THE PROGNOSIS

The Senate cleared a major hurdle Thursday night on an opioids package, increasing the possibility that a bill aimed at addressing the national drug crisis could reach President Trump's desk by year's end. 

Senators reached a deal to advance legislation that had long been stalled following House passage of a similar package to combat the epidemic of opioid addiction in the country. Senators said they hoped to vote on it as early as next week.

Signing such a measure into law would be a major accomplishment for lawmakers and the White House that, in a rare show of bipartisanship, have prioritized taking steps to combat an epidemic that killed 72,000 Americans last year. 

The crisis has hit all corners of the country, and more than two-thirds of Americans say opioid misuse is a very or somewhat serious problem in their state. And that's consistent among Democrats, Republicans and independents, according to a POLITICO-Harvard T.H. Chan School of Public Health poll released in July.

The issue took on political resonance in 2016 when GOP candidates for president, most famously former New Jersey Gov. Chris Christie, spoke passionately about the pain of addiction on loved ones. This year, the American Action News, a nonprofit supporting right-leaning politicians, is spending $5 million on advertising in 25 congressional districts urging lawmakers to act on opioids. 

Senate GOP leaders announced they would bring The Opioid Crisis Response Act, a collection of 70 lawmaker-sponsored proposals, to the floor next week for a vote. 

The House passed another package of opioid measures in June, and the two sets of bills would need to be reconciled before becoming law. President Trump has declared the opioid crisis a public health emergency and on Aug. 20 urged the Senate to pass legislation, specifically a proposal to tackle the trafficking of synthetic drugs like fentanyl.

The deal was first announced in a tweet Thursday night by Majority Leader Mitch McConnell's (R-Ky.) spokesman, Don Stewart, who wrote that Democrats lifted a hold placed on the bill and allowed the legislation to advance. Soon after, Sen. Rob Portman (R-Ohio) -- who has sponsored several bills that are part of the package including an effort to combat synthetic drugs like fentanyl -- released a statement praising the effort.

Sen. Lamar Alexandar (R-Tenn.), chairman of the Senate Health, Education, Labor and the Workforce Committee, led negotiations to hammer out remaining sticking points. 

“This legislation represents the work of over 70 senators, five committees, and countless staff who have worked together to help put an end to the opioid epidemic ravaging virtually every American community," he said in an official announcement of the deal. 

"The proposed bill includes the STOP Act to help stop illegal drugs at the border, including stopping the shipment of synthetic opioids. It allows the FDA to require prescription opioids to be packaged in set amounts like a 3 or 7 day supply of blister packs, and spurs the development of a new non-addictive painkiller. The House has already passed its version of the act, and there is a bipartisan urgency to work with our House colleagues to get the legislation to the President’s desk.”

The Senate bill had stalled over Democratic objections to a grant program they said was written too narrowly to benefit only one addiction advocacy group, the Addiction Policy Forum. The organization was closely connected to PhRMA and Democrats wanted the language broadened to cover more groups. The delay was first reported Wednesday by Politico.

Senators worked all summer to reach a deal, which has emerged as a rare bipartisan priority ahead of November's midterm elections. Trump increased the pressure on Aug. 20 by tweeting that lawmakers must pass the Portman-sponsored bill on shipments of illicit fentanyl through the international postal system.

"It is outrageous that Poisonous Synthetic Heroin Fentanyl comes pouring into the U.S. Postal System from China," Trump wrote on Twitter. "We can, and must, END THIS NOW! The Senate should pass the STOP ACT - and firmly STOP this poison from killing our children and destroying our country. No more delay!"

While the Senate and House measures share a lot in common, Politico reports that several other issues held up the bill in recent weeks, including "requiring Medicaid to cover treatment at more inpatient facilities and loosening privacy restrictions for substance-abuse patients' medical records." Those provisions are in the House version, but did not make it into the Senate's final deal.

Broadly, the bill authorizes and expands programs for addiction prevention, treatment and recovery. It allows the National Institute of Health to research new, non-addictive painkillers. 

