Axios Vitals

A briefcase with a red cross on the front.

April 11, 2018

Good morning ... Situational awareness: A traveling memorial to victims of the opioid epidemic will be unveiled today in the Ellipse, just south of the White House. HHS secretary Alex Azar and White House counselor Kellyanne Conway will be there.

The holes in Washington's opioid response

Photo: Spencer Platt/Getty Images

The federal response to the opioid crisis is still falling short, even as Congress works on another round of policy solutions, experts tell my colleague Caitlin Owens.

  • "It's an important start, but ultimately it’s a fraction of what [is] needed. This epidemic has been 20 years in the making,” said Caleb Alexander, co-director of the John Hopkins Center for Drug Safety and Effectiveness.

What's happening: Congress has already addressed the crisis in both spending bills and stand-alone measures, and committees in both the House and Senate are meeting today to work on more bills.

  • "The response from the federal government must be bipartisan, urgent, and effective," Sen. Lamar Alexander will say today at his committee's hearing.

Yes, but: As Stanford's Keith Humphreys puts it, "all of the proposals with any traction on the Hill are short-term."

Between the lines: Experts say Congress needs to spend a lot of money on treatment for people who are addicted to prescription opioids/heroin/fentanyl. Just as importantly, they argue, that money needs to be consistent over several years.

  • States need to build new infrastructure and hire more workers, and even a series of one-time funding measures can’t necessarily sustain that longer-term effort.
  • “You can’t give states one-time money and expect them to start building a new system," Brandeis professor Andrew Kolodny told Caitlin.

Go deeper:

Trump's plan for "welfare reform" is here

President Trump signed an executive order yesterday paving the way for big changes to welfare programs. And the White House defined "welfare" in a way that would likely include Medicaid and possibly other health care policies as well.

The details are thin (as is common with these executive orders, which leave most of the heavy lifting to the agencies). But here are the highlights:

  • "Welfare" is defined as "any program that provides means-tested assistance," with a special emphasis on programs that serve people below 200% of the poverty level. So, Medicaid.
  • HHS is also among the departments and agencies that Trump directed to review their existing programs and regulations.

Work is a big theme. This echoes the administration's push — already well underway — to add work requirements to Medicaid. So far, this has only succeeded in states that adopted the Affordable Care Act's Medicaid expansion.

What's next: Within HHS, the Administration for Children and Families will put out policy guidance and research "in the coming months" to implement this order, according to a statement from Steven Wagner, ACF's acting leader.

Who's breaching hospital data? Hospital employees

Photo: BSIP/UIG via Getty Images

Most data breaches in the health care industry are caused by insiders, Axios' Joe Uchill reports. That's the first time insider threats have crossed the 50% line since Verizon began tracking these statistics.

What it found: In its 11th annual data breach investigation report, Verizon said 56% of breaches in the health care sector are the result of insider threats. That’s never happened in any industry before.

Why it matters: External threats are real, but so are the less talked about internal ones that companies and organizations don't always pursue as doggedly.

Worth considering: When people hear “insider threat,” they tend to think Edward Snowden. But not all insider threats are from discontented or malicious employees. As many as 13% of the health care breaches were “driven by fun or curiosity," such as looking up information on a celebrity staying on hospital grounds.

Sign up for Codebook, Joe’s twice-weekly cybersecurity newsletter, at this link.

The United-Envision brawl gets real

The stock price of Envision Healthcare plummeted by more than 7% yesterday, or about $340 million in lost market value, after Axios' Bob Herman reported UnitedHealthcare axed its contract with the company.

Why it matters: The shock of surprise out-of-network emergency room bills has angered patients, and it could get significantly worse if a new agreement is not reached between the country's largest commercial insurer and the country’s largest operator of hospital ERs.

What to watch: United and Envision will have to resolve their bitter legal feud and come up with new contract terms in 8 months. Piece of cake, right?

What Bob’s hearing: This ordeal appears to be “particularly damaging” for Envision because it “reinforces the narrative that (Envision’s) billing practices are flawed,” financial analysts at Cantor Fitzgerald wrote late Tuesday.

  • Another Wall Street analyst did some back-of-the-envelope math and said Envision could lose up to a fifth of its profits if United’s revenues went away.

Theranos lays off even more staff

Elizabeth Holmes (on right) at a Vanity Fair event in 2015. Photo: Michael Kovac/Getty Images for Vanity Fair

Theranos has laid off most of its remaining staff, the Wall Street Journal reports. The blood-testing firm, which once had hundreds of employees and a $9 billion valuation, is now down to about 24 employees, per the WSJ, and a bankruptcy filing may be unavoidable.

  • Founder Elizabeth Holmes has already reached a settlement with the SEC and has given up most of her stake in the company.

Why it matters: Theranos had partnerships with Walgreens, Safeway and Celgene. Holmes was on the cover of business and tech magazines. And, at least for a while, the company managed to stay a step ahead of federal regulators, hiding the fact that its equipment didn’t work.

What we're watching today: Senate health committee opioid hearing at 10am ET (livestream). House Energy and Commerce health subcommittee opioid hearing at 2:15pm (livestream).

How are you? I love hearing from you. [email protected].