Opioid Crisis Worsens

Acting Director of the Centers for Disease Control and Prevention (CDC) Anne Schuchat, MD said this week that the opioid abuse crisis is worsening, pointing to new emergency room data showing a sharp uptick in opioid overdoses across the country. A new agency report found hospitalizations for opioid overdoses jumped by 30 percent in 45 states between July 2016 and September 2017. The Midwest saw the largest increase (70 percent) in hospitalizations for opioid overdoses, with rates in Wisconsin jumping 109 percent. Illinois was up 66 percent, and Indiana had a 35 percent increase. House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), Health Subcommittee Chairman Michael C. Burgess, MD (R-Texas), and Oversight and Investigations Subcommittee Chairman Gregg Harper (R-Miss.) acknowledged the troubling report and re-iterated their commitment to do more to stem the tide of the epidemic. The House Energy and Commerce Committee announced it will have a two-day legislative hearing (March 21-22) to consider more than 20 bills relating to public health and prevention efforts to combat the opioid crisis.

W&M Requests Information on Opioids

As mentioned in last week’s newsletter, the House Ways and Means Committee is requesting information from insurers, pharmacy benefit managers (PBMs), and health care providers and prescribers about how to better protect Medicare beneficiaries from opioid dependence and overdose. The Committee is currently drafting its own bipartisan opioid-related legislation and is looking to leverage Medicare to combat opioid abuse and addiction. The lawmakers request feedback by March 15 related to overprescribing, data tracking, communication and education, and expanding treatment options in Medicare.

Appropriations Discussions Continue

Members of Congress are struggling to negotiate a $1.2 trillion omnibus spending bill needed to keep the government open after March 23. While lawmakers still have more than two weeks to reach an agreement, there may be a need for yet another continuing resolution (CR) for all or part of the government. Recently, Republicans decided to limit an accounting gimmick known as CHIMPS (Changes in Mandatory Program Spending) to $14 billion that could be used to pay for spending elsewhere. This will likely result in $5 billion in cuts for the Labor-Health and Human Services appropriations bill.

In related news, Republican leaders on Capitol Hill insist that no decisions have been made on what will be included in a potential omnibus spending package, but a number of health-related provisions are reportedly being considered. Lawmakers from both parties are pushing to include legislation that would ban branded drug companies from using risk plans required by the Food and Drug Administration (FDA) to block generic competition to the spending bill. Simultaneously, some Republicans on Capitol Hill are considering revoking a Medicare rule that requires drug companies to pay more for discounts to beneficiaries.

Arkansas Medicaid Work Requirements Approved

The Trump administration has approved Arkansas’ request to impose work requirements on certain Medicaid beneficiaries, but punted on a controversial proposal that would have rolled back the state’s Medicaid expansion. Arkansas became the third state to get permission to impose work requirements after CMS approved a Medicaid waiver that included a requirement for recipients to work, participate in job training or job search activities for 80 hours a month. But the administration did not make a decision on a request to roll back the eligibility level for Medicaid beneficiaries. CMS did not outright reject the provision, and Gov. Asa Hutchinson (R) said he is continuing to work with the administration on it. If that provision had been approved, combined with the work requirements, an estimated 60,000 people were projected to lose coverage. Hutchinson sought to restrict the program so that only people who are at the federal poverty level would be eligible. The federal poverty line this year is $12,140 for a single person, or $25,100 for a family of four.

Manchin Unveils Bill to Change Controversial Opioid Enforcement Law

Sen. Joe Manchin (D-W.Va.) unveiled legislation (S.2493) last Monday aimed at helping the Drug Enforcement Administration (DEA) improve its ability to stop suspicious shipments of opioids from overtaking communities. Manchin’s bill changes a law that drew a firestorm of criticism after an explosive “60 Minutes”–Washington Post joint investigation reported the bill made it harder for the DEA to freeze opioid shipments from drug companies in the midst of a full-blown crisis.

Cochran Resigns Effective April 1

Sen. Thad Cochran (R-Miss.) will resign from the Senate on April 1, his office announced Monday, triggering a second Senate election in Mississippi this fall and reshaping the leadership of the Senate Appropriations Committee -- one of Congress’s most powerful committees. “I regret my health has become an ongoing challenge,” Cochran said in a statement released on Monday afternoon. Cochran, who was first sworn into his Senate seat in 1978, is the chairman of the Senate Appropriations Committee. Sen. Richard Shelby (R-Ala.) will reportedly take the reins of the committee upon Cochran’s departure. Cochran’s resignation could have an impact on health care spending, but it likely won’t be a major shift. Both Shelby and Cochran have supported increasing medical research spending, work that has been led by Sens. Roy Blunt (R-Mo.) and Patty Murray (D-Wash.), who head the Appropriations Subcommittee on Labor-Health and Human Services Appropriations.

Gov. Phil Bryant (R-Miss.) will appoint Cochran’s replacement, who will hold the seat until the special election on November 6. Sen. Roger Wicker (R-Miss.) is up for reelection in November and is currently facing a primary challenge from conservative state Sen. Chris McDaniel (R-Miss). With Cochran’s resignation, a special election will take place the same day to fill out the rest of Cochran’s term, which runs until 2020. McDaniel could switch and run for Cochran’s seat if he believes the appointed senator is more vulnerable than Wicker.

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