Public Health Law Watch
An initiative of the George Consortium

Public Health Law Watch blog

                            

The Health Impact Of The Proposed Public Charge Rules [from Health Affairs Blog]

On September 22, the Trump Administration announced it would soon publish in the Federal Register proposed new regulations defining when lawfully present immigrants should be considered a “public charge.” Although the draft regulations posted by the Department of Homeland Security (DHS) were not as far-sweeping as a version that was leaked last winter, if promulgated they would still have a dramatic impact on public health and the health care system.

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Wendy Parmet
A lethal game of chicken: the next trade war with China could be a matter of life and death

The most important trade war to come may have nothing to do with cars, steel or soybeans. It may involve a virus.

 The vast agricultural enterprise in southern China is the source of most new flu strains. Under rules established by the World Health Organization in 2011, China has routinely shared samples of them with researchers in the United States and other countries where vaccines are developed. But recent trade tensions may be leading it to change course.

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Robert Field
Reports on the Opioid Crisis are Full of Misidentified Problems and Poorly Calibrated Solutions [from Bill of Health]

In April, our Center for Health Policy and Law hosted a two-day conference entitled "Diseases of Despair: The Role of Policy and Law." Our friends at Harvard Law School's Petrie-Flom Center is now hosting a blog symposium from that conference on Bill of Health

The third piece is from Professor Nicolas P. Terry.  For the full post, please visit Bill of Health

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Elisabeth Ryan
Physicians and Firearms: Finding a Duty to Talk to Patients About Guns [from Bill of Health]

In April, our Center for Health Policy and Law hosted a two-day conference entitled "Diseases of Despair: The Role of Policy and Law." Our friends at Harvard Law School's Petrie-Flom Center is now hosting a blog symposium from that conference on Bill of Health

The second piece is from our own Elisabeth J. Ryan.  For the full post, please visit Bill of Health.  Additionally, a much longer version of this post will appear as an article in the forthcoming Winter edition of the Northeastern University Law Review.

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Florida enacted a statute in 2011 entitled the “Firearms Owners’ Privacy Act,” which quickly became known nationwide as simply the “Docs v. Glocks” law.

This law essentially forbade doctors from asking their patients about gun ownership, recording information about guns in the home, and “unnecessarily harassing” patients for being gun owners. The penalty was potential medical license sanctions and a fine up to $10,000.

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Elisabeth Ryan
Behind Schedule -- Reconciling Federal and State Marijuana Policy [from The New England Journal of Medicine]

This piece originally appeared in The New England Journal of Medicine

By Rebecca L. Haffajee, Robert J. MacCoun, and Michelle M. Mello

The long-standing chasm between federal and state marijuana policy recently widened when U.S. Attorney General Jeff Sessions rescinded Obama-era guidance indicating that the Justice Department would not make it a priority to prosecute federal marijuana crimes in states where the activities are legal. At present, a budgetary amendment is the only legal barrier to Justice Department enforcement of the Controlled Substances Act (CSA) against users and sellers of medical marijuana in the 30 states that have legalized it. Nothing prevents federal prosecution of recreational marijuana activities in jurisdictions where they are legal. However, spurred by Sessions’s policy, Senator Elizabeth Warren (D-MA) introduced a bipartisan bill in June 2018 (S.3032) that would exempt most marijuana-related activities from CSA application when they’re allowed under state or tribal law — legislation that President Donald Trump says he will support. As the marijuana-policy terrain shifts, it’s important to consider the potential public health benefits of closing the federal–state divide.

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Elisabeth Ryan
A Heartbreaking Tale Underscores Why Massachusetts Corrections Facilities Need to Offer Medication Assisted Treatment for Opioid Use Disorder

By Elisabeth J. Ryan

Last month, I wrote about Massachusetts criminal justice reform and lamented that a clause allowing medication assisted therapy in correctional settings had been removed from the final bill…According to the Boston Globe, however, a change in the policy is "gaining momentum - but slowly." Twenty-six groups continue to advocate for medication assisted treatment to be required in Massachusetts jails and prisons, emphasizing that, "The science and research on this is clear. To wait any longer to do this is just going to result in needles loss of life," according to the chief executive of the Association for Behavioral Health Care. The Globe story features the heartbreaking tale of a mother who had struggled with her own substance use disorder and then lost her 27-year-old son to an overdose the same day that he was released from pretrial custody. Stephen Gonzalez had been on prescribed methadone for five years prior to being arrested. The Suffolk County jail, per policy, did not provide him with the methadone while holding him in custody. His brutal withdrawal sent him into "unbearable pain." With a diminished tolerance, he sought heroin almost as soon as he got out to attend his stepfather's funeral. The overdose killed him, leaving his mother "to bury her husband and her son in the same week."