Regina LaBelle, a public policy consultant who served as chief of staff and policy adviser at the Office of National Drug Control Policy in the Obama administration, commended lawmakers for reaching an agreement.

"It emphasizes prevention, making sure we have more people who can treat people with addiction and it supports people in recovery, it does reflect what the science tells us," she said. "There's always more that can be done, but in an election year, I think this is pretty good. I really do appreciate there's an effort being made to have a bipartisan solution."

Health-care industry experts expressed concern earlier this summer that politics could disrupt the bill's chances, noting that McConnell may not want to give red state Democrats a chance to support something advantageous to their voters. But in announcing the vote next week, Stewart took a shot at those skeptics,

"Now that the Dem holds have been lifted," he wrote in an email, "the Majority Leader, despite the assertions by the uninformed, anonymous sources, has sked (sic) a vote on the bill for next week."

It's important to note, however, that while this bill authorizes new spending, it remains to be seen whether lawmakers actually appropriate money for the programs involved. Some advocates have argued along the way that a piecemeal approach will not have the same impact as long-term funding dedicated to the problem.

Still, any movement forward on opioids in this polarized climate is a win for both sides of the aisle. 

AHH, OOF and OUCH

AHH: The Trump administration announced a proposal yesterday that would enable immigrant children to be held in detention indefinitely, our Post colleagues Nick Miroff and Maria Sacchetti report, “a move advocates say could lead to a rapid expansion of detention facilities and more time in custody for children.”

The proposal from the departments of Health and Human Services and Homeland Security would terminate the 1997 Flores Settlement Agreement, which sets the current standards for detaining underage migrants.

The move will likely land the administration in a new legal battle over immigration, just months after its controversial move to stem the surge of asylum seekers from Central America by separating families who entered the United States illegally.

Nick and Maria note “U.S. District Judge Dolly M. Gee, who oversees the agreement, has rejected attempts to extend the amount of time migrant children can be held in immigration jails beyond the limit of 20 days. The new rules would lift those restrictions and allow the government to detain migrant children until their cases have been fully adjudicated.”

OOF: About 2 million low-income Americans would lose benefits under the House version of a farm bill that’s in the midst of negotiations, according to nonpartisan research firm Mathematica.

The bill includes a proposal that would change the income and expense criteria for beneficiaries of the Supplemental Nutrition Assistance Program better known for underwriting food stamps, the New York Times’s Glenn Thrush reports, and would allow states to remove up to 8 percent of people getting aid from SNAP. The research also found 34 percent of seniors in the program could lose benefits under the  proposal.

“Those estimates do not account for another proposal in the measure, which would impose strict new work requirements on beneficiaries,” Glenn writes. “An additional 1.2 million people could be stripped of aid under that plan, according to a separate analysis released in May by the Congressional Budget Office, the study’s authors said.”

Trump tweeted Wednesday calling for lawmakers to pass the House version of the bill:

“The focus on agricultural subsidies, Senate staff members said, makes it less likely that the House proposals will be part of a final deal,” Glenn adds. “But advocates for the poor were concerned that some, if not all, of the cuts could make it into the final version.”

OUCH: Experts are urging caution regarding a swirling hypothesis that rare microwave weapons could have sickened diplomatic officials and people associated with the U.S. Embassy in Cuba, our Post colleagues Sarah Kaplan and Joel Achenbach report.

The New York Times reported last week that microwaves were “now considered a main suspect” of the attacks that led to people suffering ailments, reporting painful sounds.

“There’s an old scientific aphorism that extraordinary claims require extraordinary evidence,” Sarah and Joel write. But physicist and former State Department scientific adviser Peter Zimmerman told our colleagues the claims behind the latest theory are not “giving the extraordinary evidence. They’re not giving any evidence.”

“No microwave weapon that affects the brain is known to exist,” Sarah and Joel write. “The FBI has investigated the Cuba cases and found no evidence of a plot. Searches of the U.S. Embassy and other locations in Havana have turned up no sign of a weapon. Most significantly, doctors examining the sickened diplomats have established no clear link between their symptoms and any external source.”

