Public Health Law Watch
An initiative of the George Consortium

Public Health Law Watch blog

                            

Fighting Fire With Lighter Fluid: Trump Administration Housing Policy Proposals Would Exacerbate the U.S. Affordable Housing Crisis, Heightening Health Inequities

By Madeline Morcelle

Emerging policy proposals from the Trump administration would exasperate the U.S. affordable housing crisis, heightening heath inequities. On February 12, the Trump administration released its 2019 budget proposal, advocating for deep cuts to already chronically underfunded housing programs, as well as drastic rent increases and reforms to encourage “work and self-sufficiency” for low-income individuals and families receiving rental assistance. Draft legislation (1) leaked from the Department of Housing and Urban Development (HUD) earlier this month articulated these proposals in greater depth.

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A Response to "Unintended Consequences: Medicaid and the Opioid Crisis"

Today, Public Health Law Watch sent a letter (both electronically and on paper) to every member of the U.S. Senate Committee on Homeland Security & Governmental Affairs in response to a January hearing entitled "Unintended Consequences: Medicaid and the Opioid Epidemic." That hearing and its accompanying report presented a slew of misinformation, misleading statistics, and poorly informed conclusions that attempted to blame the current opioid crisis on the expansion of Medicaid. The George Consortium members mobilized to respond with facts and real potential solutions.

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Elisabeth Ryan
Let's Get Fewer People to Die (from Northeastern Law Magazine)

by Elisabeth Ryan

Guns were never a part of my life.  In the Massachusetts suburb where I grew up, my family did not go target shooting for sport and did not keep guns in the home for protection. The very idea of hunting was repugnant in our animal-loving household. In law school, my constitutional law classes never even mentioned the Second Amendment. My life was, in all tangible aspects, unaffected by guns.  But when I worked as a public defender, I represented people who commonly faced rampant violence in their lives and neighborhoods. For them, guns were often just part of reality. When I worked as counsel in the Massachusetts Executive Office of Public Safety and Security, overseeing state gun laws, regulations and policies brought me into contact with a population of individuals for whom guns were a central part of their lives, both tangibly and symbolically. 

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Elisabeth Ryan
Involuntary Treatment for Substance Use Disorder: A Misguided Response to the Opioid Crisis [from Harvard Health Blog]

PHLW's Leo Beletsky, Elisabeth Ryan, and Wendy Parmet authored a piece this week on the Harvard Health Blog about why involuntary commitment for substance use disorder should not be touted as a tool in the opioid crisis.

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Recently, Massachusetts Governor Charlie Baker introduced “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” (CARE Act) as part of a larger legislative package to tackle the state’s opioid crisis. The proposal would expand on the state’s existing involuntary commitment law, building on an already deeply-troubled system. Baker’s proposal is part of a misguided national trend to use involuntary commitment or other coercive treatment mechanisms to address the country’s opioid crisis.

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Elisabeth Ryan
Threats to Medicaid and Community Integration for People with Disabilities

By Mary Crossley

As we enter the second year of the Trump administration, Medicaid remains in the cross hairs of conservatives in Congress and the administration. The repeated efforts in 2017 to reduce the program’s funding and change its structure, however, revealed the breadth and depth of public support the program enjoys. People with disabilities protested, putting their bodies on the line to express their outrage over proposed cuts that would threaten their access to services that permit them to live in the community rather than institutions. Along with others’, their protests helped defeat Republican proposals in 2017, but similar battles likely lie ahead.

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Elisabeth Ryan
Center for Health Policy and Law Joins Amicus Brief in Correa v. Schoeck

Public Health Law Watch is part of the Northeastern University School of Law Center for Health Policy and Law.  The Center has signed on to an amicus brief, in support of the appellant-plaintiff, in the Massachusetts Supreme Judicial Court case of Correa v. Schoeck and Walgreens.  

The amicus brief is available here: Correa v. Schoeck, amicus brief

The issue in this case is "whether a pharmacy owes a duty of care to its customer to notify her physician that her insurer will not pay for her prescription medication without prior authorization."

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Elisabeth Ryan
Immigration and Health Care Under the Trump Administration [from Health Affairs Blog]

After a brief hiatus during the holidays, a Nor'easter, and the dawn of a new semester, PHLW is back with this post by our own Wendy E. Parmet on the Health Affairs Blog.  The piece about the current state of immigration and health care comes out of her recent presentation at the Harvard Law School Petrie-Flom Center Sixth Annual Health Law Year in P/Review in December 2016.

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Elisabeth Ryan
Will Public Health Litigation Help to Solve the Opioid Crisis?

by Rebecca Haffajee

In this week’s issue of New England Journal of Medicine, Michelle Mello and I write about drug company liability for the opioid crisis. We analyze the history of litigation efforts against opioid manufacturers and distributors to hold these parties responsible, at least in part, for the epidemic. Early litigation brought by individuals harmed by prescription opioids against drug companies was minimally effective: most cases were dismissed early on and few settled. But these personal injury suits faced formidable company defenses -- such as that opioids were FDA-approved substances and that there were intervening causes (i.e., individuals not using the drugs as prescribed and doctors over-prescribing opioids) that contributed to the harm. However, in more recent years, mounting litigation lodged by governments may hold greater promise to succeed and reduce public health opioid-related harms, either through wins, settlements, or spillover effects. But let's be clear: litigation will not be a silver bullet to solving the crisis and shouldn't substitute for other public health-oriented policies and interventions. But lawsuits just might do some good here.  

