368: Island Health Push, Ending the X Waiver

Alex Wheatley, ASTHO Assistant Director of the Island Support Team, says there is an urgent need to approve agreements that continue funding for health programs in several island nations; Carolyn Mullen, ASTHO Senior Vice President for Government...

Alex Wheatley, ASTHO Assistant Director of the Island Support Team, says there is an urgent need to approve agreements that continue funding for health programs in several island nations; Carolyn Mullen, ASTHO Senior Vice President for Government Affairs & Public Relations, prepares to kick off a new report on the newscast called ‘The View from Washington D.C.’; and Dr. Mark Levine, Commissioner of the Vermont Department of Health, discusses the elimination of the X waiver and how it is a win for public health.

ASTHO Webpage: Fully Fund the Renegotiated Compacts of Free Association and Reduce Compact Impact in U.S. Territories and States Policy Statement

Politico News Article: Farewell to the X waiver

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This is Public Health Review Morning Edition for Thursday, March 2nd, 2023. I'm Robert Johnson. Now, today's news from the Association of State and Territorial Health Officials.



State leaders have been vocal especially state leaders who have large COFA migrant communities in their state.



ASTHO's Alex Wheatley talking about the Compacts of Free Association (COFA), and the urgent need to approve agreements that continue funding for health programs in several island nations, including Palau, the Marshall Islands, and the Federated States of Micronesia.



In October of this year, a lot of that funding is slated to expire without a great replacement funding source. So COFA negotiations are an important public health issue because we need to ensure that this health funding remains available, so that we can support sort of sustained and strategic programming for Freely Associated States (FAS) health systems.



The agreements also would assist states and territories like Hawaii and Guam, who provide social services to large groups of people from the Freely Associated States. Wheatley says the process is moving forward.



Each nation has signed a memorandum of understanding, which aren't final commitments, but they are big milestones and that they set some high-level funding and they set a framework for the rest of COFA negotiations. Now Congress joins the process, so between now and October, Congress needs to improve these COFA renewal packages. And that process will probably ramp up when President Biden includes COFA in his budget in about two weeks.



Wheatley adds a delegation of island health officials will visit Capitol Hill next week seeking support to get the agreements across the finish line.



I think the conversations with Hill members and the voices of our islands carry a lot of weight. And I'm confident that it'll have an impact. I mean, we have 12 representatives flying in from the Pacific and Atlantic. That to me implies that these conversations they do expect to have an impact, but we'll see. I'm looking forward to sort of where we go from here.



Next week, we'll connect with some of those delegates and share their comments on the newscast. Join us then to hear the latest on their advocacy efforts. 


Speaking of advocacy, tomorrow we kick off an exciting new report here on the newscast. We call it the "View from Washington D.C." It features comments and insight from ASTHO's Senior Vice President of Government Affairs and Public Relations, Carolyn Mullen. As Congress goes about its work, Mullen will join us to talk about proposed legislation, offer budget updates and explain how ASTHO is engaging the public health policy debate. Our first conversation with Carolyn Mullen is coming your way tomorrow morning.


Healthcare says so long to the X-waiver. Some of you might remember it was the requirement that providers wanting to treat opioid use disorder with buprenorphine. First undergo special training and seek federal permission to prescribe the drug. Well, the outdated rule was eliminated in late January as part of a ceremony at the White House. Vermont Health Commissioner Dr. Mark Levine says it's about time.



Well, for a clinician, it means of course, that all they need is a DEA license, just like they use for opioid prescriptions. So, if the patient has a health care professional who has a DEA and is prepared to prescribe medications for opioid use disorder, their access to that treatment is automatically enhanced, because they can present to the office setting and get a prescription.



Levine says the elimination of the X-waiver also is a win for public health.



Now for a state health official, I think this removal of what was truly an unnecessary barrier, can really make a difference in health at a population level. Because there will be an opportunity for more prescriptions to be written, potentially by clinicians who just didn't want to go through that whole cumbersome process with the X-waiver.


Levine says without a doubt, the end of the rule means more lives can be saved.



Whether they're going to a primary care or other type of practice and identifying this as a problem for them. Any opportunity we have to get them very quickly connected at what often is a very vulnerable moment is really, really critical, because we may not see that person again, and then may show up unfortunately as a really negative statistic. An unfortunate overdose death.



You can read more about the X-waiver decision using the link in the show notes. 


That'll do it for today's newscast. We are back tomorrow morning with more ASTHO news and information. I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Mark Levine MD

Commissioner of Health, Vermont Department of Health

Alex Wheatley MPA

Senior Analyst, Island Support, ASTHO