THE PROGNOSIS

Health and Human Services' Jonathan White, a career government official and commander in the U.S. Public Health Service Commissioned Corps., will be grilled by senators today over the agency's failure to keep track of unaccompanied immigrant children once they leave government care. 

His appearance comes on the heels of a new report from the subcommittee's leaders, Sens. Rob Portman (R-Ohio)  and Tom Carper (D-Dela.), detailing ways they believe HHS and other federal agencies fall short in protecting these kids after they are turned over to sponsors. Now, Portman and Carper, the chairman and ranking member on the Homeland Security and Governmental Affairs subcommittee on investigations, will have their chance to hold White and other officials to account.

Here's the background: HHS is responsible for sheltering migrant children who cross the border alone until an adult sponsor living in the U.S. claims them. In 2014, during the Obama administration, nearly 77,000 kids crossed the U.S.-Mexico border without a guardian, creating a massive humanitarian crisis that overburdened the shelter system. In 2015, it was discovered that HHS had turned over eight unaccompanied minors to human traffickers. This led senators to begin investigating the background check process on adults coming forward to claim children and the follow-up by the government to ensure the children are safe after they're with their sponsor. 

HHS has contended that it doesn't have jurisdiction over what happens to the children once they're no longer living in the shelters. But, back when the committee first started looking into the issue almost three years ago, HHS agreed that it would begin calling to check on the kids 30 days after they left the shelter.

Of the 7,635 calls they made to sponsors, officials were unable to determine the whereabouts of 1,475 children that left HHS custody from October to December 2017. They also discovered that 28 children had run away, five were removed from the United States and 52 were living with another person who was not the official sponsor, the report says.

Portman and Carper's subcommittee report alleges that HHS did nothing to try to locate the children after that. It also blames HHS for making little effort to set kids up with post-release social services, to ensure they attend their immigration hearings, and to provide better care to kids with mental health conditions. 

The senators also say this issue has been exacerbated by Trump's now-ended separation policy.  As I reported yesterday: "The ongoing legal debate over President Trump’s family separations threw a spotlight on the broader problem. When a federal judge ruled in June that the government had to reunite separated children with their parents quickly, that work took precedence over all else. The subcommittee staff sought updated data from 2018 about the children’s whereabouts. But the report said HHS told them it 'can either work to reunite families or update data — but not both.'" 

You can expect some fireworks at today's hearing. Already the Trump administration is in full defense mode, releasing a joint statement from HHS, the Department of Homeland Security and the Justice Department Wednesday night slamming the report. 

"The report demonstrates fundamental misunderstandings of law and policy related to the safety and care of Unaccompanied Alien Children (UAC)," the three agencies wrote. "The subcommittee does not focus on the real challenges with preventing children from being smuggled and trafficked in the first place, nor does the Subcommittee capture the extensive work done to protect UACs once they arrive here."

The Trump administration took particular issue with the contention that it had made matters worse by its policies. Expect today's witnesses -- including officials from Justice, Immigration and Customs Enforcement (ICE) and Customs and Border Protection -- to be defensive on that point.

"The Subcommittee initiated this review in 2014 following a surge that occurred under the Obama administration," the agencies wrote. "Despite Congress failing to enact any meaningful legislation to address pull factors and close loopholes in current law, the Subcommittee now erroneously indicates that those problems have been exacerbated by the Trump Administration. In fact, the Trump Administration has ensured enforcement of our immigration laws."

But all eyes will be on White. The last time we saw White, he dropped a bombshell during an Aug. 1 Senate hearing on the agency's efforts to reunite immigrant families who were separated at the border as a result of the White House's "zero tolerance" policy. White said he warned the White House about the serious emotional toll on kids when they're taken from their parents -- and was assured it wasn't going to happen.

For weeks now, White has been hunkered down with other HHS officials furiously trying to comply with a federal judge's order to get children and their parents back together expediently. From his position in HHS's Office of Refugee Resettlement, White was tasked with overseeing the reunification operation and providing updates to the judge. 