Read more in our Perspective, entitled "Drug Companies' Liability for the Opioid Epidemic."

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Elisabeth Ryan
Minor Access to Prophylaxes in Massachusetts: STI Consent, the Mature Minor Rule, and the Definition of "Treatment"

By Jason Potter

The Massachusetts Joint Committee on Public Health is currently considering House and Senate bills to amend the Commonwealth’s emergency consent statute (Section 12F), which allows certain minors to self-consent to general medical care, and allows all minors to self-consent STI diagnosis and treatment. The bills would add the term “prevention” to the Commonwealth’s STI consent statute, thus allowing minors in Massachusetts to consent to STI diagnosis, treatment, and preventive care. Known as the “PrEP Bill,” S.1186 and H.3249 are sponsored by Senator Julian Cyr and Representative Jack Lewis, respectively. The senators are seeking to expand the language of the portion of Section 12F pertaining to STI-related care so minors may consent to HIV Pre-Exposure Prophylaxis (PrEP) and the human papillomavirus (HPV) vaccine. In my 2016 article PrEP and Our Youth: Implications in Law & Policy, I proposed this very change. On June 27, 2017, I testified before the Joint Committee in support of the PrEP Bill.

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Could repealing net neutrality be bad for our health? [From Health Cents, philly.com]

The following post, from George Consortium member Robert I. Field, was originally published in Health Cents on philly.com.

By Robert I. Field

Repealing net neutrality could be bad for American health care.

The Federal Communications Commission plans to vote this week on a proposal to repeal Obama-era rules that require Internet Services Providers, companies that connect your computer to the Internet like Comcast and Verizon, to treat all websites equally. The rules prohibit ISPs from speeding up or slowing down traffic to a site for financial or other reasons.

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"Benefits, Limitations, and Value of Abuse-Deterrent Opioids" in JAMA Internal Medicine

Two members of our team - Dr. Gregory Curfman and Professor Leo Beletsky - and friend of PHLW Ameet Sarpatwari have an important new piece out in JAMA Internal Medicine entitled "Benefits, Limitations, and Value of Abuse Deterrent Opioids."  "Abuse deterrent opioids" are formulations of the drugs meant to be tamper-resistant, "intended to make manipulation more difficult or to make abuse of the manipulated product less attractive or less rewarding." Looking at the Institute for Clinical and Economic Review report on Abuse-Deterrent Formulations of Opioids: Effectiveness and Value and adding independent analysis, the authors found that the selective use of abuse deterrent opioids may mitigate opioid abuse and diversion. However, the use may also promote switching to more dangerous opioids (like heroin). Finally, they found no evidence that abuse deterrent opioid use reduces overdose deaths. 

Read the entire article here.

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Why is Congress not prioritizing health care for children and other vulnerable populations?

By Jennifer Lea Huer

Back in September of this year, Congress was faced with the decision of whether or not to renew funding for both the Children’s Health Insurance Program (CHIP) and the Community Health Center Fund. Both sources of funding expired on October 1, 2017. As of the date of this post, 68 days have passed since Congress failed to renew funding for these crucial programs. Much has been written about the imminent need to reauthorize CHIP funding; states are already warning their residents that funding is running low and decisions about cutting coverage may soon follow. In addition to the estimated 9 million children in danger of losing coverage if CHIP funding is not renewed, recent studies estimate that millions more people could lose access to care if Congress does not take concrete steps to reauthorize funding for community health centers.

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Of Mosquitoes and “Moral Convictions”: How Rolling Back the Affordable Care Act’s Contraceptive Mandate Jeopardizes Women’s and Children’s Health

By Linda C. Fentiman

December 5 is the deadline to submit comments on the Trump Administration's recent action to gut the Affordable Care Act’s contraceptive mandate, which requires employer-sponsored health plans to ensure women's access to free, effective contraception.  This decision, announced in October in two Interim Final Rules, threatens serious harm to American children, because of the risk that women who lack access to contraception will become pregnant, contract Zika, and unwittingly transmit the virus to their developing fetus.  Since 2015, as an exponentially expanding Zika epidemic swept across Latin America, the United States, and its territories, thousands of children around the globe have been born with microcephaly.  On the U.S. mainland alone, almost 100 children have been diagnosed with microcephaly or other Zika-associated birth defects.   In Florida, the Department of Health has recently reported a new, sexually transmitted, case of Zika in Miami-Dade County.  In 2017 alone, 225 cases of Zika infection were confirmed in Florida; 119 are pregnant women, and three infants have been born with congenital Zika syndrome.  New York City, more than 400 pregnant women have been diagnosed with Zika since January 2016 and at least 20 infants have been born with microcephaly or other Zika-associated birth defects.

