| Hey, good morning! The Health 202 is copying Congress, and will be off on Friday. Send us what we missed for Monday's edition: rachel.roubein@washpost.com. Today's edition: Providers notch a win in a surprise billing lawsuit. Obamacare increased health coverage for Black Americans, though the gains depend on whether the state expanded Medicaid. But first… | The "crack pipe" controversy distracts from bipartisan work on the opioid crisis |  The Biden administration has prioritized increasing access to naloxone, the opioid overdose reversal drug. (John Raby/AP) | | | Addiction policy advocates fear recent conservative outrage over "crack pipes" could set back the Biden administration's nascent effort to combat the nation's growing drug crisis. Unveiled in April, the White House's first-year priorities for curbing overdose deaths embraced several divisive policies. But supporters of such measures are concerned a new firestorm — ignited by a misleading article and amplified by Hill Republicans — could further polarize measures they contend are increasingly becoming mainstream and crucial to saving lives. | - "It feels like decades of progress and very quickly the momentum started to shift against us," said Ryan Hampton, a national addiction recovery advocate who himself is in recovery.
| | This dynamic is playing out at a fraught moment for the nation's drug crisis. Overdose deaths recently hit record levels amid a global pandemic that's stretched the public health system to its limit. | | President Biden's drug plan was the first to use the term harm reduction — which refers to policies aimed at curbing deaths and infectious diseases, rather than just achieving abstinence. The administration homed in on promoting syringe service programs; the opioid overdose reversal drug, naloxone; and test strips to detect the powerful synthetic fentanyl. | | On Feb. 7, a Washington Free Beacon article relied on assumptions when it alleged federal dollars from a new grant program would be used to distribute "crack pipes." It unleashed a conservative uproar that could elicit further scrutiny over the administration's overall addiction strategy, as White House officials maintain support for the harm reduction strategies they laid out in April, and again in October. | - "This goes back to some historical perspective that harm reduction approaches — and again, despite all the evidence to the contrary — can be seen by some as enabling drug use," said Michael Botticelli, who ran the White House drug policy office under President Barack Obama. "I fear that the latest controversy will create a microscope under which people will view these kinds of efforts."
| | The Biden administration's response: After the Free Beacon story, top officials stated that no federal funding would "be used directly or through subsequent reimbursement of grantees" for pipes in safe smoking kits. | - A Biden administration spokesperson told The Health 202 that such pipes are considered illegal drug paraphernalia under federal law. There isn't a statute prohibiting the use of federal funds to purchase pipes, but without a specific reference to pipes in the grant funding announcement as an authorized purchase, "why would it follow that a grantee could use federal funds to purchase something that is otherwise considered illegal drug paraphernalia."
| | But over the last two weeks, the blowback has continued. | - Sen. Marsha Blackburn (R-Tenn.) threatened to block swift consideration of a stopgap spending bill over disputed claims about the new grant program.
- Sen. Marco Rubio (R-Fla.) sought to force a vote on a measure explicitly banning federal funding for the pipes.
- Rubio, along with Sen. Joe Manchin (D-W.Va.), introduced legislation barring the grant program from using federal funds to purchase syringes, which it is allowed to do.
| | Meanwhile: White House officials say they're committed to pursuing the slate of measures they released last year, as several advocates said they want to see the Biden administration intensify public education efforts around harm reduction policies. | - "Expanding access to high-impact public health services like overdose reversal medication, syringe services programs, and effective addiction treatment and recovery is a key part of the Administration's response to prevent overdoses and save lives," Rahul Gupta, the head of the Office of National Drug Control Policy (ONDCP), said in a statement to The Health 202.
| | The administration knew acceptance of the harm reduction policies wouldn't come easily. But "you can't take anything off the table" when a record 100,000 Americans per year are dying from an overdose, said Regina LaBelle, who served as Biden's acting ONDCP director until the fall. But some Republicans have long been wary of some measures, and experts say the controversy this week could further inflame those tensions. | - Take Sen. Tom Cotton (R-Ark.), who has demanded answers from HHS on pipes. He recently co-chaired a bipartisan opioid commission report, which his office said endorsed increasing naloxone access and best practices for distributing fentanyl test strips. However, the senator opposes handing out new needles, "which encourages drug use," but supports other parts of the programs, like needle disposals, spokesperson James Arnold wrote in an email.
| | Harm reduction policies are geared toward those with an addiction who aren't ready to access treatment, Nora Volkow, director of the National Institute on Drug Abuse, said in an interview. | - "So how do we reach out to them?" she asked. "That's where some of these alternatives — harm reduction practices — even though they may not have the same level of impact as others, like treatment for opioid use disorder, may be able to provide benefits."
| | |  | Agency alert | | More Black Americans gained health insurance, but it also depends on where they live |  Dr. Chidinma Nwakanma gives Matteisha Young her first covid-19 shot at a vaccination clinic in Philadelphia. Dr. Nwakanma has been assisting with community clinics to encourage Black Americans to get vaccinated. (Photo by Caroline Gutman for The Washington Post) | | | The Affordable Care Act led to a significant increase in health-care coverage for Black Americans. But a dozen states have refused to expand Medicaid eligibility under the law, leaving nearly 1 million without insurance, our colleague Akilah Johnson reports. Per a new report from the Department of Health and Human Services: | - The increase: From 2011 to 2019, Black Americans under 65 without insurance dropped from 7.1 million to 4.4 million.