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Elisabeth Ryan
Medicare is Not Going Broke [from philly.com]

By Robert I. Field

Have you heard the news? Medicare will run out of money in just four years. Can the program survive?

Four years is the time until the Trust Fund that provides financial support for Medicare will become insolvent – that is, according to a prediction that the Fund’s Trustees made in 1997. Then in 1998, they upped the timeframe to ten years and in 1999 to 16. They shrank it back to 12 years in 2006 and to eight in 2009.

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Elisabeth Ryan
Massachusetts Denies the First "Compassionate Release" Application

By Elisabeth J. Ryan

In May, I wrote here about the new "compassionate release" program in Massachusetts that allows "incarcerated individuals diagnosed with a terminal illness - defined as an incurable condition that will likely cause death within 18 months - or those with 'permanent incapacitation' to request medical release before the end of their sentences. Ultimately, the decision is left to the commissioner of corrections or to the appropriate sheriff, who determines whether 'the prisoner will live and remain at liberty without violating the law and that the release will not be incompatible with the welfare of society.'" I also noted that, "How those in power will interpret that clause remains to be seen."  We now know that the first applicant has been denied.

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Elisabeth Ryan
The latest strategy to undermine Obamacare: challenge the constitutionality of a mandate that doesn’t exist [from Philly.com]

By Robert I. Field

Can a law be unconstitutional if it doesn’t exist? That may sound like an abstract riddle, like the proverbial tree falling in a forest, but it is central to a lawsuit challenging the constitutionality of the Affordable Care Act. The suit, brought by 20 Republican attorneys general, seeks to have the entire law thrown out, and the Trump administration recently announced its support.

The challengers’ argument goes like this. In 2012, the Supreme Court upheld the ACA’s mandate requiring all Americans to maintain health insurance or pay a penalty. The Court characterized the penalty as a tax, but one that is waived for the those who have coverage. Under this reasoning, the mandate is a tax penalty that comes under Congress’s broad power over taxation.

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Robert Field
SJC Rules in Correa v. Schoeck: Pharmacies Have a (Limited) Duty to Notify Physicians About the Need for Prior Authorization

By Elisabeth J. Ryan

Back in January of this year, the Center for Health Policy and Law (of which PHLW is a part) signed onto an amicus brief in support of the appellant-plaintiff in the Massachusetts case of Correa v. Schoeck. On June 7, the SJC ruled in the plaintiff's favor, reversing the lower court's order of summary judgment for the defendant pharmacy.  The court held that a pharmacy has a "limited legal duty to take reasonable steps to notify both the patient and her prescribing physician of the need for prior authorization each time [she] tried to fill her prescription." 

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Elisabeth Ryan
Motivated by increasing numbers of "deaths of despair," the AMA adopts new policies aimed at reducing gun violence

By Jennifer Lea Huer

Earlier this week the American Medical Association (AMA) House of Delegates held their annual meeting in Chicago, Illinois, during which delegates voted to adopt multiple policies related to firearms and gun violence. Some of these policies reinforce and enhance policy positions the AMA has supported for years, while other policies offer specific recommendations for legislation that is currently under consideration at the state and federal levels.

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Jason Smith
Massachusetts Criminal Justice Reform and Public Health: Part 2, Drug Crimes and Mandatory Minimum Sentences

By Elisabeth J. Ryan

In April 2018, Massachusetts Governor Charlie Baker signed a major criminal justice reform bill, the result of years of efforts by legislators and advocates to implement changes to many existing “tough-on-crime” laws. The bill, at more than 120 pages, contains a plethora of changes, including raising the minimum age for juvenile justice involvement from 7 to 12, restricting the use of solitary confinement, and eliminating mandatory minimums from most drug crimes except for trafficking. However, the bill also creates new crimes, like trafficking in carfentanil.

PHLW will be looking at various provisions of the bill and how they intersect with public health. In Part 1, we looked at the creation of “medical parole” in the Commonwealth. In today’s Part 2, we look at drug crimes and mandatory minimum sentences.

