Opioid crisis becomes central issue in debate over Medicaid

Opioid crisis becomes central issue in debate over Medicaid
© Victoria Sarno Jordan/Keren Carrion

The national opioid crisis is becoming a political hurdle for Senate Republicans negotiating an -ObamaCare repeal-and-replace bill that could end the healthcare law’s expansion of Medicaid. 

Legislation approved by the House would cut off Medicaid expansion in 2020, ending payouts to states and reducing federal funding to the program by about $880 billion, according to the nonpartisan Congressional Budget Office.

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That’s a big problem for lawmakers such as Sens. Rob PortmanRobert (Rob) Jones PortmanSenate moving ahead with border bill, despite Trump 13 GOP senators ask administration to pause separation of immigrant families Lawmakers, businesses await guidance on tax law MORE (R-Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoSenate panel advances three spending bills Press shuts out lawmakers to win congressional softball game Senate DHS bill includes .6 billion for ‘fencing’ on border MORE (R-W.Va.), who fear the cuts could hurt thousands of people in their states receiving help for addictions to prescription drugs and heroin.

Nearly 30 percent of people receiving health coverage through Medicaid expansion have a mental health or substance use disorder or both, according to the National Council for Behavioral Health.  

In states like West Virginia, Ohio and Alaska, Medicaid pays for between 34 to 50 percent of one form of medication-assisted treatment for substance use disorders.

Overall, Medicaid, which helps low-income and disabled people, is the single largest payer for these services.

-ObamaCare gave states the option of expanding Medicaid, and states that did so received federal money. Many of the states hit hardest by the opioid epidemic are those that chose to expand Medicaid.

“What we’re seeing now in Alaska with Medicaid expansion — we’re seeing individuals who for the first time ever have an ability to receive treatment that they need,” Sen. Lisa MurkowskiLisa Ann MurkowskiIcebreaking ships are not America’s top priority in the Arctic 13 GOP senators ask administration to pause separation of immigrant families Trump plan to claw back billion in spending in peril MORE (R-Alaska) said.

Of opioid addicts in her state, Capito says: “Without that expanded Medicaid, they wouldn’t be getting treatment.

“They would be without any kind of coverage in that area, so it’s exceedingly important to kicking this thing, pardon the pun, to make sure that those folks have access and coverage,” she told The Hill.

Republicans in the Senate are divided over how to handle Medicaid as part of their healthcare legislation.

While the issue wasn’t a priority in the House, it is sure to be divisive in the upper chamber.

Republicans representing states that did not expand Medicaid are keen to roll back the expansion, while those representing states that accepted it are split. Some want to preserve the expansion in some form, and GOP governors who expanded the program don’t want to see health coverage taken away from thousands of their constituents.

Portman said he’s been working with Capito on the issue, and senators from states that expanded Medicaid have been holding meetings since February.

Possible solutions, according to Portman, include creating a smoother transition to ending the expansion, as opposed to the House bill’s deadline of 2020. Financial assistance — in the form of tax credits — could be increased to better help those coming off the Medicaid rolls afford health insurance in the private market.

Additionally, new money could be targeted toward states with the worst opioid addiction rates to help fund treatment facilities, services and prevention efforts, according to Capito.

¨We’re just trying to be sure, at a time when we’re facing this crisis, that we don’t make things worse,” said Portman, who highlighted the issue in his reelection campaign and is the -co-author of the bipartisan Comprehensive Addiction and Recovery Act signed into law last year.

This effort came as the rate of deaths from opioid overdoses has quadrupled since 1999.

Advocates are concerned.

“Low-income, childless adults who are living with addiction are among the people hardest hit by the epidemic,” said Rebecca Farley, vice president for policy and advocacy at the National Council for Behavioral Health. “These are people who wouldn’t qualify for Medicaid otherwise.  … This is, in many ways, an overlooked ripple effect of the cuts that are being proposed in this bill.”

According to one advocate, who asked not to be named in order to more freely discuss strategy, meetings between advocates and senators who may be sympathetic to the issue are on the books for this week. This includes with the offices of Sens. Dean HellerDean Arthur HellerThe Hill's Morning Report — Sponsored by PhRMA — GOP lawmakers race to find an immigration fix 13 GOP senators ask administration to pause separation of immigrant families The Hill's Morning Report — Sponsored by PhRMA — Defiant Trump meets with House GOP amid border blowback MORE (R-Nev.), Cory GardnerCory Scott GardnerSenate moving ahead with border bill, despite Trump 13 GOP senators ask administration to pause separation of immigrant families Sessions floats federal law that would protect states that decriminalize marijuana MORE (R-Colo.), Dan Sullivan (R-Alaska), Susan CollinsSusan Margaret CollinsSenate Gang of Four to meet next week on immigration Republicans agree — it’s only a matter of time for Scott Pruitt Skyrocketing insulin prices provoke new outrage MORE (R-Maine), Murkowski, Capito and Portman.

If Republicans don’t find a solution, it’s easy to imagine Democratic attack ads accusing the GOP of taking away treatment for those with a drug disorder.

“I think even Republicans in the Senate would be hesitant about cutting a program on which families depend who have members in recovery and getting addiction treatment in the midst of an opioid epidemic,” Sen. Sheldon WhitehouseSheldon WhitehouseLive coverage: FBI chief, Justice IG testify on critical report GAO to look into Trump's reduction of carbon social costs Overnight Energy: Pruitt used security detail to run errands | Dems want probe into Pruitt's Chick-fil-A dealings | Yellowstone superintendent says he was forced out MORE (D-R.I.) said.