AGENCY ALERT

— The same day the administration made an announcement that it plans detain minors for longer than the Flores settlement allows, Modern Healthcare’s Susannah Luthi reports HHS is set to increase funds to care for detained migrant children.

Susannah writes  HHS will hike the $1.3 billion that was initially set aside for the care of migrant children by more than $100 million, “a sign that the system’s expenses are increasing under enhanced scrutiny following the Trump administration’s halted family separation policy.”

She adds the department did not confirm the amount but a “congressional aide close to the issue said the department is maxing out the 10% boost allowed to the original appropriation amount.”

— You might be able to take these names off of your suspect list. The offices of HHS Secretary Alex Azar and Veterans Affairs Secretary Robert Wilkie have both denied that the administration officials authored the anonymous op-ed in the New York Times in which a top administration official claimed to be part of the so-called resistance to the Trump White House.

Azar spokeswoman Caitlin Oakley said in a statement, per the Associated Press: “It was not him." Curt Cashour, spokesman for Wilkie said in a statement to CNN that “neither Secretary Wilkie nor anyone else at VA wrote the op-ed."

If you’re curious about the other two dozen or so administration officials who have publicly denied writing the op-ed, our Post colleagues Katie Mettler and Nick Kirkpatrick have compiled a list and are updating it here.

HEALTH ON THE HILL

—Supreme Court nominee Brett M. Kavanaugh’s third day of hearings on the Hill began with drama over released emails once marked “committee confidential.”

In one email Kavanaugh wrote in 2003, he argued against describing the 1973 Supreme Court ruling Roe v. Wade as the “settled law of the land.”

“I am not sure that all legal scholars refer to Roe as the settled law of the land at the Supreme Court level since Court can always overrule its precedent, and three current Justices on the Court would do so,” Kavanaugh wrote when he was a White House lawyer in the Bush administration regarding a draft of an op-ed in favor of a judicial nominee.

The email, made public by the Senate Judiciary Committee yesterday after it was first given to the New York Times, was among documents deemed “committee confidential,” our Post colleagues Robert Barnes and Michael Kranish report.

They explain the email was written in reference to a proposed op-ed in support of Priscilla Owen, who was nominated by President George W. Bush for the U.S. Court of Appeals for the 5th Circuit.  "The draft of the op-ed was designed to undercut Democratic complaints that Owen would overturn Roe,” Robert and Michael write. “The draft said that ‘it is widely understood accepted by legal scholars across the board that Roe v. Wade and its progeny are the settled law of the land.’ Kavanaugh seemed to dismiss the importance of that argument, and said the more important point was that Owen would have no ability to overturn Roe as an appeals court judge.”

Yesterday, Sen. Dianne Feinstein (D-Calif.) asked Kavanaugh to explain the email, which she said has “been viewed as you saying you don’t think Roe is settled." Kavanaugh said he was referring to “views of legal scholars” rather than his own personal view.

In a statement yesterday, NARAL Pro-Choice America said the emails “are rock solid evidence that he has been hiding his true beliefs and if he is given a lifetime seat on the Supreme Court, he will gut Roe v. Wade, criminalize abortion, and punish women. Everything he said yesterday in front of the Senate Judiciary Committee about ‘settled law’ was nothing but a show to mislead the Senate.”

— During one exchange with Sen. Ted Cruz (R-Tex.), Kavanaugh appeared to refer to birth control as “abortion-inducing drugs.”

Cruz asked Kavanaugh to talk about his 2015 dissent in the Priests for Life v. HHS case. The nominee described the case in which the Catholic group sued HHS over the requirement under Obamacare that health-care providers cover birth control.

During his explanation, Kavanaugh said the group had a religious objection to “abortion-inducing drugs.”

NARAL tweeted following the remark:

From Sen. Jeff Merkley (D-Ore.):

In her six takeaways from Kavanaugh’s Day 3 on the Hill, our Post colleague Amber Phillips writes he “didn’t convince any Democrats on his abortion stance.”