The separation policy is still very much on the minds of lawmakers. On Tuesday, 17 Democratic senators sent a letter to DHS Sec. Kirstjen Nielsen demanding that the remaining 539 children still apart from  their parents be reunified.

They ask that the several hundred parents who were deported before given a chance to reunite with their children be brought back to the United States on "humanitarian parole."

AHH, OOF and OUCH

AHH: The state of Arkansas released data revealing that residents are struggling to meet the new work requirements for Medicaid beneficiaries, which could put those individuals at risk of losing coverage.

The data found 5,426 people in the state are in the second month of not complying with the work requirements, the Hill’s Jessie Hellmann reports. If Medicaid enrollees don’t meet the requirements – 80 hours of work per month – for three months out of the year, they could lose coverage. Last month, 12,722 people either didn’t report or didn’t meet the work requirement, and 12,587 of those people didn’t even log on to the state’s Medicaid website, Jessie reports.

There were 135 people who did report their activities but didn’t meet the 80-hour standard, and 844 people who did report at least 80 hours of work.

OOF: New preliminary data from the Centers for Disease Control have found there were roughly 72,300 overdose deaths across the country last year, a number that represents a 9.5 percent spike since the previous year and a new record, our Post colleague Christopher Ingraham reports.

“That staggering sum works out to about 200 drug overdose deaths every single day, or one every eight minutes,” Christopher writes.

The data reveals a surge in deaths as a result of synthetic opioids, including fentanyl. “There were nearly 30,000 deaths involving those drugs in 2017, according to the preliminary data, an increase of more than 9,000 over the prior year,” he writes. “Deaths involving cocaine also shot up significantly, putting the stimulant on par with drugs such as heroin and the category of natural opiates that includes painkillers such as oxycodone and hydrocodone.”

Where is this problem most acute? The highest death rates were in New England and parts of Appalachia, including West Virginia, Pennsylvania, the District of Columbia, Ohio and Maryland had the five highest rates. The rates also fell in a number of states, namely including Massachusetts, Vermont and Rhode Island, New England states where fentanyl was an early problem and where there are relatively high mortality rates. And overdose rates increased markedly in several Mid-Atlantic and Midwestern states, including Ohio, Indiana, West Virginia and New Jersey.

Here’s a sliver of a silver lining: “Nationwide, deaths involving opioids have plateaued and even fallen slightly in recent months, from an estimated high of 49,552 deaths in the 12-month period ending in September 2017 down to 48,612 in the period ending January of this year,” Christopher writes. “While it’s too early to say whether that trend will continue through 2018, those numbers are somewhat encouraging.”

OUCH: A new report from the Department of Veterans Affairs’ inspector general found that more than a third of veterans had to undergo “unwarranted” medical reexaminations in order to receive disability benefits, our Post colleague Joe Davidson reports.

In 19,800 out of 53,500 cases during the March-August 2018 review, VA personnel sought reexaminations, about 37 percent of cases.

“While reexaminations are important in the appropriate situation to ensure taxpayer dollars are appropriately spent, unwarranted reexaminations cause undue hardship for veterans,” the report said. “They also generate excessive work, resulting in significant costs and the diversion of VA personnel from veteran care and services.”

Joe also reports the department spent $10.1 million on the reexaminations, which the report estimates could turn into $100.6 million over the next five years.

“Reexaminations are not necessary when veterans qualify for exclusions, including having a permanent disability or a disability that has not substantially improved over five years,” Joe adds.

“VA’s goal is to ensure all Veterans receive the benefits to which they are entitled under the law,” VA press secretary Curt Cashour said in an emailed statement. “While we apologize for any inconvenience to the affected Veterans, these exams were meant to ensure VA was meeting that goal.”

HEALTH ON THE HILL

— Mark your calendar. Oral arguments in the critical Texas lawsuit that is looking to take down Obamacare has been scheduled for September 10, Politico’s Paul Demko reports. The lawsuit that has been brought forth by 20 red states charging that the health care law is unconstitutional. The case has been a focal point for Democrats ahead of the midterm elections in November and as they prepare for the confirmation battle for President Trump’s Supreme Court nominee Brett Kavanaugh.

