together.

Indeed, Port Isabel isn't set up to house minors. There are currently just three immigrant detention facilities with a total of about 3,300 beds that are equipped to house parents alongside their children. A 100-bed center in Pennsylvania is the only facility where men are allowed, while two much larger centers in Texas house only women with children.

ICE indicated Friday it’s looking into opening more family facilities, issuing a notice saying it may seek up to 15,000 additional beds toward that purpose. HHS is also seeking more capacity for migrant children still on their own. The Pentagon has agreed to house up to 20,000 unaccompanied children on military bases in the coming months, our colleagues Dan Lamothe, Seung Min Kim and Nick Miroff first reported. HHS had asked whether beds could be provided for children at military installations for occupancy July through December, per a memo sent to members of Congress.

Lawyers seeking a quick return of the children to their parents say there’s nothing precluding the administration from taking immediate action. Jerry Wesevich, who is representing three migrant parents, petitioned a federal court on Friday to require federal authorities to immediately provide basic information about their children’s whereabouts and well-being.

“Forced separation traumatizes parents and children, and this trauma is compounded when parents and children are denied basic information about each other’s well being and reunification prospects,” Wesevich wrote in a request for a temporary restraining order filed with the U.S. District Court for D.C.

Ultimately, the parents are seeking a swift reunion. “We want immediate reunification,” Wesevich told me. “Some of our clients do not know where their kids are.”

But there may be some additional obstacles to the goal of getting the unaccompanied children -- now housed in shelters and foster homes across the country -- back to their parents, namely, that government records could be inadequate to link parents with very young children who may not be able to identify them. And attorneys for the immigrants say the parents are not getting information on the whereabouts of their children, despite the promises by HHS.

Rochelle Garza, an immigration lawyer in Brownsville, said he tried a toll-free phone number for HHS's Office of Refugee Resettlement. The man who finally answered told Garza that he could offer nothing more than an email address, the same generic one listed on the flier distributed to some parents, Maria, Kevin Sieff and Marc Fisher reported yesterday.

"The children who were forcibly separated from their parents at the border by the United States government are all over the country now, in Michigan and Maryland, in foster homes in California and shelters in Virginia, in cold, institutional settings with adults who are not permitted to touch them or with foster parents who do not speak Spanish but who hug them when they cry," our colleagues write.

Last week, one legal aid organization, the Texas Civil Rights Project, told Kevin that it had been able to track down only two children of more than 300 parents the group represents. “Either the government wasn’t thinking at all about how they were going to put these families back together, or they decided they just didn’t care,” said Natalia Cornelio, the organization’s criminal justice reform program director.

Still, there are signs HHS recognizes the urgency of the problem. Its “unaccompanied children reunification task force,” first reported by Politico, is notably being run by the assistant secretary for preparedness and response, the branch of HHS that typically responds to public health emergencies.

“Secretary Azar is bringing to bear all the relevant resources of the department in order to assist in the reunification or placement of unaccompanied alien children and teenagers with a parent or appropriate sponsor,” HHS press secretary Evelyn Stauffer said in a statement on Friday.

AHH, OOF and OUCH

AHH: Michigan Gov. Rick Snyder on Friday signed a new law that would require able-bodied Medicaid recipients to work at least 80 hours a month or lose coverage under the state’s Healthy Michigan plan.

“Five years after he led the push to expand Medicaid eligibility under the federal Affordable Care Act, Snyder signed the new work requirements over protests from Democrats and advocacy groups who decried it as a legislative effort to strip health insurance from low-income residents,” the Detroit News’s Jonathan Oosting reports.

Of the 670,000 individuals covered under the state’s Medicaid plan, the work requirements could apply to about 540,000 adults, according to the state's nonpartisan House Fiscal Agency. The agency also predicts 5 to 10 percent of people could withdraw from the program as a result.

OOF: A federal judge challenged the administration's new restrictions on recipients of Title X family planning funds after three national abortion rights groups and the American Civil Liberties Union sued to block the moves, The Post's Spencer S. Hsu reports. The new grant rules, announced in February, would requiring providers to prioritize practices such as abstinence over sexual health services, such as contraception.

In court Thursday, the three groups argued that the changes were so substantive that they should be struck down because they introduced new criteria for grant applicants worth 25 percent of the scores used to select winners. HHS attorney Alicia Hunt urged the judge to reject that argument, saying whatever new factors or weighting was introduced by the department, final award decisions were entirely up to senior department officials and off-limits to court review.

Hunt's argument did not appear to sit well with U.S. District Judge Trevor N. McFadden of the District of Columbia, Spencer writes. “Is it your position that the [grant notice] could say anything it wanted, and it doesn’t matter because the DAS [deputy assistant secretary] has final say?” McFadden, a 2017 Trump appointee, asked Hunt.

“But now you’re adding an eighth factor, and it’s the most important factor,” McFadden said of the change, which states that applicants will be judged on four new priorities and “key issues” in addition to seven previous criteria set by federal regulations since 1971. “Isn’t that a dramatic impact,” McFadden asked, if recipients who previously scored up to 100 might now be graded only at 75.

OUCH: The counties that most widely supported Donald Trump during the 2016 residential election were also the counties with the highest rates of chronic opioid use, a new study published in the journal JAMA Network Open has found.

