| Welcome to Thursday's Overnight Health Care. It's been a busy day on the Brett Kavanaugh front. Christine Blasey Ford, who is accusing the Supreme Court nominee of sexual assault, is opening the door to testifying next week. Kavanaugh is also insisting on a hearing, telling senators he wants to "clear my name." On the health care front, the Department of Health and Human Services is under fire. The administration is still dealing with a rising number of unaccompanied children illegally crossing the border. And there is a new controversy over how HHS is paying for the rising costs for those minors. HHS diverting funds from health programs to pay for unaccompanied minor detentions The Department of Health and Human Services (HHS) is reallocating up to $266 million in funds this year to house the increased number of detained migrant children as part of the Unaccompanied Alien Children (UAC) program. According to a letter from HHS Secretary Alex Azar to Sen. Patty Murray (D-Wash.) and other lawmakers obtained by The Hill, up to $186 million will come from other programs within the department, and up to $80 million will come from refugee programs. The request occurs as new administration policies have led to higher numbers of children being housed in detention centers for much longer before they are returned home or sent to live with a sponsor. The administration is also planning to slash the yearly number of refugees admitted the country. The letter shows HHS plans to take money from a variety of other health programs. That includes $16.7 million from the Centers for Disease Control and Prevention, $9.8 million from Medicare and Medicaid program operations, and $87.3 million overall from the National Institutes of Health. "The number of unaccompanied alien children in HHS custody has increased steadily, and existing shelter capacity is nearly full," Azar wrote in the letter, which was first reported by Yahoo News. "Based on this growth pattern, and an increased length of time needed to safely release unaccompanied alien minors to sponsors, HHS is preparing for the trend of high capacity to continue." HHS's justification: The department has limited authority to shift funding between accounts or between programs whose funding levels are specified in law, officials say. These types of requests are not new. Similar transfers of money are also used in times of public health emergencies, such as the Zika virus outbreak in 2016. They have occurred for immigrant children program as recently as fiscal 2017. HHS said that the only prior reallocation that happened in 2018 was a transfer of $17 million from the Ryan White HIV/AIDS program-- and that was from money appropriated in fiscal 2016. Does Congress need to be involved? HHS has to notify Congress of their intention to use the transfer authority, and the relevant committee chairs need to sign off. In this case, all are Republicans. Democrats were not happy with the decision: "The Trump administration should not rob funds from vital health and human services initiatives to make up for their failed immigration policies," said Rep. Rosa DeLauro (D-Conn.), ranking member of the House appropriations subcommittee that deals with HHS. DeLauro and other Democrats have raised concerns about the long-term strategy as costs for housing the minors continue to rise. "If the Trump administration needs additional funding to carry out their failed policies, like the government-sanctioned child abuse that resulted from their 'zero-tolerance policy,' they should request an emergency supplemental package from Congress instead of hiding behind transfers," DeLauro added. Read more on the letter here. Meanwhile, top Trump health officials defended the move. During a briefing with reporters, HHS Secretary Azar said the "broken immigration system" was to blame for the influx of unaccompanied minors, and said the increased funding will not hurt the programs being targeted. "It's not disruptive to the programs. This is very consistent with past practices with end of the year funding," Azar said. "The simple fact is, we at HHS do not control the number of children who come into the country and are referred to us. It [funding] is not appropriated on a per child basis ... so sometimes this is necessary." Azar said he had "walled off" opioid funding, emergency response funding, and mental health funding from being impacted by the transfer, which amounted to .25 percent of all other appropriations. Joe Grogan, director of health programs at the White House Office of Management and Budget, said his agency makes sure transfers don't hurt the programs losing money. "We pressure test where they are going to move money from various accounts," Grogan told reporters at a health policy event in D.C. "Sometimes it's easy to pick a talking point, and say this money is coming out of this account, but we figure out at OMB, can this money be spent practically, is there a legal reason why it can't be spent on its intended purpose." Read more here Lawmakers consider easing costs on drug companies as part of opioids deal Pharmaceutical companies could be getting a victory as part of a bipartisan bill aimed at fighting the opioid epidemic. The powerful pharmaceutical industry has been pushing for months to roll back a provision from February's budget deal that shifted more costs onto drug companies, and they sense they have a chance to attach the change to the bipartisan opioid package currently moving through Congress. What to watch: Where do Democrats come down on this? Democrats say the proposal is being pushed by Republicans. But since it is a bipartisan package, the question is whether Democrats end up agreeing to a deal on the provision. So far it is unclear. One Democratic staffer involved in the negotiations, however, said members of the party have concerns. "The proposal is being pushed by Republicans. We have a lot of concerns about adding a PhRMA bailout that will force seniors to pay more for their health care onto a bill that's intended to help people fight the opioid epidemic," the staffer said. Drug pricing advocates are also not happy. "ALERT: Big Pharma trying to use the opioids bill as a vehicle to give themselves $4 billion windfall -- many of the same companies that contributed to the opioids crisis to begin with," Ben Wakana, executive director of Patients for Affordable Drugs, tweeted on Thursday. Read more here. Pharmacy benefit managers trade group gets a new CEO. The trade group for pharmacy benefit managers (PBMs) is getting a new CEO, JC Scott, who comes from the group for medical device makers, AdvaMed. The move comes at a time when PBMs have been under fire from the pharmaceutical industry and at times from the administration and Capitol Hill over whether their role as "middlemen" is driving up drug prices. PBMs argue that the opposite is true. They negotiate lower drug prices and the drug companies are the ones setting them high. "I'm extremely excited about this opportunity to represent an industry that lowers costs, protects consumers, and delivers value for millions of Americans," Scott said in a statement. Making that case will be a big part of his job. The Hill event Join us Thursday, Sept. 27, for "Evolution of Telehealth: Patient Awareness and Education," featuring Rep. Buddy Carter (R-Ga.), Sen. Bill Cassidy, M.D. (R-La.) and Rep. Doris Matsui (D-Calif.). Editor-in-Chief Bob Cusack will sit down with our speakers to discuss the growth of telemedicine, and how policymakers in Washington are responding to the shifting delivery of medical care. RSVP Here. What we're reading Democratic candidates are actually embracing ObamaCare (Bloomberg) Democrats seek to subpoena documents on Medicaid work rules (Washington Examiner) State by state In unlikely alliance, PhRMA sides with landlords in California referendum on rent control (Stat News) Nebraska unveils Trump-backed health plans for farmers, ranchers (Washington Examiner) Trump jumps into the Nevada Senate race -- ground zero in the midterm debate over ObamaCare (CNBC) Maine courts to hear Medicaid expansion arguments (Associated Press) | 
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