AGENCY ALERT

— HHS Secretary Alex Azar wrote an op-ed published by The Post Wednesday entitled, "Obamacare forgot about you. But Trump didn’t."

In the piece, Azar focuses on the slice of Americans who buy insurance on the Affordable Care Act exchanges, but do not qualify for government subsidies and thus have seen dramatic increases in their monthly premiums. He writes that, "Obamacare has forced unsubsidized Americans to choose between unaffordable insurance and no insurance at all."

Azar touts the White House's decision to expand short-term plans that are far cheaper, but offer much less coverage. He writes that, "The Trump administration has gone to significant lengths to ensure customers know that these plans are not subject to the same regulations as Obamacare plans and that they are not the right choice for everyone. In fact, we require more robust warnings about the limits of these plans than President Barack Obama’s administration did."

— But, in an opinion piece in the New York Times, two prominent health care professors write that Trump's unilateral changes to Obamacare are illegal. 

"Faithfully executing the laws requires the president to act reasonably and in good faith. It does not countenance the deliberate sabotage of an act of Congress. Put bluntly: Mr. Trump’s assault on Obamacare is illegal," write Nicholas Bagley, a professor of law at the University of Michigan and Abbe R. Gluck, a professor of law at Yale.

They list the numerous ways the Trump administration has taken steps to dismantle the Affordable Care Act, including the aforementioned "short-term plans."

"In effect, these rules are creating a cheap form of “junk” coverage that does not have to meet the higher standards of Obamacare. This sort of splintering of the insurance markets is not allowed under the Affordable Care Act as Congress drafted it," they write.

OPIOID OPTICS

— In a 24 hour period, 70 people overdosed in New Haven, Conn. at the New Haven Green on what authorities believe was synthetic marijuana, also known as K2.

“Most were treated at local hospitals, though at least five refused to be transported. By late Wednesday night there had been no deaths reported,” our Post colleague Samantha Schmidt reports. “In some cases, patients who were hospitalized later returned to the Green and had to be treated a second time, New Haven Police Officer David Hartman told WTIC. One person had to be transported three times over the course of the day, he said.”

An Emergency Department official at Yale New Haven Hospital told the New Haven Register that the Drug Enforcement Administration said the drug had K2 mixed with fentanyl, Samantha writes. “Federal officials last month issued a warning about the spread of synthetic marijuana across the country,” she adds. “In recent months, K2 has caused hundreds of people in about 10 states to be hospitalized, sometimes with severe bleeding. Several people have died because of complications. The danger lies in the drug’s unpredictability and its tendency to be cut with potent opioids or in some cases an anticoagulant used in rat poison.”

— Oregon is considering a first-in-the-nation plan that would stop coverage for opioids for chronic pain patients who are beneficiaries of the state’s Medicaid program. The proposal would mean such patients would see covered opioid doses drop to zero in the first year beginning in 2020, Stat News’s Lev Facher reports.

“We believe Oregonians in chronic pain deserve safe and effective pain management,” Dr. Dana Hargunani, the chief medical officer of the Oregon Health Authority, told Lev. “And at the same time, we’re concerned about overdose and death, and we believe pain patients have been put at higher risk with regard to overprescribing.”

Some are worried that such a change would push chronic pain patients to illicit drugs, or to obtaining prescription painkillers by other means, essentially creating more problems than it would solve.

“The state declined to provide an estimate of how many pain patients the policy could affect. But nearly 1 million Oregonians are enrolled in Medicaid,” Lev reports. “More than 10 percent of adults nationwide have experienced pain every day for the previous three months.”

“A recent systematic review of dose reduction and discontinuation found more evidence was needed across the board: both to evaluate the belief that forced opioid tapers can increase suicidality — and to evaluate the overall outcomes of such a practice,” Lev adds.

The state could approve the proposal as soon as October.

STATE SCAN

— The State of New York this week joined the ranks of more than two dozen other states suing Purdue Pharma over its contribution to the opioid epidemic.