The president received about 39 percent of the 2016 vote in 638 counties that had the lowest rate of long-term Medicare opioid prescriptions (defined as a 90-day supply or more) and 60 percent of the vote in 693 counties that have the highest rate of long-term opioid use, our colleague Chris Ingraham reports. The study gave a score of 42 to the relationship between chronic opioid use and the 2016 presidential vote, where zero means no correlation and 100 means a perfect correlation.

“The numbers don't at all suggest that opioid use was a causal factor in the 2016 presidential vote,” Chris warns. Instead, "individual and county-level socioeconomic measures explained much of the association between the presidential vote and opioid use," he writes.

HEALTH ON THE HILL

— On Friday, House lawmakers passed a package of almost 60 bills to help fight the opioid crisis, with bipartisan support for measures aimed at expanding nonaddictive pain treatment and fighting the rise of synthetic opioids such as fentanyl, our colleague Katie Zezima reports. The package also pushes the opening of opioid recovery centers and allows for physician assistants and nurse practitioners to prescribe drugs that treat opioid addiction.

The bills passed the House 396-14. “This package is not Congress’ first legislative response to this crisis, nor will it be our last. But it does include meaningful solutions that will update archaic policies, better equip our communities to respond to this evolving epidemic, and save lives,” Reps. Greg Walden (R-Ore.) and Mike Burgess (R-Tex.) said in a statement.

— Politico’s Adam Cancryn reports the dozens of bills could benefit a small group of drug companies if they become law. The companies, including Alkermes, its rival Indivior, drugmaker Braeburn Pharmaceuticals and California-based Heron Therapeutics, spent millions lobbying Congress in support of the bills. Here's what these companies lobbied for:

  • Alkermes spent $1 million lobbying to support a bill that would pay for centers where people can detox and start treatment
  • Indivior spent $180,000 in support of a bill that would ease restrictions on controlled substances used in injectable treatment
  • Drugmaker Braeburn Pharmaceuticals spent $100,000 to lobby the same bill as Indivior, as it develops a competing injectable.
  • Another group of drugmakers, including Heron Therapeutics, spent hundreds of thousands to lobby for additional Medicare payments to pay for non-opioid painkillers. 
OPIOID OPTICS

— Elinore McCance-Katz, the Trump administration’s director of the Substance Abuse and Mental Health Services Administration told the New York Times in an interview that she spends “half” her time addressing the opioid crisis. McCance-Katz worked to pioneer opioid addiction treatment with buprenorphine in the 1990s, and now wants to help train doctors to prescribe it to patients as well, reporter Abby Goodnough writes

“When we first thought about this treatment, it was really thought about as a way to integrate treatment of opioid use disorders, opioid addiction, into primary care,” McCance-Katz told Abby.

McCance-Katz added some primary care physicians are still hesitant to use the treatment because of a lack of exposure in medical school or residency. “If you don’t learn how to treat what is a complex disorder, then you feel uncomfortable taking it on. And because these disorders often involve psychosocial problems, many primary care doctors feel they may not have the resources to fully assist people,” she said. “So the way to address that is to bring addiction treatment into the mainstream of medicine.”

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

The Missouri Democrat started choking this past week at her caucus' weekly lunch.
Politico
MEDICAL MISSIVES
To Your Health
Approval of the medication, intended for childhood epilepsy, could lead to reclassification of cannabidiol, or CBD.
Laurie McGinley
AGENCY ALERT
Medicare health plans will be able to combine medical and social services under a new law that had support from both parties in Congress and the Trump administration.
New York Times
STATE SCAN
New York’s Medicaid program says Orkambi, a new drug to treat cystic fibrosis, is not worth the price. The case is being closely watched around the country.
New York Times
Federal health officials say the hospital hasn't done enough to improve care after a recent string of patient deaths. The decision comes a month after the Houston Chronicle and ProPublica found serious problems with the program.
Houston Chronicle
DAYBOOK

Coming Up

  • The House Appropriations Subcommittee on Labor, Health and Human Services and related agencies holds a markup on the 2019 fiscal year appropriations on Tuesday.
  • The Senate Finance Committee holds a hearing on drug affordability and innovation on Tuesday.
  • The House Veterans Affairs Committee holds a hearing on VA electronic health record modernization on Tuesday.
  • HHS Secretary Alex Azar speaks at the Heritage Foundation on Tuesday.
  • The FDA’s Anesthetic and Analgesic Drug Products Advisory Committee and the Drug Safety and Risk Management Advisory Committee hold a joint meeting on Tuesday.
  • The Senate Homeland Security and Government Affairs holds a hearing on Medicaid fraud and overpayments on Wednesday.
  • The Senate Judiciary Committee holds a hearing on the “Eligibility Requirements for the Radiation Exposure Compensation Program” on Wednesday.
  • The Senate Veterans Affairs Committee holds a hearing on the nomination of Robert Wilkie to be Veterans Affairs Secretary on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health care costs on Wednesday.
  • FDA Commissioner Scott Gottlieb holds an online opioids summit on Wednesday.
  • The Alliance for Health Policy holds its 2018 Signature Series Congressional Briefing on Health Care Costs in America on Friday.
SUGAR RUSH

Mother reunited with her 14-year-old son, whom she had been separated from for more than eight months:

"What kind of government does that?" Protests in a border town:

A view above an immigrant children’s shelter in Tornillo, Tex.: