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HHS cheers overdose drop but urges states to cap Medicaid

Administration proposes capped Medicaid funding in exchange for added flexibility

(Ian Wagreich/CQ Roll Call file photo)
(Ian Wagreich/CQ Roll Call file photo)

The White House announced the first decline in overdose deaths since the earliest days of the opioid crisis and attributed it to administration actions, even as officials simultaneously said they would let states cap funding for Medicaid, a common way for patients to get treatment.

A 4 percent dip in the number of overdose deaths from 2017 to 2018 could indicate that the crest of the opioid crisis has passed, said White House senior aide Kellyanne Conway, who called the new Centers for Disease Control and Prevention data a “turning point.”

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The trend line in overdose deaths rose from 1999 to 2016, with different rates of change over time, but the 2018 rate dropped meaningfully from 2017, said the CDC.

Conway attributed the progress to the administration’s actions, including implementing a 2018 bipartisan law that called for millions more in grants to address the opioid crisis.

The improvement in the overdose rate contributed to an overall uptick in Americans’ longevity. For the first time since 2014, life expectancy in the U.S. increased in 2018, attributable in part to advancements in cancer treatment, according to a new National Center for Health Statistics report released Thursday.

However, the drug overdose decreases may not be continuing into 2019.

“The decline doesn’t appear to be continuing into 2019. It appears rather flat and maybe actually increasing a little bit,” Robert Anderson, head of the mortality statistics branch at the CDC’s National Center for Health Statistics, said on a call with reporters.

Those increases are being driven by the evolving nature of drug abuse, with the numbers of deaths due to synthetic fentanyl continuing to increase, as well as deaths from cocaine, methamphetamines, and combinations of those three drugs, Anderson said.

Health and Human Services Assistant Secretary of Health Brett Giroir, who helps lead the administration’s efforts on the opioid crisis, said the White House has been “shocked” by declines in longevity in the U.S. over the past few years.

In an interview with CQ Roll Call, Giroir cited the reduction in opioid overdose deaths to things like the declining use of prescription painkillers, increased use of the overdose reversal drug naloxone and expanded access to addiction treatment.

But he acknowledged the need to focus on threats that could reverse the positive trends, like methamphetamine use. He said that methamphetamine users were often illicit opioid users first, “so we do believe that the overall work we’ve been doing on opioids will substantively affect in a positive way the number of people who wind up using” drugs like methamphetamine.

More broadly, he attributed the increases in life expectancy to factors like the strong economy in addition to improvements in some of the health statistics.

Giroir pointed to other Trump administration priorities that he hoped would help keep life expectancy moving in the right direction, including efforts to limit HIV transmissions, addressing chronic kidney disease, trying to limit tobacco use and encouraging people to get vaccinated against influenza.

Potential coverage changes

Meanwhile, another Trump administration official, Centers for Medicare and Medicaid Services Administrator Seema Verma, announced the agency would expand states’ options to limit Medicaid funding.

Four in 10 non-elderly adults with opioid use disorder are covered by Medicaid, according to a 2019 Kaiser Family Foundation report.

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The new policy would also permit states to create a closed drug formulary, allowing states to decline to cover some pricey drugs, but with guardrails to protect drugs for individuals with HIV or behavioral health conditions. Those protections would seem to safeguard patients with opioid use disorder from the part of the Trump administration’s proposal affecting medication.

But Democrats and consumer advocates raised concerns that the proposed limits on overall funding could negatively impact patients at risk of overdoses.

“The block grant is bad news for the substance use disorder epidemic,” said Jocelyn Guyer, managing director at Manatt Health. “There’s no two ways about it. There’s fewer federal resources. … The first thing you would need to worry about is fewer people having coverage than otherwise have it.”

She said she is “deeply concerned about the impact of the block grant on some of the progress we’re just starting to see with regard to the opioid epidemic.”

Democrats in Congress raised similar alarms that the Medicaid guidance could compromise recent gains against the opioid crisis.

“This rule will harm our ongoing efforts to combat the opioid and addiction epidemic and will increase the number of Americans without access to affordable health care coverage,” Sen. Mark Warner, D-Va., said in a statement.

Oklahoma GOP Gov. Kevin Stitt announced Thursday that the state plans to submit a waiver to receive capped Medicaid funding in exchange for added flexibility.

Giroir defended the policy, arguing that state experiences with block grants for things like substance abuse have allowed them to spend their dollars as they see fit.

“I fundamentally believe that states will know how to better focus their health care dollars on what they need for their states,” he said.

Giroir, who is from Texas, added: “Someone in Washington, D.C., can’t tell somebody in Texas what’s necessary for south Texas.”

Sandhya Raman contributed to this report.

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