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White House weighs in on Medicaid expansion in Virginia. Office of Management and Budget Director Mick Mulvaney issued a statement Thursday that the agency’s Twitter account said was “on the Obamacare Medicaid expansion in Virginia.” “The program has resulted in an explosion of state and federal spending, and abundant evidence suggests that new enrollees are not experiencing health improvements to justify the dramatic increase in cost,” Mulvaney said. The statement went on to note that President Trump’s budget request supports repealing the expansion, as well as changes to Medicaid such as work requirements. OMB did not respond to multiple requests for comment but told the Associated Press that the tweet speaks for itself. A Health and Human Services official pointed to the support for Graham-Cassidy in Trump’s budget. “We typically do not comment on state plan amendments or waiver requests in Medicaid until they have been received and reviewed by the department,” the official said.  

Can the Trump administration reject requests to expand Medicaid? Though Virginia is still working on the details of its expansion, lawmakers have floated the idea of adding various changes rather than a straight-up expansion. To do that, they would need to pass a 1115 waiver in the legislature, something they could do alongside expansion. According to Eliot Fishman, senior director of health policy at pro-Obamacare group Families USA, if there is nothing legally wrong with an expansion application then CMS has to approve it. He explained that if Virginia were to pass Medicaid with a waiver then the expansion part would have the option to proceed as the waiver continues to be evaluated by the Centers for Medicare and Medicaid Services. Virginia Gov. Ralph Northam’s office told the Washington Examiner that he was “confident” that expansion would happen in the commonwealth. Northam met with HHS Secretary Alex Azar on Saturday and was “assured that the Trump administration will continue to evaluate applications for expanded coverage, and would look favorably on waivers to connect Virginians with work and incentivize healthy choices,” said Ofirah Yheskel, the governor’s press secretary.

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Trump calls for ‘very strong’ penalties against opioid companies, drug dealers. Trump, in a surprise visit to the Opioid Summit on Thursday, said his administration will soon unveil new policy initiatives that aim to combat the opioid crisis, noting that his priority was to “get tough” on drug dealers and begin prosecuting certain opioid manufacturers. “Hopefully we can do some litigation against the opioid companies,” he said. “I think that’s very important because a lot of states are doing it. I keep saying if the states are doing it, why isn’t the federal government doing it?” While the president touted some of his administration’s actions, he simultaneously argued that more needs to be done to punish drug dealers and “pushers” who have been selling opioids. “Most of them don’t even go to jail,” Trump claimed. “If you shoot one person, they give you life. They give you the death penalty. These people can kill 2,000, 3,000 people and nothing happens to them.” Trump later referenced how some countries execute drug dealers, a proposal he has reportedly floated to aides in private. “Some countries have a very, very tough penalty – the ultimate penalty. And by the way, they have much less of a drug problem than we do,” he said.

Azar commits to approaching opioid epidemic as a ‘medical challenge’ rather than moral failing. Azar stressed that the Trump administration views the opioid epidemic as a disease rather than a moral failing, and it will take that approach in its policy implementation. “At HHS and across this administration, we know that we need to treat addiction as a medical challenge, not as a moral failing,” he said. Azar noted the Trump administration would be starting a media campaign to educate people about the dangers of addiction but also would stress that addiction can happen to anyone. “I do think the destigmatization of substance use disorder is critical,” he said. “We have to get people willing to seek out treatment.” Azar pointed to the Trump administration’s promotion of drug courts, which place people with addictions who have committed crimes into substance abuse treatment rather than jail. The health secretary was in the later parts of his remarks responding to a question from Kathryn Burgum, North Dakota’s first lady, who was in the audience at the summit and has been in addiction recovery for 16 years. She wanted to know if the Trump administration’s communication campaign would “promote understanding and empathy.” Without understanding, she said, people will be hesitant to seek treatment. “I did not seek real help for almost 20 years because I was ashamed,” she said.

Azar invites more states to seek Medicaid waivers to fight opioids. Azar encouraged more states to use the Medicaid program as a way to fight the opioid epidemic. The Trump administration has hastened the process by which states can apply and receive approval for Medicaid waivers, and has approved five aimed at the opioid epidemic. “I actually berated the governors saying, ‘Why have I only gotten five of these so far?’ We are eager to work with them, we have a streamlined process for approving them, and I want more,” he said. One way waivers can be used is to allow more healthcare facilities to be reimbursed for providing treatment. By law, medical facilities are not allowed to have more than 16 beds to receive Medicaid funds. The rule, which dates to 1965 and was intended to promote the expansion of smaller community-based substance abuse treatment centers, has contributed to long wait lists for treatment. More beds are allowed for states that ask to make changes through a waiver.

Melania Trump opens opioid summit with letter from grieving mother. First lady Melania Trump opened the summit with a letter from a mother whose son died from a drug overdose. The mother, Betty Henderson, was brought to the stage as Trump read the letter she had written about her son, Billy, a month after he died. In the letter Henderson implored Trump to work to fight the epidemic. “No mother should ever have to claim their child’s body,” she wrote in a portion of the letter Trump read aloud. “I’m sure that you as a mother would have an understanding of the depths of despair experience I had on that day.” The letter continued: “I’m asking for your help in claiming these lost souls before drugs take them from this earth.” Trump said the story had touched her personally, and had touched people in the room. “Thank you for having the strength to reach out in the midst of your grief,” she told Henderson. She urged the more than 200 people gathered at the White House to keep Henderson and her son in mind as they discuss how to combat the epidemic. “Sadly, she’s not alone, and we need to change that,” Trump said.