- About 37 percent of Black Americans who are uninsured live in three states: Florida, Georgia and Texas. None have expanded Medicaid.
- Barriers remain: The cost of health insurance continues to prevent access to care for Black Americans at higher rates than their White peers.
| Meanwhile, in the courts… | | In a win for providers, a federal judge struck down a controversial facet of the federal health department's rule shielding patients from the sky-high cost of surprise medical bills. Multiple lawsuits from providers targeted the amount a mediator considers for insurers to pay doctors when resolving billing disputes. A Trump-appointed judge sided with the Texas Medical Association that argued the payment amount chosen deviated from congressional intent. | - It's the first court ruling on an issue that's divided even lawmakers who wrote the legislation. The ruling leaves in place the key consumer protections ensuring those who inadvertently seek care out of their insurance network aren't slapped with a hefty bill.
| | Rep. Frank Pallone Jr. (D-N.J.), who chairs the House Energy and Commerce Committee: |  | | | | First in The Health 202: HHS is distributing another round of provider relief funds. | | Roughly $560 million will be sent to over 4,100 providers across the country this week, the department is expected to announce today. This comes as the omicron variant has fueled staff shortages in recent weeks, and facilities can use the funds to support recruitment and retention efforts. The distribution efforts are particularly focused around reimbursing a higher percentage of losses for smaller providers and bonus payments for those serving patients with Medicaid, CHIP and Medicare coverage. | | |  | Coronavirus | | Pregnancy-related deaths increase during pandemic's first year |  Maternal and infant mortality rates in the United States are higher than other industrialized countries. (Charles Krupa/AP) | | | Pregnant women and new mothers died at a higher rate in 2020 — a rise that mostly afflicted women of color, according to a new report from the National Center for Health Statistics. U.S. maternal mortality rates have increased significantly over the past few decades. They rose by 14 percent overall in 2020 compared to the year prior. By the numbers: | - Black women experienced the most deaths, with 55 maternal deaths per 100,000 births — nearly triple the rate for White women.
- Rates among Hispanic women increased as well, and are now similar to White women, whose numbers remained essentially unchanged.
| | The report stopped short of providing a reason for the spike, but The Post's Salvador Rizzo reports that some experts said it was possible the pandemic's strain on hospitals, coupled with the lack of a vaccine at the time, could have heightened barriers minority women already face in accessing the health care system. Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation: | Masks come off. Is it too song, or long overdue? | | When Democratic leaders began to join their Republican counterparts in dropping indoor mask mandates, some residents lauded the move, but others have kept their face coverings firmly in place, The Post's Fenit Nirappil, Jane Gottlieb, Ryan Slattery and Katherine Kam report. The abrupt end to mask mandates in all states but one comes as the omicron wave recedes and White House officials signal that the country may be approaching a new phase of the pandemic. | - "Some people say it's long overdue and time to trust vaccines as the best shield. Others worry that political pressure to return to normal is endangering the immunocompromised, elderly and young children not yet eligible for vaccines. Many are unsure when they will ever feel comfortable again in a maskless world, their hopes dashed before by new variants," our colleagues write.
| | Hear more from residents in blue states about navigating life without mandates:  | | | | | |  | In other health news | | - First in The Health 202: Several House members are planning to introduce a bill to cap the cost of insulin at $35 per month. The legislation — from Reps. Angie Craig (D-Minn.), Dan Kildee (D-Mich.) and Lucy McBath (D-Ga.) — is similar to a provision in Biden's sweeping economic bill stalled in the Senate.
- Moving in: Leaders from multiple spinoff groups of the self-described "Freedom Convoy," which occupied downtown Ottawa for more than three weeks, are using social media to call on Americans to mobilize toward the nation's capital to protest vaccine mandates, The Post's Ellie Silverman reports.
- New shot on the horizon? European pharmaceutical companies Sanofi and GlaxoSmithKline said they will seek emergency use authorization from the FDA for their coronavirus vaccine, which achieved 100 percent efficacy against severe infection and hospitalization in a late-stage trial, The Post's Brittany Shammas and Carolyn Y. Johnson report.
| | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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