“For anyone who worries that Kavanaugh would vote to overturn legalized abortion, there's plenty in his past writings and statements and court rulings to be concerned about,” Amber writes. “We know what key Democrats have come to conclude. What will two swing-vote Senate Republicans read into this?”

STATE SCAN

— Millions of people covered under Obamacare insurance plans will see small premium increases and others will see price reductions in 2019, according to an analysis from the Associated Press and consulting firm Avalere Health.

“The analysis found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for next year,” the AP reports. “This year the average increase nationally was about 30 percent. The average total premium for an individual covered under the health law is now close to $600 a month before subsidies.”

Although Avalere director Chris Sloan warns it is “still a market that's unaffordable for many people who aren't eligible for subsidies,” the AP reports some premiums are set to decrease or increase by less than 10 percent for 41 states with about 9 million customers. “Eleven of those states are expected to see a drop in average premiums. In six other states, plus Washington, D.C., premiums are projected to rise between 10 percent and 18 percent,” per the report.

The data also found a resurgence of insurers. In 19 states, there will be either new insurers in the marketplace or an expansion of current insurers. “There are no bare counties lacking a willing insurer,” per the AP.

— A group that formed in response to the administration’s family separation policy is calling on Arizona Gov. Doug Ducey (R) to establish an independent investigation into reports that some migrant children were abused at shelters.

Uncage and Reunite Families, a group that includes elected officials, activists and religious leaders, is criticizing a previous investigation by the state that “only found issues with personnel records and delayed background checks,” the Associated Press reports.

“Arizona has seen numerous allegations of sexual abuse at its many shelters for immigrant children, including one made by the government of El Salvador, which said it received reports of three children, 12 to 17, who were sexually abused at unnamed shelters in Arizona,” per the AP.

— And here are a few more good reads: 

TRUMP TEMPERATURE
She was referring to a policy that limits the FDA's ability to hire people who have not lived in the U.S. for three of the past five years.
Stat
OPIOID OPTICS
In place of OxyContin, BlueCross BlueShield of Tennessee will encourage doctors to prescribe painkillers that are designed to be harder to abuse.
The Tennessean
Maryland authorities announced charges Thursday against an Arizona-based drugmaker that they say engaged in a nationwide scheme "characterized by extraordinary misconduct" to boost profits amid the coast-to-coast opioid epidemic.
Associated Press
MEDICAL MISSIVES
Most nursing homes in Florida are still working to meet new backup-power rules, which were triggered by a dozen patient deaths after Hurricane Irma knocked out air conditioning at their residence a year ago.
Wall Street Journal
Gridlock
Health officials met the plane to start evaluating passengers and dispatch them to area hospitals.
Alex Horton
Agencies and response teams are often pulled together quickly in response to planes full of passengers reporting symptoms of unknown illnesses.
Stat
Business
They may look like toys, but the shared scooters can inflict the same harm as any other motorized vehicle, critics say.
Peter Holley
To Your Health
A 55-year-old woman in Missouri developed a condition known as "black hairy tongue."
Lindsey Bever
Overweight women limited their weight gain with a diet and exercise program during pregnancy, but it did not lower their rate of complications like gestational diabetes.
The New York Times
The California Occupational Safety and Health Administration has fined Disneyland $33,000 for violations involving cases of Legionnaires' disease among park employees.
Los Angeles Times
INDUSTRY RX
U.S. drugstore chain Walgreens Boots Alliance Inc said on Thursday emergency allergy shots from Kaleo will be available in its stores, the latest effort to address shortages of the lifesaving treatment during the back-to-school season.
Reuters
SECOND OPINION
DAYBOOK

Today

  • The American Enterprise Institute and Brookings Institution host an event on paid family leave.
SUGAR RUSH

A premature baby in a tiny cap and gown “graduated” from the neonatal intensive care unit on Aug. 21 at the University of South Alabama Children’s and Women’s Hospital in Alabama:

 

President Trump slams the New York Times, says op-ed writer "probably a she:"