Opioid crisis threatens GOP ObamaCare repeal

Fears that cuts to Medicaid could exacerbate a national opioid epidemic that took more American lives last year than the Vietnam War have emerged as a huge threat to the Senate GOP's ObamaCare repeal-and-replace bill.

The legislation includes a $2 billion fund to help people with substance use disorders, but critics say that's not enough to make up for the deep cuts to Medicaid that would come if the bill becomes law.

“It’s just unconscionable to me that anybody who is serious about dealing with this opioid addiction could be satisfied with the bill — even supporting $45 billion, let alone $2 billion,” Michael Botticelli, the director of the Office of National Drug Control Policy under President Obama, told The Hill. He said the bill would “really have disastrous consequences for people who are struggling with opioid addiction.”

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Republican Sens. Shelley Moore CapitoShelley Wellons Moore CapitoSenate GOP battles for leverage with House on spending Lawmakers, media team up for charity tennis event The Hill's Morning Report — Trump picks new fight with law enforcement, intelligence community MORE (W.Va.) and Rob PortmanRobert (Rob) Jones PortmanSenators introduce bill to change process to levy national security tariffs A single courageous senator can derail the Trump administration GOP senator warns against 'fishing expedition' for Kavanaugh documents MORE (Ohio) want substantially more dollars to go toward the opioid epidemic, and $2 billion in funding for the next fiscal year is a far cry from the pair’s proposal for $45 billion over a decade.

The opioid epidemic has hit West Virginia and Ohio particularly hard. Both states expanded Medicaid, and nearly 30 percent of those receiving health coverage through Medicaid expansion have a mental health issues or substance use disorder or both, according to the National Council for Behavioral Health.  

Both states also went for President Trump in the 2016 election, adding an intriguing wrinkle to the political discussions. Trump desperately wants the healthcare win, but also reportedly described the House legislation as “mean.” How blue-collar voters interpret the GOP legislation overturning ObamaCare could have long-lasting political repercussions.

“The lack of robust funding for opioids is just one problem in this bill, but a big one,” a Senate GOP aide wrote in an email. “We have to ensure that those currently receiving opioid treatment under Medicaid expansion can continue to have treatment under a new system. And right now that wouldn’t happen.”

Medicaid, which helps low-income and disabled people, spends big on behavioral health services. Starting in 2025, the Senate bill will begin to cut Medicaid deeper than the House bill, as the cap on Medicaid payments would grow at a slower rate, known as CPI-U.

The legislation also ends extra federal funds for ObamaCare’s Medicaid expansion, though over a longer period of time than the House’s version, which halted the money in 2020. The Senate bill phases the program out slowly from 2021 to 2024, which is shorter than the seven-year transition Portman and Capito wanted.

Their thought is a robust fund would help offset changes to the Medicaid program.

On Thursday, neither Portman nor Capito took a strong stance for or against the bill — but both indicated the opioid epidemic was critical in their evaluation of the legislation.

In a statement, Capito said she would review the text over the next few days, “using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction.”

Portman’s statement was stronger, saying although there were some “promising changes” to lower premiums, he still had “real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.”

Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellHill.TV poll: Majority of Republicans say Trump best represents the values of the GOP The Hill's 12:30 Report Republican strategist: Trump is 'driven by ego' MORE (R-Ky.) faces a serious challenge in getting the legislation through the Senate and cannot afford to lose Capito and Portman.

Even with their votes, he does not have the support he needs now to move the bill given opposition from a quartet of conservatives along with Sen. Dean HellerDean Arthur HellerBattle of the billionaires drives Nevada contest Trump’s endorsements cement power but come with risks Collins and Murkowski face recess pressure cooker on Supreme Court MORE (Nev.), the most vulnerable Republican up for reelection next year. McConnell can only afford two defections.

It stands to reason that McConnell will probably need to increase the fund in order to win Portman’s and Capito’s support. GOP leaders have insisted the text released Thursday was just a draft, and there’s still time for changes as McConnell pushes toward a vote before July Fourth recess.

Republicans are using a fast-track budget maneuver, known as reconciliation, to repeal ObamaCare because it avoids a Democratic filibuster. That means they can pass the bill with a simple majority. But with a 52 to 48 majority, they have a slim margin for error and are walking a delicate tightrope in appeasing enough moderates and conservatives to pass the legislation.

“The bill will continue to change and this is going to be an ongoing negotiation until Tuesday or thereabouts when the leader will then have to file the bill on the Senate floor,” Senate Majority Whip John CornynJohn CornynIt’s possible to protect national security without jeopardizing the economy Archivist rejects Democrats' demand for Kavanaugh documents Senate Judiciary announces Kavanaugh's confirmation hearing MORE (R-Texas) said Thursday afternoon.

“I think what this does is, after seven or eight years, it just causes people to focus by saying you're going to have to vote on it and people are going to have to make decisions and engage in negotiations which otherwise they sort of like to put off.”

Former Obama administration officials and advocates say $2 billion isn’t enough money, though they also say neither is $45 billion.

“Many of the people who are promoting this bill, I’ve spent countless hours in their states and districts. They fully understand the magnitude of this issue, and they fully understand what the impact of this bill is going to have for people in their states with addiction,” said Botticelli, who himself has been in long-term recovery from a substance use disorder.  

Rebecca Farley David, vice president of policy and advocacy at the National Council for Behavioral Health, offered similar sentiments.

“Although $2 billion does seem like a larger number, it's just paltry in comparison to the scope of the need for opioid treatment in this country. It's laughable almost,” she said.

As for $45 billion over 10 years, that’s “woefully inadequate,” she said.

The $2 billion for fiscal 2018 included in the bill isn’t just for opioid treatment, David noted. According to the legislation, the money goes “to provide grants to States to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders.”