Congress Moves on Opioid Epidemic Bills

Last Tuesday, the US House and Senate embarked on a two-week “vote-a-thon” to act on dozens of bills setting a governmental course of action on the opioid abuse crisis. The timing of this, the New York Times reports, is propelled not only by the intensity of the crisis but also by the legislator’s need to ” score a popular win they can tout for the midterm elections.”

Some of the proposed bills are highly contentious, illuminating Congress’ ongoing schism regarding the government’s role in health care. Roll Call quoted Senator Frank Pallone (D-NJ), a ranking member of the Energy and Commerce Committee, as saying, “Collectively these bills do not go far enough in providing the resources necessary for an epidemic of this magnitude…While these bills are well intentioned, Republicans’ ongoing efforts to repeal the ACA, gut Medicaid, and take away critical protections for people with pre-existing conditions would have a devastating impact on people who suffer from opioid substance abuse.”

Nevertheless, many of the bills that are gaining bipartisan support include one that would allow the government “to repay up to $250,000 in student loans for some drug treatment workers who agree to serve in areas with especially severe [opioid] problems,” the Times noted.

The Columbus Digest reports that Sherrod Brown (D-Ohio), a member of the Senate Finance Committee, persuaded the Committee to support legislation to compel pharmaceutical companies and medical device manufacturer to “publicly disclose the payments they make to nurse practitioners and physician assistants for promotional talks, consulting and other interactions. The measure is aimed at increasing transparency around prescribing practices and the relationship between drug companies and prescriptions for opioids.”

Of particular interest to AAHIVM members is H.R. 5353, the “Eliminating Opioid Related Infectious Diseases Act of 2018”, passed by the House on June 12. The bill authorizes $40 million a year over five years for the Centers for Disease Control and Prevention (CDC) to assist state and local governments and others to enhance surveillance systems to track opioid use-related infectious diseases, increase HIV and hepatitis testing and prevention. This will also improve linkages between HIV and hepatitis treatment and substance use disorder treatment.

This bill addresses hepatitis C (HCV), the incidence of which rose by 350 percent between 2010 and 2016. The AIDS Institute reports that “HCV deaths now surpass deaths associated with all 60 other notifiable infectious diseases combined. While progress has been made in reducing the number of new HIV infections in the country, including the number of new cases associated with injection drug use, the opioid crisis can reverse this trend. Certain communities and areas of the country… are experiencing increases of HIV due to injection drug use”.
Once passed in the House, H.R. 5353 was introduced in the Senate and folded into the”Opioid Crisis Response Act of 2018″ that is being sponsored by Senators. Lamar Alexander (R-TN) and Patty Murray (D-WA).

The Medicaid Work Requirements Watch

In Arkansas, as of June 5, “able-bodied” Medicaid recipients are required to prove that they are working or volunteering at least 80 hours per month. Failing to do so three times in one year results in the participant being “locked out” of Medicaid for the remainder of the year. In recent research, the Urban Institute and the Robert Wood Johnson Foundation calculated that that this could result in 39,000 Arkansans (15% of all enrollees) losing their Medicaid coverage and being uninsured for as much as nine month.

This study also showed that 78% of the non-elderly Medicaid recipients in this group of 39,000 people had one or more of these challenges: “no access to a vehicle in their household, no access to the internet in their household, less than a high school degree, a serious health limitation [that doesn’t qualify as a disability], or a household member with a serious health limitation”, all barriers to “finding work and documenting completed work hours”.

Arkansans assigned with Work Requirements have to document their work hours via an online portal that the state has created, according to HealthInsurance.org. No option is provided to relate their information by phone or office visit. Meanwhile, state census Bureau data show that Arkansas has the second-lowest rate of home internet access in the nation, exceeded only by Mississippi.

Maine’s battle over Medicaid Expansion rages on as Gov. Paul LePage defies a court order to file the mandatory, federal paperwork with CMS. After 59% of Mainers voted for Medicaid expansion last fall, Politico reports, the LePage administration refused to comply, forcing advocates to file suit to compel implementation. When the court ruled that the administration had to initiate the federal paperwork process required for expansion, the LePage administration appealed and is now contending that they cannot be forced to take action while the case is on appeal. Maine’s Superior Court ordered LePage to comply with a ballot initiative by June 11 – a deadline that has now passed without action. Medicaid expansion in Maine would provide coverage to roughly 80,000 low-income adults, Politico reports. It will also include Work Requirements for “able-bodies” Medicaid recipients.

Nine states now have completed 1115 Waivers submitted to CMS that, if approved, will enable them to require that “able-bodies” Medicaid recipients engage in work of voluntary activities as a condition of their coverage. These are Arizona, Kansas, Mississippi, North Carolina, South Carolina, Ohio, Utah and Wisconsin. Three states are already implementing Work Requirements (Arkansas, Indiana and New Hampshire).

Kentucky’s Waiver has CMS approval for Work Requirements but its implementation is currently stalled by a law suit against the federal government. In an Amicus Brief supporting the suit, 43 public health experts and eight medical school deans argue that work requirements would “directly violate the Medicaid program” and that imposing them “would block Kentucky’s poorest and most vulnerable Medicaid beneficiaries from receiving necessary health benefits.”

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