The complaint charges Purdue with misrepresenting its products and the risk of addiction. “The opioid epidemic was manufactured by unscrupulous distributors who developed a $400 billion industry pumping human misery into our communities,” Gov. Andrew M. Cuomo (D) said in a statement. “This lawsuit sends a clear message all these who mislead the public to increase their profit margins that we will hold you accountable for your actions.”  

Purdue, as it has with other such lawsuits, denied the allegations but acknowledged concern about the opioid crisis, according to Reuters.

— Blue Cross Blue Shield of Arizona has pledged $10 million in investment over three years to address the state’s opioid abuse. The state has faced at least 2 deaths a day from opioid overdose since June 15, 2017, the Arizona Republic’s Stephanie Innes reports.

“Funds have already been disbursed to expand the supply of Naloxone, which is a medication that can reverse an opioid overdose,” Stephanie reports. “Other plans for the money include expanding medication-assisted treatment for opioid misuse, removing barriers to treatment, and helping health-care providers to balance pain management with addiction prevention in their treatment of patients.”

The investment from the insurer follows $10 million Arizona state officials  put toward addressing opioid misuse for underinsured and uninsured residents. 

— The central committee for the Missouri Democrats over the weekend unanimously voted to remove a controversial antiabortion amendment that was added in June to the party’s platform.

The now removed language read: “[W]e respect the conscience of each Missourian and recognize that members of our party have deeply held and sometimes different positions on issues of personal conscience, such as abortion. We recognize the diversity of views as a source of strength, and welcome into our ranks all Missourians who may hold differing positions on this issue,” per the Kansas City Star’s Jason Hancock. As of the Saturday reversal, new language included reads: “A woman’s right to choose and the right of every person to their own bodily autonomy and to be free from government intrusion in medical decisions, including a decision to carry a pregnancy to term, and oppose any efforts to limit access to reproductive health care.”

“Stephen Webber, Missouri Democratic Party chairman, told The Star on Monday that discussion of the platform Saturday wasn’t contentious, demonstrating that the party is unified heading into the fall campaign,” Jason reports. “The controversy over the abortion platform plank was magnified by its timing. The party adopted the antiabortion amendment a day after Gov. Mike Parson, a Republican, signed a budget cutting off funding from Planned Parenthood and soon after U.S. Supreme Court Justice Anthony Kennedy announced his retirement, thus opening the possibility that the Roe v. Wade decision that legalized abortion could be overturned.”

 — And here are a few more good reads from The Post and beyond:

TRUMP TEMPERATURE
U.S. senators agreed on Wednesday to debate and vote in the next few days on more than $850 billion in spending on defense, labor and healthcare programs, as the Trump administration announced its objections to some parts of the bill.
Reuters
MEDICAL MISSIVES
To Your Health
Nonsmokers who were exposed to secondhand smoke as children were 30 percent more likely to die of chronic obstructive pulmonary disease.
Kate Furby
From the Mayo Clinic to Harvard, sources don't always get the facts right about preeclampsia. Reached by ProPublica, some are making needed corrections.
ProPublica
The CDC reported more than 100 measles cases across 21 states and DC on Wednesday.
CNN
Studies show that female doctors tend to listen more, and their patients — both male and female — tend to fare better.
The New York Times
INDUSTRY RX
CVS Caremark will allow its clients to exclude coverage of drugs with extremely high launch prices under a new program the company said is aimed at pressuring manufacturers to lower drug costs.
The Hill
DAYBOOK

Today

  • The House Financial Services Committee holds a hearing on “The Role of Federal Housing and Community Development Programs to Support Opioid and Substance Use Disorder Treatment and Recovery."
  • The Senate Homeland Security and Government Affairs Permanent Subcommittee on Investigations holds a hearing on “Oversight of Efforts to Protect Unaccompanied Alien Children from Human Trafficking and Abuse."

Coming Up

  • The Senate Homeland Security and Government Affairs Committee holds a hearing to examine “Centers for Medicare and Medicaid Services efforts to fight Medicaid fraud and overpayments” on Aug. 21.
SUGAR RUSH

Five times for White House press secretary Sarah Huckabee Sanders has deflected on Trump revoking security clearances: