A County Official on the Front Lines of the Opioid Crisis Makes His Case on Capitol Hill

WASHINGTON — Dr. Michael Brumage spent more than two decades of his life serving as a physician and commander of public health clinics in the U.S. Army all over the world—in Germany, Japan, Iraq and the Balkans. But now he serves his country in a different capacity.

Two years ago, after nearly 25 years of life abroad, Brumage came home to West Virginia, where he now leads the Kanawha-Charleston Health Department as its executive director and health officer. He is a native of the Wild and Wonderful State, but it was a place he admitted he never thought he’d end up—at one point before he returned, he was seriously considering a move to New Zealand. He now speaks of his homecoming as a “calling.”

This week, Brumage let his sense of calling guide him once again. This time to the nation’s capital.

On Tuesday, Brumage got into his car and drove nearly 400 miles on a mission to speak with U.S. Sen. Shelley Moore Capito about what he sees as the potentially devastating local impacts of the Better Care Reconciliation Act, the health bill currently being crafted by Republican leadership in the Senate.  

“West Virginia is a small place,” Brumage admits. In fact, just one day before he met with Capito he’d run into the senator’s husband, son and daughter-in-law at a Rotary event in Charleston. But still, a formal sit-down meeting with the senator was a brand new experience for him.

And, by his own admission, as a public servant, Brumage has to be careful not to appear to be acting as an advocate or activist. Instead, he says, views himself as more of an educator.

“My job is to educate, and in my role as a public health educator, I felt [the meeting] was important at this moment because what comes next is going to be life-altering for all of the United States. And I felt it was important that I at least show up to do this.”

So show up he did—along with several CEOs of West Virginia-based Federally Qualified Health Centers, the state director of the AARP, the chief operating officer of the state’s primary care association and other leaders in West Virginia’s public health community.

In the conversation with Capito, Brumage focussed on three main points: The bill’s impact on the opioid epidemic, the future of West Virginia’s health infrastructure and what the state stands to lose if Medicaid expansion is phased out—topics that, it must be said, are irrevocably intertwined.

With regard to Medicaid, Brumage doesn’t mince his words. “Of any state we have the most to lose from the passage of this bill,” he told Route Fifty in an interview following the meeting with Capito.

“It’s no secret that we rank at or near the bottom in most major health categories in West Virginia. That’s not a place where any of us want to be,” said Brumage

But, he adds “many of us have seen that the Medicaid expansion portion of the [Affordable Care Act], as flawed as it is, was a huge success for our state because it enabled people to have access to care who have never had that before.”

For Brumage, that loss of access is scary for a number of reasons.

First, he’s concerned about what that could mean for the people he serves who are in treatment for opioid disorders. The opioid epidemic has been central to Brumage’s work in Kanawha County—he played a role in opening the county’s first needle exchange in 2015 and is about to start a pilot project to help first responders cope with the emotional toll of the overdose crisis.

When asked about the $45 million that had been added to the revised version of the health bill to target the opioid epidemic, Brumage said he really just didn’t think that would be enough.

Nobody Sees It Until It’s Broken

But, going beyond the individual human scale, Brumage is deeply concerned for what a loss of the Medicaid expansion might mean at an institutional level.

“Everyone is talking about what we can do and how we can take care of the people who might be affected,” he said. “But, at the same time, the infrastructure piece is the bigger thing that’s running in the background that nobody really sees until it’s broken.”

And that’s the piece of this that Brumage said he emphasized the most emphatically with the senator.  

Brumage is particularly worried about what this bill might mean for hospitals, for health departments and for Federally Qualified Health Centers—which provide services regardless of someone’s ability to pay, and charge based on a community board-approved sliding scale.

“FQHCs get 50 percent of their budget from Medicaid,” he said, “and when their budget goes down, they have to lay people off, which means good paying jobs coming out of the most vulnerable communities.”

And beyond the economic impact, Brumage is especially frightened for what the scaling back or loss of these facilities could mean in the case of a natural or man-made disaster.

These scenarios aren’t hypothetical for Brumage. At the meeting with Capito, he brought up 2016’s “thousand year flood” which left many communities in West Virginia reeling—some of which have yet to fully recover.

And, Brumage feels particularly strongly about the need for resilient public health infrastructure because of an experience even farther from home. In 2011, he was working as the chief of preventative medicine of Pacific Regional Medical Command in Japan when the Tohoku earthquake and tsunami struck the Fukushima Daiichi Nuclear Power Plant complex. He was “intimately involved” in the recovery effort that followed.

The Outlook

Brumage went into the meeting with Capito more hopeful than when he left.

“I was cautiously optimistic when I went into the meeting [on Tuesday] that there would be no chance that the health bill would pass. And I’m less optimistic now,” he said.

By her own admission, Senator Capito had been unequivocally against the previous revision of the bill, for many of the same reasons Brumage outlined.

"As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers," Capito said in a statement in late June.  

But, Capito remains open-minded about the newest draft of the legislation, which leaves the cuts to Medicaid untouched. Brumage respects Senator Capito—in his interview with Route Fifty, he described her as “straightforward,” “authentic,” and someone who “says what she means.” But nonetheless, he’s worried.

“I think there was a lot of good that came from the ACA,” he said. There are some things need to be fixed quickly, but the whole idea of pulling the rug out and starting from scratch, I find it difficult to see what good can come of that.”  

The Conversation Back Home

If all Brumage wanted was a conversation about the Better Care Reconciliation Act, he didn’t have to travel all the way to the nation’s capital to have it. That’s all anyone can talk about back home in West Virginia, he said.

“It’s a huge topic of conversation. It’s almost the topic of conversation these days.”

County officials have hosted two separate public meetings held in the Kanawha courthouse to bring experts and health leaders together to give their take on what this could mean for the county and for West Virginia.

The only problem, Brumage said, was finding someone to take the “pro” position.

“Nobody had a positive spin on what this was going to mean for our state,” he said. In fact, Brumage added that his county commissioner challenged him personally to come up with someone who “thought it was a good idea.”

“We asked and we couldn’t find anyone who was a proponent of the changes,” he said.