When Senate Republicans first began crafting legislation aimed at repealing and replacing Obamacare, a few reluctant members demanded that any final measure include funding to combat the nation’s opioid crisis.
Republican leadership largely agreed. Though the initial Senate bill—the Better Care Reconciliation Act— dramatically slashed Medicaid funding, it also contained $45 billion to help with opioid addiction, recovery and research, as a way to ensure that Americans receiving addiction treatment wouldn’t lose access to it if they were dropped from Medicaid.
Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-W.V.) had fought for that addition. Nearly 100 Americans die each day from an opioid overdose, according to the Centers for Disease Control, and Ohio and West Virginia are among the states that have been hit the hardest by the epidemic.
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The Better Care Reconciliation Act ultimately never came to a vote. But now the Senate is preparing to consider an entirely different Obamacare repeal-and-replace bill, one authored primarily by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-LA). And though that measure does not contain additional funding to combat the opioid epidemic—despite cutting Medicaid spending—neither Portman nor Capito have indicated that they will oppose it.
Capito has been quiet about how she will vote on the bill, having met with Senate Majority Leader Mitch McConnell (R-KY) to discuss it on Monday. Her office did not return a request for comment.
Portman, meanwhile, seems to be leaning toward supporting Graham-Cassidy. In a conversation with The Daily Beast on Tuesday, he said the $45 billion addition to the BCRA was essential so that Medicaid recipients receiving opioid addiction treatment could “land on their feet” if they were dropped from Medicaid. But he said Graham-Cassidy “is a little different because it keeps Medicaid expansion in place if a governor chooses to do so, like my governor."
In fact, according to the Kaiser Family Foundation, a massive “redistribution” of federal funds would take place under Graham-Cassidy, slashing funding to states like Ohio that expanded Medicaid while shifting it to states that chose not to expand Medicaid. That’s one of the reasons Gov. John Kasich (R-OH) is opposed to the bill. An aide to the governor did not respond to a request for comment on whether he was encouraging Portman to follow suit. But Portman, for his part, said he was talking to Graham and Cassidy “about the opioid issue because we’re studying it and trying to figure out what the impact might be.”
“I’m hopeful there can be some help with regard to that particular issue because we still know that it’s a problem,” he told The Daily Beast.
Supporters of Graham-Cassidy have argued that by providing fewer restrictions on how a state could use those federal funds, the bill would pave the way for a more efficient use of those resources.
“I think by doing block grants to the states, states can really allocate those funds as they see appropriate and probably do it in an efficient manner,” Sen. Ron Johnson (R-WI), one of the bill’s sponsors, told The Daily Beast. “We currently spend $14 billion a year on treatment in our $30 billion per year war on drugs. So the federal government’s already spending money that way. I’d say let the states decide how to use it best.”
But activists working on the opioid epidemic don’t see it that way. Gary Mendell, who leads the anti-addiction group Shatterproof, said Graham-Cassidy hits Americans struggling with addiction harder that the Senate’s previous efforts to repeal Obamacare.
“This bill further betrays promises to address the epidemic and it would endanger the lives of millions of Americans fighting to overcome opioid addiction,” Mendell told The Daily Beast. “Instead of using the opioid epidemic as a talking point, they need to go back to the drawing board and come up with actual solutions.”
Other supporters of Graham-Cassidy have acknowledged that it would leave certain states with more limited resources to both treat their Medicaid population and, more specifically, the opioid crisis. But they argued that bill was worth passing anyway because of the other reforms it would make to the federal health care system, and because of procedural limitations confronting the chamber.
Sen. Thom Tillis (R-N.C.), who is likely to vote for Graham-Cassidy, conceded that “we’ve got to get [additional funding]” to address the opioid crisis and that “state and local governments need” monetary help. But he noted that that Republicans are facing a September 30 deadline to pass a bill with just 50 votes, meaning quick action is necessary. The bill, Tillis insisted, is not “in any way a backing-away from the commitment” to provide more resources for the opioid epidemic.