Trump’s drug czar nominee reveals family member has addiction. Trump’s nominee to be the nation’s next drug czar shared publicly for the first time on Thursday that his family has been personally affected by the opioid epidemic. Jim Carroll, who has been nominated as director of the Office of National Drug Control Policy, and is currently serving as its acting director, did not disclose who the family member was. “For the first time publicly I want to tell you that … I have a family member who has been touched by this,” Carroll said. “Last year I was in the rehab center with my family member holding that person’s hand, helping them through this and trying to be that support system. And so it’s a great honor for me to take this on. This is a professional and a personal challenge for me, for the president and every member of this administration.”

FDA asks online retailers to restrict anti-diarrheal medication used by people with opioid addictions. The FDA sent a letter to online retail giants Thursday asking them to limit the sale of an over-the-counter, anti-diarrheal medicine that drug users are taking to mimic a euphoric high from opioids. In a letter to Amazon, Ebay, Walmart, and Jet, FDA Commissioner Scott Gottlieb noted that a growing number of people are taking the drug loperamide in high doses, which can result in serious heart problems or death. The FDA has become aware that people are taking these high amounts of the drug, a caplet often known by its brand-name Imodium A-D, as an alternative to an opioid, both to manage symptoms of withdrawal and to get high. Imodium is often known in drug circles as the “poor man’s methadone.”

Mark Meadows wants ‘retroactive’ repeal of Obamacare’s individual mandate this tax season. Rep. Mark Meadows sent a letter to the House Appropriations Committee on Thursday, pushing the panel to begin the process of passing a “full retroactive” repeal of Obamacare’s individual mandate. Though Congress included a repeal of the fines the uninsured were required to pay in its sweeping tax bill signed into law last year, that won’t take effect until 2019.

West Virginia drops lawsuit against DEA. West Virginia dropped a lawsuit against the Drug Enforcement Administration on Thursday after Attorney General Jeff Sessions called for reforms to the agency. The state sued the DEA in December to force changes to the agency’s cap that mandates how many opioids can be manufactured each year. However, the lawsuit was dropped after Sessions called for changes to the yearly limit. “The DEA’s quota system is fundamentally broken,” West Virginia Attorney General Patrick Morrisey said Thursday. “For far too long, it served the industry’s wants, instead of the patients’ needs, inexcusably neglecting evidence of diversion to rely on a formula that continues to kill hundreds each day.” Sessions issued a directive Thursday calling for the DEA to consider amending its regulations governing the production cap for opioids.

Claire McCaskill won’t benefit from Planned Parenthood’s 2018 campaign donations. Planned Parenthood said Thursday it would spend $20 million to support candidates in eight states this year, but that would not include Missouri, where Democratic Sen. Claire McCaskill is running for reelection. McCaskill, who is a pro-choice senator, is facing a tough re-election fight, but Planned Parenthood says they will be running advertisements and spending money on door-to-door efforts in states that will help Democrats take control of Congress. Planned Parenthood feels their money could be used better in states they feel they have the opportunity to flip a Senate seat. Trump, a harsh critic of the group, won Missouri by more than 18 percentage points in the 2016 presidential election. Initially, the women’s health organization, which provides abortions among other services, said it would try to help candidates in Arizona, Florida, Michigan, Minnesota, Nevada, Ohio, Pennsylvania, and Wisconsin, which are all swing states. Planned Parenthood Action Fund Director Deirdre Schifeling said Planned Parenthood is focusing on donating money to races they believe will be “a decisive factor.” “Reproductive rights and health is at stake in this country and has been at stake for years, but especially this year,” Schifeling said. “We think this is critical — critical for protecting, and hopefully expanding, access to reproductive healthcare in the states.”

Trump administration expected to grant Arkansas Medicaid waiver: report. The Trump administration is expected to approve a federal waiver to allow Arkansas to install work requirements, according to a report in Politico. Arkansas would become the third state to get approval for work requirements, joining Indiana and Kentucky. While Arkansas could get approval for work requirements, it remains unclear if Health and Human Services would approve a “partial expansion” of Medicaid. The waiver would change eligibility into the program. Arkansas wants to cap eligibility on the expansion at the federal poverty line, Politico said.

Orrin Hatch: Obamacare supporters are the ‘stupidest, dumbass’ people I’ve ever met. Republican Sen. Orrin Hatch said the people who support Obamacare are the “stupidest, dumbass” people he’s ever met. The Utah Republican made the comments while speaking at the American Enterprise Institute on Thursday. “[We] finally did away with the individual mandate tax that was established under that wonderful bill called Obamacare,” Hatch said. “Now, if you didn’t catch on, I was being very sarcastic. That was the stupidest, dumbass bill that I’ve ever seen.” “Some of you may have loved it,” he continued. “If you do, you are one of the stupidest, dumbass people I’ve ever met. There are a lot of them up there on Capitol Hill from time to time.” According to a poll released Thursday, Obamacare support reached its highest level ever since 2010 when the poll began. The Kaiser Health Tracking Poll found that Obamacare has the support of 54 percent of the public.

RUNDOWN

Axios Healthcare cuts drive West Virginia teachers’ strike

STAT News Kentucky could become the first state to tax opioid prescriptions

Vox This senator has a plan to end pre-existing conditions for good

Washington Post HHS chief pushes Trump opioid commission’s top recommendation

Kaiser Health News Time running short for Congress to stabilize insurance markets

New York Times They’re hosting parasitic worms in their bodies to help treat a neglected disease

ProPublica First responders in Florida aren’t covered for PTSD, but that may change after Parkland shooting