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 panel advances bill to protect government devices against cyber threats Senate panel advances bill to protect government devices against cyber threats House passes bill to establish DHS cyber 'first responder' teams MORE (R-Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoBipartisan senators propose forcing EPA to set drinking water standard for 'forever chemicals' Bipartisan senators propose forcing EPA to set drinking water standard for 'forever chemicals' August recess under threat as yearly spending bills pile up 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 MurkowskiInterior spending bill holds Trump administration accountable for 2017 promises Hillicon Valley: Hacker group targeted electric grid | House Democrats press CBP over facial recognition program | Senators offer bill to protect health data | Groups file FCC complaint over carriers' use of location data Hillicon Valley: Hacker group targeted electric grid | House Democrats press CBP over facial recognition program | Senators offer bill to protect health data | Groups file FCC complaint over carriers' use of location data 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 HellerThis week: Barr back in hot seat over Mueller report Trump suggests Heller lost reelection bid because he was 'hostile' during 2016 presidential campaign Trump picks ex-oil lobbyist David Bernhardt for Interior secretary MORE (R-Nev.), Cory GardnerCory Scott GardnerHillicon Valley: Senate sets hearing on Facebook's cryptocurrency plans | FTC reportedly investigating YouTube over children's privacy | GOP senator riles tech with bill targeting liability shield | FAA pushed to approve drone deliveries Hillicon Valley: Senate sets hearing on Facebook's cryptocurrency plans | FTC reportedly investigating YouTube over children's privacy | GOP senator riles tech with bill targeting liability shield | FAA pushed to approve drone deliveries Senate panel advances bill to protect government devices against cyber threats MORE (R-Colo.), Dan Sullivan (R-Alaska), Susan CollinsSusan Margaret CollinsSenate confirms Trump judicial nominee criticized for being hostile to LGBT community Senate confirms Trump judicial nominee criticized for being hostile to LGBT community GOP frets about Trump's poll numbers 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 WhitehouseOvernight Defense: House passes T spending package with defense funds | Senate set to vote on blocking Saudi arms sales | UN nominee defends climate change record Overnight Defense: House passes T spending package with defense funds | Senate set to vote on blocking Saudi arms sales | UN nominee defends climate change record Trump's UN pick faces Senate grilling MORE (D-R.I.) said.