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DC FIRST TO SCORE MENTAL HEALTH MEDICAID WAIVER: There’s at least one type of Medicaid expansion that the Trump administration can get behind.
The Centers for Medicare and Medicaid Services on Wednesday approved a Medicaid 1115 waiver in the District of Columbia that allows more treatment options for patients with serious mental illness and serious emotional disturbance. The waiver lifts a limit on Medicaid that otherwise says facilities can only be reimbursed if they treat no more than 16 mental health patients at a time. It will allow patients to get residential care for at least 30 days and then to be connected with services in their communities afterwards.
The limit on the number of patients allowed, known as the “institution for mental diseases exclusion,” was put in place by Congress in 1965 to prevent institutionalization. At the time, the expectation was that states would set up treatment facilities for people in their communities. But they never materialized, leaving patients with few options besides regular ER visits, homelessness, or cycling through the criminal justice system, and becoming more prone to suicide.
The Trump administration had sent a letter to Medicaid directors last year telling them to apply for the waiver, and Indiana and Vermont have similar applications pending. By approving the D.C. waiver, the Trump administration is carrying out a part of the 21st Century Cures Act, enacting provisions that have bipartisan support.
And it’s all happening at a time when the politics of Medicaid remain fraught, including over work requirements and state decisions about whether to extend the government-funded coverage to poor people under Obamacare. The focus on serious mental illness still fits into the Trump administration’s mindset about Medicaid, which is that the program should be reserved for particularly vulnerable people.
Since CMS Administrator Seema Verma has been at the agency, the provisions have extended to substance abuse disorder, too. Amid the opioid crisis, CMS officials have approved waivers in 26 states to help pay for addiction services.
On Wednesday, D.C. joined that list in addition to getting the waiver for serious mental illness. Local officials are hoping the waiver will make a difference for a city where about a third of patients with mental health disorders also misuse drugs and alcohol, and where opioid overdoses increased 236% in D.C. from 2014-2017.
Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at [email protected]. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.
SEE YOU IN DECEMBER? PELOSI DRUG BILL WON’T GET A NOVEMBER VOTE AFTER ALL: The floor vote for the Lower Drug Costs Now Act, or HR3, from Speaker Nancy Pelosi, keeps getting pushed back. It was supposed to get a vote ahead of Thanksgiving but a final Congressional Budget Office score isn’t ready yet, so it had been pushed back until December, Politico and The Hill report.
HEALTHCARE.GOV TALLIES ARE OUT: For the first two days, at least, because enrollment weeks are measured Sunday through Saturday. CMS data show 177,082 people selected plans on healthcare.gov. Last year, the first snapshot only collected signups for three days, but they had reached 371,676.
The healthcare.gov site faced technical problems on launch day this year that prevented people from selecting plans. Another reason there’s a drop-off is because Nevada set up its own state exchange this year, so people in the state will be signing up there instead of on healthcare.gov.
IOWA DEMOCRATS ARE FEELING UNEASY ABOUT WARREN’S HEALTHCARE PLAN: Democratic voters in Iowa are unnerved by Elizabeth Warren’s “Medicare for all” plan as signs point to her winning the first nominating vote coming up in February. Both the price tag – $26 trillion – and the chance that it gives President Trump ammo to call her a socialist made Democrats at a Spencer, Iowa, event queasy. “I’m not saying it’s wrong, but I’m scared. I really am. I’d be scared to have an appendectomy, too — it’s big, it’s bold, it may be great,” Tim Fairchild told the Washington Examiner after a Pete Buttigieg town hall in Spencer.
CLINTON DEMOCRAT EQUATES WARREN’S ‘MEDICARE FOR ALL’ WITH SAMURAI SUICIDE: William Galston, former deputy assistant for domestic policy to President Clinton, wrote in a Wall Street Journal op-ed entitled “Elizabeth Warren’s Health-Care Hara-Kiri,” a reference to ceremonial samurai suicides. He wondered how wise Democrats would be to consider the “big structural change” of Medicare for all ahead of the 2020 election. “Ms. Warren insists that if Democrats are willing to put up a fight, they can get “Medicare for all” done. As I recall, the Light Brigade was full of fight, but its charge into enemy lines still yielded an epic catastrophe,” Galston said.
