House passes bill to make patient history of drug use more accessible

The House passed bills Wednesday that combat the opioid crisis by making it easier for a doctor to find out if a patient has a history of drug abuse and expanding the number of places where states can send addicted patients and get Medicaid dollars to pay for it.

Both measures drew a level of dissent, however, that contrasted with the batches of opioids bills that breezed through the chamber under fast-track rules this month, as GOP leaders try and show they’re serious about reining in the opioids crisis that kills tens of thousand of Americans each year.

Fifty Democrats and seven conservative Republicans formed an unusual alliance in opposing the first bill on patient-privacy grounds, though it still passed easily, 357-57.

The measure by Rep. Markwayne Mullin would streamline a set of health-privacy laws so that records of a patient’s substance abuse are no longer segregated from their general medical records, so doctors get a full picture.

“When a doctor is treating someone, they don’t know who they’re treating if they’re only treating half the patient,” said Mr. Mullin, Oklahoma Republican and chief sponsor.

Procuring records on drug treatment required an extra level of consent from the patient. Failure to get those records could lead to errors in which patients are provided opioids that fuel their addiction or drugs that clash with opioids and will result in adverse reactions, the bill’s champions said.

Sponsors said in some cases, patients fail to disclose their substance-abuse history or land in the emergency room and are unable to communicate with doctors.

Rep. Roger Marshall, Kansas Republican and doctor, said the change is a “big deal.”

“As a practicing physician I didn’t even know that that was bifurcated out of the record when I asked for it,” he said.

Champions of the measure also said splitting up the records may itself stigmatize addiction, by treating it differently than things like cancer and heart disease.

But Rep. Frank Pallone, New Jersey Democrat, said it will have the opposite effect by reducing the number of people will to come forward to seek treatment, since the record will follow them around. He said people who suffer from substance abuse disorders should be able to decide when they share that history, and to whom.

Opponents also worry the records will be disclosed by digital hackers or unscrupulous health workers if the records are combined, resulting in legal problems or the loss of employment and housing opportunities.

“It may be illegal for information to be disclosed outside these health care organizations, but information does get out,” Mr. Pallone said. “Breaches do happen.”

Sponsors said anyone who shared the information improperly would be penalized under their bill, and that disclosure is limited to treatment settings.

“This can’t be used for any other purpose,” said Energy and Commerce Committee Chairman Greg Walden, though 50 Democrats and seven conservative Republicans still voted “no.”

Also Wednesday, the House passed a bill, 261-155, that allows more opioid suffers to seek treatment at institutions for mental disease, or IMDs.

Under current law, states cannot receive federal matching funds for Medicaid-eligible patients age 18 to 64 unless they’re housed in facilities have 16 or fewer beds. The cap was put in place to avoid the “warehousing” of people in mental asylums, though GOP leaders say the rule is antiquated and limiting treatment beds,

The bill from Rep. Mimi Walters lets states repeal the limit for five years, so patients can receive opioids treatment for up to 30 days at hospitals, nursing facilities or other places with a high number of beds.

“It is to repeal the IMD exclusion and remove this outdated barrier to inpatient treatment,” said Ms. Walters, California Republican.

GOP leaders accepted a provision from Rep. Bobby Rush, Illinois Democrat, that lets people suffering from cocaine and crack cocaine addiction be included.

Mr. Rush said too often, Congress only snaps to attention when drug problems, like the opioids crisis, affect white families.

“This leaves vulnerable, non-white Americans without any chance to escape from their illness and resulting suffering,” Mr. Rush said, yet 140 of his fellow Democrats couldn’t stomach the broader bill.

Mr. Pallone said the bill was too narrow and an ineffective way to spend Medicaid dollars, since states can already secure federal waivers that erase the limits if they make sure patients have a full range of prevention and follow-up services.

Looking forward, Mr. Walden said he is confident the Senate will take up and pass the bills and dozens of other opioids bill soon, clearing the way for President Trump’s signature.

GOP leaders are compiling the House measures into a big bill that will hit the floor Friday. He said Democrats have agreed to a patchwork of ways to pay for the bill’s $3 billion price-tag, which comes on top of the roughly $4 billion that Congress threw at the opioids problem in a major spending bill earlier this year.

“I think we’re making real progress,” Mr. Walden said. “There will be more work to be done.”