| Welcome to Thursday's Overnight Health Care, where we're working for the weekend -- but also for President Trump's drug pricing speech tomorrow. What we know: Trump's reforms will target every facet of the industry. But will Trump repeat his refrain that drug companies are "getting away with murder?" Will he go off script? If we take HHS Secretary Alex Azar at his word, the speech will basically cover EVERYTHING. We'll be ready. But first, meet the "forgotten people" of the opioid epidemic. That's Native Americans, who are among the hardest hit. Yet scant attention has been paid to how the crisis is ripping through their communities. Consider the numbers: - Native Americans and Alaska Natives have the second highest opioid overdose fatality rate of any race. But the underreporting is far greater than that of other groups, perhaps as high as 30 percent, according to Robert Anderson, the CDC's chief for its mortality statistics branch.
What Native Americans are doing: At least 20 tribes have sued drug manufacturers and distributors over the opioid crisis, and at least 10 more lawsuits are under contract and are expected to be filed soon. They're joining the lengthy list of hundreds of counties, cities and other health care stakeholders who are filing lawsuits. - All the cases have been consolidated in Cleveland, Ohio, in what's known as a multidistrict litigation. The point is to save time and money, while also ensuring pre-trial rulings are consistent.
Key quote: "Native Americans are a forgotten people when it comes to this crisis," said Jeff Gaddy, an attorney at Levin Papantonio who has been working to file opioid lawsuits, including for the Seneca Nation of Indians. "The Senecas, as well as other tribes across the country, are refusing to accept that and filing lawsuits to hold big pharma accountable for the harms that they've caused," Gaddy said. The tribe's president, Todd Gates, said he would like to use settlement money, if it comes, to fund prevention and treatment. Read more here. More on opioids: A package aimed at addressing the opioid crisis will likely be on the House floor in June, according to a spokesperson for Majority Leader Kevin McCarthy (R-Calif.). House Energy and Commerce Chairman Greg Walden (R-Ore.) had been aiming for a vote by Memorial Day weekend; the legislation is currently going through the committee process, with a final mark up before the full committee next week. Azar drops hints on Trump's big drug pricing speech The health care world is eagerly waiting to see what Trump says tomorrow... and who gets hit the hardest. HHS Secretary Alex Azar dropped some hints at a Senate hearing on Thursday, saying that basically everyone in the drug pricing world will be on the hook. Key quotes: "Tomorrow the president will be rolling out a comprehensive plan around drug pricing that addresses all aspects of the channel including the role of the pharmacy benefit manager, drug companies, others in the system," Azar said. Asked specifically if the plan will target drug companies themselves, Azar said, "Yes it will. All players will be impacted." What to watch: Azar says drug companies will be hit, but we'll be watching how much of the plan goes after drug companies directly and how much targets other actors, like the negotiators known as pharmacy benefit managers, which are also expected to take a blow. Read more here. Azar also defended the administration's proposed rule on short-term plans. Democrats pushed Azar to explain why the administration wants to expand the sale of cheap, skimpy insurance plans. His answer? More choice for people getting priced out of ObamaCare. The explanation: "These short term plans are the same ones the Obama administration had for eight years," Azar said. He emphasized that the short-term plans "may not be the right option for everybody" but noted that for some individuals, "it may be better than nothing." Cheap plans, high premiums? Democrats argue more short-term plans will result in steep premium increases because young healthy people will flee the ObamaCare individual market in favor of much cheaper plans. Why are they so cheap? They don't have to cover as much. No pre-existing condition guarantees, no maternity care, mental health or prescription drug coverage. Read more here Mandatory Medicaid work requirements? If Sen. John Kennedy (R-La.) has his way, the federal government would require states to impose a 20-hour weekly work requirement on Medicaid beneficiaries. At least it's an ethos: Kennedy said he believes in the "dignity of work," a phrase used by many Republicans, including CMS Administrator Seema Verma to describe why work requirements are good for Medicaid beneficiaries. No ties to coverage? Kennedy, said he wants to focus on finding people jobs, not punishing them for being unemployed. That's a change from the waivers that have been approved so far, which cut off coverage if people don't meet the work requirements. "We don't want to throw people out in the cold, but we want to help them understand the dignity of work," Kennedy said. The catch: But without cutting off coverage, it's not a work requirement, so much as just a work suggestion. And currently, states that impose work requirements don't have to provide any funding for job training or job search. Read more here. This may come as a shock to all you health care readers out there, but the issue isn't voters' top concern in the midterm elections. Rather, it's shaking out to be a referendum on President Trump, according to a Kaiser Family Foundation poll. The poll found a congressional candidate's stance on the president to be the top concern for voters. But, among policy areas, health care ranks No. 1 for Democrats. The issue is much further down the list for Republicans -- No. 4 -- and it's tied for second amongst Independents. Read more here. Fentanyl is a main driver of opioid overdose deaths, and 85 percent of the drug that's intercepted is seized at ports of entry. But a report from Sen. Claire McCaskill (D-Mo.) claims that staffing shortages at the country's ports of entry could be undermining federal efforts to seize a powerful synthetic opioid. U.S. Customs and Border Protection (CBP) is currently about 4,000 port officers short of what the agency needs, according to a report from minority staff on the Senate Homeland Security and Governmental Affairs Committee released Thursday. Read more here. What we're reading Trump drug-pricing speech adds dose of uncertainty for healthcare investors (Reuters) FDA seeks injunction to stop two stem cell companies after patients blinded (The Washington Post) For the babies of the opioid crisis, the best care may be mom's recovery (Kaiser Health News) State by state Illinois wants to provide health care with virtual technology (Associated Press) In Wisconsin: Day 7 on hunger strike - Milwaukee Public Schools union organizer demands health care for substitute teachers (Milwaukee Journal Sentinel) A contentious West Virginia Senate race pits two candidates with close ties to pharma (Stat) | 
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