Axios Vitals

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March 02, 2018

Good morning … I did not know Sen. Orrin Hatch had a YOLO mode, but here we are.

Azar: HHS will approve opioid waivers quickly

President Trump at the White House opioid summit. Photo: Win McNamee/Getty Images

The White House’s opioid summit yesterday was mainly a chance for the administration to highlight steps it has already taken, many of which are pretty minor. But we did learn a few new things:

Treatment: Health and Human Services secretary Alex Azar made clear that HHS will use its waiver authority to expand Medicaid payments for substance abuse treatment.

  • Current law limits Medicaid reimbursements for treatment in large facilities. Legally, states have to ask permission before HHS can tinker with that cap — but Azar urged them to ask and said the department would say yes.
  • He also urged states to seek this particular waiver on its own, so it can be approved quickly, rather than submitting it in a package of other changes they want to make to their Medicaid programs.

Substitutes: The Food and Drug Administration yesterday asked online retailers to limit the sale of certain diarrhea medicines, which people addicted to opioids sometimes abuse as a substitute. The Washington Examiner has more details.

Trump: Drug dealers should get death penalty

President Trump was largely focused on illegal drugs as he addressed the White House summit yesterday. He mentioned how easy it is to get addicted to opioids after receiving a legitimate prescription, but focused primarily on illegal drugs and drug dealers.

  • To be clear, illegal prescriptions, the illegal trade of fentanyl, and the comorbid rash of heroin abuse are all very much a part of this crisis.

“We need strength with respect to the pushers and to the drug dealers,” Trump said. “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.”

  • Trump essentially said out loud what my colleague Jonathan Swan previously reported he’s been saying in private — that the U.S. should be executing more drug dealers.
  • For what it’s worth, some of the countries Trump has singled out as not having big drug problems due to executions — China, for example — actually have enormous drug problems.

Health care cuts drive West Virginia teachers' strike

Public school teachers across West Virginia have been on strike for a week — over their pay, but also their health benefits, Axios’ Bob Herman reminds us this morning. And the benefits squeeze they’re experiencing isn’t unique. It spans many employers, over many industries.

The big picture: Wages and health benefits are linked — as the cost of health care has climbed, increases in compensation often have gone toward those benefits instead of pay raises.

Key quote: "In West Virginia, we know they weren't known for having high salaries, but they were known for good health insurance," a high school history teacher told HuffPost. "That used to be something to attract people. Now that's eroding."

Uber, but for self-referrals?

ICYMI yesterday, Uber started a new service that lets hospitals, clinics and other providers order rides for patients to get to and from appointments.

That raised an interesting question: Can health care providers cover a patient’s Uber ride even though anti-kickback law says it’s illegal to pay for anything that could induce referrals?

The answer, relayed to Bob from the law firm Fox Rothschild:

  • Yes, new federal exemptions went into place last year allowing providers to pay for patient transportation.
  • There are a lot of conditions, though: For example, providers can’t advertise that they pay for Uber rides. Hospitals also can’t send luxury Hummer limos to pick you up. Sorry.
  • Perhaps most importantly, the transportation can only be used for patients who have "scheduled an appointment, or previously attended an appointment.”

A missing component of the gun debate

Data: Centers for Disease Control; Chart: Andrew Witherspoon / Axios
Data: Centers for Disease Control; Chart: Andrew Witherspoon / Axios

Although the Parkland school shooting was the impetus for the current gun debate, guns are involved in more suicide deaths than homicide deaths. That’s true overall and for older people, while teenagers and young adults are more likely to die from gun-related homicide than suicide.

Why this matters: This data is obviously tragic. But it also indicates that our brief and extremely emotional gun control debates leave out a key part of the issue.

What's on your radar for next week? I always welcome your tips and suggestions: [email protected].