Overnight Health Care: Opioid crisis takes personal toll on Washington | Trump order targets public assistance programs | Trump to deliver speech on drug pricing

Welcome to Overnight Health Care. We’re here to make your case of the Mondays go away. We’ll examine how the opioid crisis has impacted Washington, how Trump is trying to put his mark on the country’s public assistance programs, as well as an update on Utah’s effort to get Medicaid expansion on the ballot.

 

‘Close to Home’

The first of The Hill’s Close to Home series on opioids, presented by Partnership for Safe Medicines, looks at the toll the opioid epidemic has taken on the nation and at Washington, D.C.’s response. The rest of the series will focus on lawmakers who have a personal connection to the epidemic, such as a brother in recovery and a grandson who died of an overdose.

The toll: Tens of thousands of families, including those of officials working at the highest levels of government, have seen loved ones struggle with an addiction. An estimated 115 people die per day of an overdose involving opioids.

The response: It hasn’t been easy to clamp down on the opioid epidemic, which has shown no signs of abating. Some say there’s a sense the nation isn’t doing enough. Others say that the federal government’s response is improving, and that lawmakers are recognizing addiction as a disease, rather than a moral failing.

Key quote: “My old boss, Michael Botticelli [former President Obama’s drug czar], would say all the time, ‘you can’t hate up close,’ ” said Regina LaBelle, the White House Office of National Drug Control Policy’s chief of staff under Obama.

“If your brother or your sister or your neighbor is dying of a drug overdose, you are less likely to want to have a punitive response, and the difference in what happened today than what happened in the ’80s reflects that.”

What’s next: Lawmakers in both chambers are hammering out bills to respond to the crisis. 
Read more here.

 

Trump is looking to make his mark on public assistance programs. The administration is seeking to completely revamp the country’s social safety net, targeting recipients of Medicaid, food stamps and housing assistance.

Trump is doing so through a sweeping executive order that was quietly issued early last week. It was a busy week, with the continuing saga of Michael Cohen and Stormy Daniels, and the White House didn’t publicize it, so the order largely flew under the radar. It’s made Democrats and liberal activists apoplectic.

So what does this order do? It calls on the Departments of Health and Human Services, Housing and Urban Development, Agriculture and other agencies across the federal government to craft new rules requiring that beneficiaries of a host of programs work or lose their benefits.

What’s the logic behind it? Conservatives believe in the power of “economic mobility,” basically that the poor can work themselves out of poverty. Welfare reform has long been a goal of GOP lawmakers, and there’s broad support in the Republican conference for imposing stricter work requirements and block granting state funding for programs like Medicaid and food stamps.

The controversy: Opponents say the administration is blending the issues of welfare and broader public assistance programs in a deliberate way, in order to lower support for popular initiatives. “Welfare” has historically been used to describe cash assistance programs like Temporary Assistance for Needy Families, and many of Trump’s base use it as a derogatory term. Democrats and activists say the administration is seeking to expand the definition of welfare to mean food stamps, Medicaid and other programs as a way to demonize them.

Get the full story here.

 

Top drug pricing official divests

Daniel Best, the HHS secretary’s point man on drug pricing reform, has divested from several health care investments, an agency spokesperson told The Hill. 

Best, a former CVS health executive, has been serving as Alex Azar’s senior adviser on drug price reform, raising questions about potential conflicts of interest.

A public financial disclosure report obtained by The Hill shows Best had investments in several health care companies, including CVS Health and health insurance companies Aetna, Humana and Anthem.

Best also had investments in Keryx Biopharmaceuticals and Celgene, both drug companies, as well as Rite Aide and Express Script Holding, a PBM.

Best has divested of all these interests, an HHS spokesperson told The Hill.

“Mr. Best is in full compliance with all federal ethics laws, rules and regulations. He has divested all of the holdings that he was required to divest pursuant to his ethics agreement, including the investments you mention in your email.”