HHS IS TAKING PHARMA GIANT GILEAD TO COURT OVER HIV MEDICATION PATENTS: Health and Human Services filed a patent infringement lawsuit against Gilead, the company behind HIV prevention drugs Truvada and Descovy, which have long been criticized for their exorbitant prices – $2,000 for a month’s supply. HHS alleges that Gilead is marketing the drugs as pre-exposure prophylaxis, or PrEP regimens without the proper licensing, as HHS holds the patents for the drugs. Truvada and Descovy are the only two drugs on the market that have been approved to prevent HIV, but the hefty price tag has drawn scrutiny from congressional Democrats who are demanding that the administration take a closer look at Gilead’s sales and possible patent infringement.
Gilead has come under fire for alleged price-gouging for a while now. In a May House Oversight Committee hearing, several lawmakers blasted Gilead as making their PrEP medications inaccessible to those who need them most. The late congressman Elijah Cummings told the company’s CEO Daniel O’Day: “There’s nothing like holding the hand who is dying from AIDS. … All we are trying to do is represent our constituents and help them stay alive.” Rep. Alexandria Ocasio-Cortez then asked O’Day why the drug is less expensive in other countries, like Australia, where the price is about $8. “I think it’s important here that we notice that we the public, we the people, developed this drug. We paid for this drug, we led and developed all the patents to create PrEP,” Cortez said. “There’s no reason this should be $2,000 a month. People are dying because of it.”
KELLYANNE CONWAY SUGGESTS THAT VAPE SHOPS MAY BE EXEMPT FROM THE FLAVOR BAN: Counselor to the president Kellyanne Conway said in front of the White House Wednesday that vape shops, which specialize in nicotine vaping products, may be excused from abiding by Trump’s proposed flavor ban. “This is a burgeoning health crisis; the difference is between kids and adults,” she said. “So, if we’re talking about e-cigarettes, the president, yes, he’s been discussing this with his team and he will, or HHS, will make an announcement soon.”
FEDERAL JUDGE PUTS THE KIBOSH ON TRUMP’S ‘CONSCIENCE RULE’: U.S. District Judge Paul Engelmayer in New York on Wednesday blocked a Trump administration rule set to go into effect Nov. 22 that would have allowed healthcare providers to refuse to perform or refer to certain procedures that violate their religous or moral beliefs, including sterilizations, abortions, or medically assisted suicide. The rule would have allowed healthcare workers to file complaints to the Health and Human Services Office for Civil Rights if they’re forced to participate in or refer for a procedure that violates their beliefs. Engelmayer, an Obama appointee, wrote in his 147-page order that the rule “represents a classic solution in search of a problem” and that employers would have a hard time avoiding “inefficiencies and dislocations” in the workplace.
ALEXANDER BACKS TRUMP PICK TO HEAD THE FDA: Republican Senator Lamar Alexander, chairman of the Health, Education, Labor, and Pensions Committee, is lending his support to the confirmation of Dr. Stephen Hahn as head of the Food and Drug Administration. After a meeting with Hahn Wednesday, Alexander said: “Dr. Hahn knows firsthand the importance of bringing new, lifesaving drugs and devices quickly through the regulatory process as well as the need for innovation for patients with debilitating and chronic pain,” Alexander said following a meeting with Hahn.
The Rundown
The Washington Post China touts its crackdown on fentanyl, urged by Trump, as drug-ring members are sentenced
Mississippi Clarion Ledger The election is over. What’s it mean for Mississippi roads, healthcare and teacher pay?
Politico How the FDA and EPA’s failure to communicate could put patients in danger
The Philadelphia Inquirer Millennial health is deteriorating faster than older generations — at a steep economic cost
Kaiser Health News Rural seasonal workers worry about Montana Medicaid’s work requirements
Calendar
THURSDAY | Nov. 7
House in recess.
Nov. 7-8. Renaissance Washington. World Anti-Microbial Resistance Congress. Brochure.
WEDNESDAY | Nov. 13
8 a.m. 1099 14th Street NW. Axios event on “Healthcare in 2020” including Health and Human Services Secretary Alex Azar. Details.