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One of the earlier versions of this reform bill contained a provision that would have allowed people with opioid use disorders to have access to medication assisted treatments (MAT) while in prison. That would have been a major public health triumph, as illustrated by its success in Rhode Island prisons. MAT remains the gold standard of care for opioid use disorders; studies show that people on MAT are more than twice as likely to remain opioid-free. Incarcerated individuals have much higher than usual rates of substance use disorders and are 129 times more likely to die of an overdose within two weeks of release from prison, compared to the general population.  The Rhode Island program that gave its incarcerated population access to MAT not only resulted in much higher rates of adherence to treatment after release, but also corresponded with a 12% reduction in overdose deaths statewide. Unfortunately for Massachusetts, which has one of the highest overdose death rates in the country, the provision that would have provided MAT is prisons did not make it to the final criminal justice bill. Instead, the bill takes a split approach to drug crimes – it reduces the reach of “school zone violations,” shores up “Good Samaritan” laws, and eliminates some mandatory minimum sentences, but it also creates a new trafficking crime with a new mandatory minimum sentence, which is what this part of our series focuses on.

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Elisabeth Ryan
Massachusetts Criminal Justice Reform and Public Health: Part 1, Medical Parole

By Elisabeth J. Ryan

In April 2018, Massachusetts Governor Charlie Baker signed a major criminal justice reform bill, the result of years of efforts by legislators and advocates to implement changes to many existing “tough-on-crime” laws. The bill, at more than 120 pages, contains a plethora of changes, including raising the minimum age for juvenile justice involvement from 7 to 12, restricting the use of solitary confinement, and eliminating mandatory minimums from most drug crimes except for trafficking. However, the bill also creates new crimes, like trafficking in fentanyl and carfentanil.

PHLW will be looking at various provisions of the bill and how they intersect with public health. First, we look at the creation of “medical parole” in the Commonwealth.

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Elisabeth Ryan
Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment [from American Journal of Preventive Medicine]

George Consortium member Rebecca L. Haffajee has a new article in the American Journal of Preventive Medicine focusing on some of the reasons why only 40% of people with opioid use disorder actually receive medication-assisted treatment. One major reason is that so few physicians are licensed to even prescribe buprenorphine (such as Suboxone). As the article details, numerous workplace barriers contribute to this lack of licensing, including insufficient training, lack of peer support, inadequate reimbursement, and regulatory hurdles.

For complete article with footnotes, please see:  https://www.sciencedirect.com/science/article/pii/S0749379718300746

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Elisabeth Ryan
It's Time for Uncomfortable Solutions to the Opioid Epidemic [from The Fix]

We are thrilled to present some work from brand new George Consortium member Abraham Gutman! This piece from The Fix discusses the fact that we need to get creative, and uncomfortable, in addressing the opioid crisis. Be sure to follow Av's great Twitter feed at @abgutman.

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The results of the War on Drugs: an America that is the most incarcerated nation in the world, a sharp decrease in the price of heroin, and a new Jim Crow for Black communities.

Not every problem has a solution that we are comfortable with. The opioid epidemic and the overdose crisis are two examples of such problems. There has been a lot of work by states and cities to tackle the epidemic and mitigate harm. Laws limiting opioid prescriptions have been enacted (controversially), DEA regulations on who can administer treatment were laxed, Prescription Drug Monitoring Programs were founded, and states of emergency were declared.

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Elisabeth Ryan
New Dangers For Immigrants and the Health Care System [from Health Affairs Blog]

PHLW's Wendy E. Parmet and Elisabeth J. Ryan co-authored an article posted on the Health Affairs Blog about the potential changes to the definition of "public charge" and how that will negatively impact health care and the health care system. 

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New Dangers For Immigrants And The Health Care System

By Wendy E. Parmet and Elisabeth Ryan

The Trump administration’s crackdown on immigrants may soon create new perils for the health care system if a set of proposed regulations by the Department of Homeland Security (DHS), leaked last month to the Washington Post, are promulgated. The regulations would dramatically expand the definition of “public charge,” a criteria used in immigration law to determine both admissibility to and deportability from the United States. As a result, many immigrants, including many low wage health care workers, may be deterred from using publicly-funded health care benefits to which they and their dependents, including their citizen children, are legally entitled.

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Elisabeth Ryan