End near for Oregon’s drug-public health experiment

Mar 28, 2024

Driving the Day

A Portland Police officer holds a business card showing a number to call for drug use health screening and services.

In February 2021, drug possession was decriminalized in Oregon, and police officers handed out cards with a number to call for health screenings and services after a drug citation, but the measure has been deemed unsuccessful. | Patrick T. Fallon/AFP via Getty Images

‘NOT GIVEN THE TIME IT NEEDED’ — Public health advocates fear the repeal of an Oregon law decriminalizing drug possession will end the nation’s first experiment in treating addiction to hard drugs as a public health problem, POLITICO’s Carmen Paun and Aitor Hernández-Morales report.

How we got here: The Oregon legislature has voted to repeal a law decriminalizing drug possession for personal use, joining other cities in adopting new tough-on-drugs policies. Democratic Gov. Tina Kotek is expected to sign the measure, passed after a surge in fatal overdoses and public drug use, in the coming days.

But public health supporters of the law say the repeal comes before decriminalization had a chance to work.

They point to Portugal, which saw a 75 percent drop in drug deaths since adopting the same strategy in 2001 through 2022, as evidence that Oregon is giving up too early.

Oregon’s experiment “was not given the time that it needed,” said Tera Hurst, executive director of Oregon’s Health Justice Recovery Alliance.

How Portugal succeeded: In response to sky-high overdose rates in the late 1990s, Portugal’s parliament decriminalized drugs in 2000. In 2001, it reoriented the country's response to the opioid crisis by reframing it as a public health crisis — and not a crime.

João Goulão, the Portugal official who’s overseen the drug treatment system since its implementation, told POLITICO the Oregon legislature’s decision seemed premature.

“When you’re taking on something as complex as the opioid crisis, you can’t really expect to see dramatic changes from one day to the next,” he said.

Hurst and other decriminalization advocates said the Oregon law didn’t succeed because of implementation problems: a failure to fund new treatment services for 18 months after the law passed, a failure to train police for their new role in addressing addiction and a failure to direct drug users to treatment.

Proponents of the repeal, which will allow police to make arrests for drug possession while offering options to avoid jail by seeking treatment, said they aren’t abandoning a public health-led approach. Instead, they’re pursuing the needed fixes.

“… [W]e needed to make sure that it wasn’t just easy to be a drug addict on the streets of Portland,” said Kate Lieber, a Democrat who’s the majority leader in the Oregon State Senate. “We couldn’t do that without recriminalization.”

WELCOME TO THURSDAY PULSE. Starting next week, D.C.’s public libraries will begin offering free eclipse glasses so you can safely view April 8’s solar eclipse.

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Around the Agencies

A pedestrian walks past an Obamacare sign outside an insurance agency

President Joe Biden is extending open enrollment for Obamacare for an additional four months. | Joe Raedle/Getty Images

FIRST IN PULSE: ACA DEADLINE EXTENDED — Americans who lost Medicaid coverage when the Covid-19 public health emergency ended now have additional time to enroll in Obamacare plans, POLITICO’s Adam Cancryn reports.

Tens of millions of people removed from Medicaid rolls will now have until Nov. 30 to sign up for new coverage under a plan to be announced today by HHS and first shared with POLITICO — an extension of the July 31 deadline initially set for the special enrollment period.

The new timeline will apply to all those seeking coverage through HealthCare.gov, with officials encouraging state-run insurance marketplaces to adopt the change as well.

Why it matters: The move comes as health officials grapple with a nationwide purge of state Medicaid rolls for the first time since the pandemic hit, following the expiration last April of a Covid-era policy meant to prevent vulnerable people from losing coverage amid the health crisis.

More than 19 million people have since been kicked off the Medicaid program, exceeding the administration’s original projections. The vast majority of those Americans have lost their insurance for procedural reasons and not necessarily because they were newly ineligible.

The process has resulted in the biggest reshuffling of the health insurance landscape since Obamacare. And it’s raised fears that a notable portion of those dropped from Medicaid will become uninsured, denting a record of expanding health coverage that President Joe Biden is making a central plank of his reelection bid.

STATE OF ‘IMPROPER’ PAYMENTS — HHS programs accounted for about $100 billion of an estimated $236 billion in inappropriate payments across the federal government in fiscal 2023, according to a new Government Accountability Office report.

That includes $51 billion in improper payments in Medicare — ones that should never have been made or were disbursed in the wrong amount — and $50 billion in Medicaid, according to the GAO, Ben reports. The totals don’t include some programs “susceptible to significant improper payments,” such as HHS' Temporary Assistance for Needy Families.

The share of proper Medicare payments in fiscal 2023 was in line with historical figures across administrations, while the rate of Medicaid payments was in line with pre-pandemic levels. Improper Medicaid payments grew during the pandemic.

Federal health programs like Medicare and Medicaid account for a substantial portion of overall federal spending. The GAO estimates that $2.7 trillion in improper payments across the federal government have been made over the past two decades, GAO said.

House Republicans called for more to be done to cut wasteful spending.

“We must root out the gross mismanagement of Americans’ hard-earned tax dollars, rein in spending, and reverse the curse of a debt crisis that looms large over our children’s future,” House Budget Committee Chair Jodey Arrington (R-Texas) said in a statement.

HHS didn’t respond to a request for comment.

Cybersecurity

REPORTING HOSPITAL CYBERATTACKS — A proposed rule would require large hospitals and certain medical manufacturers to report hacks to the government within 72 hours and ransom payments within 24 hours, POLITICO’s John Sakellariadis reports.

The rule was proposed Wednesday by the Cybersecurity and Infrastructure Security Agency.

While the proposal notes that many health care entities have reporting requirements under HIPAA, those requirements are limited to personal health information.

Health care entities would be required to report attacks that lead to a substantial loss of an entity's information system, a disruption of its ability to engage in operations, unauthorized access to an information system or a serious impact on the safety or resiliency of a system’s operations.

Why it matters: After a cyberattack on Change Healthcare in February disrupted the health care system, regulators are scrambling to prepare for the next attack. UnitedHealth Group, which owns Change, a large medical bill clearinghouse, reportedly paid a $22 million ransom to the hackers.

According to the CISA, covered entities include large hospitals with more than 100 beds, critical access hospitals and manufacturers of certain drugs and medical devices.

What’s next: CISA is giving the public 60 days to offer feedback on the proposed rule. The final version won’t be published for another 18 months after the public comment period closes.

In Congress

KUSTER BOWING OUT — Rep. Ann McLane Kuster (D-N.H.) isn’t seeking reelection in the fall after more than a decade in the House, Ben reports.

“This work has been many things — rewarding, frustrating, inspiring, and challenging. But, more than anything, it has been an honor,” Kuster said in a release Wednesday.

Kuster, 67, who chairs the moderate New Democrat Coalition, serves on the Energy and Commerce Committee’s Health Subcommittee and founded the Bipartisan Addiction and Mental Health Task Force. A spokesperson for Kuster told Pulse she’ll push to reauthorize the SUPPORT Act tackling the opioid epidemic and expand access to mental health and substance use treatment in the criminal justice system before her term ends.

She adds to the growing list of health care policymakers headed for the exits, a trend that’s raised concern in health policy circles about losing institutional knowledge on legislating.

COLE WINS SUPPORT — Rep. Tom Cole (R-Okla.) is gaining momentum in his bid to succeed House Appropriations Chair Kay Granger (R-Texas) after she announced her intention to give up the gavel early, POLITICO’s Caitlin Emma reports.

Almost all the top House Republican appropriators expressed their support in a letter endorsing Cole.

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