Best’s final divestiture confirmation was received by the HHS ethics office Tuesday, according to the report. He also signed an ethics agreement April 2.

The Hill requested copies of both of those documents, and will update readers once we receive them.

 

We learned Monday that Trump will give a speech about drug pricing. According to the White House, Trump will give a speech on lowering drug prices on April 26, although that date could change. We expect Trump to be flanked by HHS Secretary Alex Azar and FDA chief Scott Gottlieb, like he was back in March when he first announced that drug pricing proposals would be forthcoming, and prices would be dropping “beautifully.”

What to expect: Not a lot. The White House indicated that no new policy proposals will be unveiled at the speech, other than a request for information on “various drug pricing ideas,” according to deputy White House press secretary Hogan Gidley. Trump may also talk about proposals he has already made as part of his budget. But no legislation.

The goal: The administration is an a difficult spot. Trump hammered drug companies on the campaign trail but has not proposed sweeping changes. The administration wants to make it clear they have not forgotten and are on top of the issue. Congress doesn’t seem likely to take action anytime soon, so if the White House can highlight what they’ve already proposed, and a couple of ideas, that could give them a boost.

Our story can be found here.

 

West Virginia attorney general reaches $550K settlement in opioid case

The allegations: Attorney General Patrick Morrisey accused Larry’s Drive-In Pharmacy of dispensing nearly 10 million doses of painkillers in 11 years to a county of fewer than 25,000 people.

Specifically, Morrisey — who is vying for the Republican nomination to run against Sen. Joe Manchin (D-W.Va.) — alleged that the pharmacy didn’t identify suspicious prescriptions or determine if it was dispensing a suspicious volume of opioids, according to a press release.

The settlement: $550,000. But the pharmacy, which is no longer open, denies all wrongdoing and liability as part of the settlement and contends that its actions were legal and in compliance with all regulations, according to the agreement.

Looking forward: More opioid lawsuits. Counties, tribes, cities and others have filed hundreds of lawsuits against opioid manufacturers and distributors, which have been consolidated in Cleveland. We’ll be keeping our eyes peeled on that case, which is in front of U.S. district court Judge Dan Polster, who was nominated to the bench by President Clinton.

Read more here.

Monday roundup:

• Utah is one step closer to Medicaid expansion, after an activist group succeeded in gathering enough signatures to put the issue on the November ballot. More than 165,000 signatures will be submitted Monday to place a Medicaid expansion initiative on the ballot. Organizers from the group Utah Decides Healthcare needed more than 113,000 signatures from registered voters to earn a ballot spot. If approved, the initiative would require the state to expand Medicaid to people making up to 138 percent of the federal poverty level, and would prohibit enrollment caps.

• The Maryland Health Benefit Exchange’s board of trustees, which administers the state’s ObamaCare exchange, voted to officially file a federal application for a reinsurance program in hopes of bringing down the cost of premiums in 2019 and 2020, according to a press release. The state’s Republican governor, Larry Hogan, recently signed a bill greenlighting the idea.
• Health and Human Services (HHS) Secretary Alex Azar is back at work Monday after being hospitalized for a minor infection.
• The Trump administration hopes to move forward with a rule expanding alternatives to ObamaCare plans by this summer, Secretary of Labor Alex Acosta said Monday.

 

State by state

Va. House committee tries again for Medicaid expansion, with tougher work rules (The Washington Post)

Indoctrinated (Texas Observer)

Behind closed doors, Tennessee governor asks again: Can state expand health care for working poor? (The Tennessean)

 

What we’re reading:

Naloxone-access programs miss many opioid users (Reuters)

Lamar Alexander is nothing like Trump. But he explains Trump’s Washington. (Vox)

Amazon has shelved a plan to sell drugs to hospitals, and insiders say there are two reasons why (CNBC)

From The Hill’s opinion pages

Longer sentences won’t stop the opioid epidemic

Here’s how to address the inevitable challenges to the individual market