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Briefly: Some Interesting Public Health Law Moves in Massachusetts

As you enjoy a very nutritious helping or two of Thanksgiving dinner this week, here's some interesting happenings in Massachusetts public health law for you to chew on (haaa).  

By Elisabeth J. Ryan

This week, the Commonwealth of Massachusetts became the first state in the nation to ensure that most health insurance plans cover birth control without cost-sharing to patients.  Technically, this provision already exists federally in the still-good-law Affordable Care Act.  However, in October, the federal government issued rules to roll back that requirement by allowing any employer to avoid such coverage by invoking religious or moral objections to contraception. The Massachusetts law still contains religious exceptions, including for churches and "qualified church-controlled organizations" as employers; it also does not cover any employers who insure themselves and are thus subject solely to federal, rather than state, regulations.  This law was intended as a direct rebuke to Trump and his Cabinet; the fact that it was drafted, passed, and signed within a matter of weeks is actually quite a remarkable feat for the Massachusetts state government.  Both the health insurance industry and the reproductive rights community supported the bill and helped to negotiate the resulting language.  In addition to the birth control access without cost-sharing, the bill also expands coverage by allowing a one-year supply of birth control pills, by increasing the types of birth control covered, and by covering the so-called “morning after” pill without a prescription. 

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GOP Tax Bill Would Inflict Real Pain on Nonprofit Hospitals [From Philly.com]

Originally posted on Philly.com, George Consortium member Robert I. Field highlights the threats that the GOP tax reform proposal would pose to nonprofit hospitals.

By Robert I. Field 

Nonprofit hospitals have had much to fear from Congress recently. The Senate came within one vote of repealing much of the Affordable Care Act, which would have left millions of patients uninsured and unable to pay for hospital care. And Congress may soon consider major cuts to Medicare and Medicaid, which could slash reimbursement for many hospital services.

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Generic Drugs and the PTAB

By Gregory Curfman, MD

When the Hatch-Waxman Act was passed into law in 1984, it established the generic drug industry and thereby forever changed the marketplace for prescription drugs. Today 80% or more of all prescriptions are filled with generic drugs, which has resulted in a savings of $1.67 trillion from 2007 to 2016. To incentivize generic drug entry into the market, the Hatch-Waxman Act provides that the first generic company to submit an Abbreviated New Drug Application (ANDA) will have the exclusive right to market its drug for 180 days. This provision, referred to as “first to file,” provides a strong financial inducement to file an ANDA early.

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CT Court Rules that State Cannot Vaccinate Children in its Temporary Care Without Parental Consent

By Elisabeth Ryan

The Supreme Court of Connecticut has, for the second time in three months, ruled that the state Department of Children and Families cannot vaccinate children in its custody without explicit parental consent.  News outlets have proclaimed in alarmist headlines that “State Can’t Vaccinate Kids in Temporary Custody,” but that’s untrue – Connecticut can continue to vaccinate children in its temporary custody, as long as the parents agree.  The state is not actually prohibited from vaccinating any and all children in its custody, but the decision is still concerning from a public health perspective.

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Smart Gun Technology and the Potential to Save Lives

By Elisabeth J. Ryan

In the 1970s, a California man designed a magnetic lock that could be installed in the revolvers used by law enforcement, rendering the gun inoperable unless the user was wearing a special ring with an opposing magnet.  This device, designed so that someone who grabbed a police officer’s gun would not be able to turn that gun back on the officer, represented the first “smart gun” technology (and can still be purchased today for a mere $420). Beginning in the 1990s, technology entrepreneurs and even gun manufacturers began to develop more sophisticated firearm technology designed to “prevent shootings, both intentional and unintentional, by children, thieves, and other unauthorized users.” But developers faced vehement opposition, not from anti-gun activists pursing a once-vocal push for individual disarmament but from very loud and very angry gun rights activists. Technology development withered.  Both Colt and Smith & Wesson abandoned federal grants for such projects after suffering a “revenue-crushing boycott” from their customers because of the research. Of course, the mere fact that the federal government administered such grants led some to question whether the money for public safety technology improvement was really “a smoke screen to eventually take all handguns that are not smart guns out of the hands of law-abiding U.S. citizens...”  

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Navigating Minor Consent Laws Toward Confidential PrEP Access for Adolescents

By Jason Potter

According to the CDC, as of 2015, youth ages 13-24 comprised a staggering 22% of all new HIV infections in the United States. Given this alarming incidence rate, developing new and effective HIV prevention modalities for adolescents and young adults, and eliminating major delivery barriers, has become a priority. In the sphere area of biomedical HIV prevention for at-risk adolescents, one legal barrier looms large. The issue of caregiver consent (or the less inclusive “parental consent”) forms an oppressive threshold barrier to operationalizing biomedical HIV prevention among at-risk adolescents under the age of majority.   

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Making America Healthy Again: Analyzing Trump's Take on the Social Determinants of Health [from Health Affairs Blog]

George Consortium member and Northeastern University professor Patricia Illingsworth concludes on the Health Affairs Blog that the Trump administration shows "little interest in addressing the social determinants" of health, such as "education, socioeconomic status, poverty, the physical and social environment, employment, and discrimination, among others..."  

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