Senate Republican leaders, working feverishly to find 50 votes for their bill to repeal the Affordable Care Act, have agreed to modify the legislation by adding $43 billion over 10 years in special funds to treat opioid addiction.
The change, which Politico first reported Wednesday evening and CBS News later confirmed, didn’t come out of thin air. It’s an attempt to win support from Sen. Shelley Moore Capito (R-W.V.) and Sen. Rob Portman (R-Ohio), both of whom have said they cannot support the legislation in its current form.
Whether the bid will succeed remains to be seen.
And whether it should, well, that’s a different question entirely.
Capito and Portman have called publicly for a $45 billion fund, citing the raging opioid epidemics in their states and the need to provide treatment ― particularly at a time when, as part of repealing the Affordable Care Act, Republicans would slash Medicaid funding.
Medicaid has become a lifeline for states with serious opioid problems, in part because so many people rely on the program to pay for their addiction treatment.
The initial version of the Senate legislation, which Senate Majority Leader Mitch McConnell (R-Ky.) and his allies released last week, included an opioid treatment fund but allocated a measly $2 billion to it over a decade.
At the time, it was widely assumed that McConnell knew the sum was insufficient ― that his plan, all along, was to increase the funding once Capito and Portman demanded it, giving them a visible victory in negotiations that they could use to justify eventual support of repeal legislation.
Bumping up the fund by $43 billion over 10 years would be no small thing. But it would still represent a small fraction of the money that repealing Obamacare would drain from federal health programs.
It also might not be enough to treat the fast-growing opioid epidemic and the myriad medical complications, such as Hepatitis C, it causes. One health economist, Harvard University’s Richard Frank, estimated in Politico that addressing the opioid crisis would require something like $183 billion.
Other experts have warned that, depending on the structure of the still-undefined opioid fund, state officials could simply use the money to plug other holes in their budgets.
Whether the $45 billion is adequate, opioid treatment isn’t the only issue crucial to Ohio and West Virginia in the health care debate. In West Virginia, for example, the percent of adults without insurance fell to 6.1 from 17.6 between 2013 and 2016, according to Gallup. Only two states saw bigger drops, and the Affordable Care Act’s expansion of Medicaid was the biggest reason why.
Repeal would reverse that progress, by phasing out extra federal matching funds for the expansion. It would also rearrange the program’s funding going forward, limiting federal contributions in a way that, over time, is likely to create ever larger shortfalls and force major cutbacks in who or what Medicaid covers.
West Virginia’s uninsured rate would skyrocket back up to where it was before, according to a new study from the Urban Institute, while federal health care funding for the non-elderly would fall substantially. In 2022, the year the institute’s researchers chose to make their focus, the state would be getting $1.8 billion less than it would if Obamacare remained in place, with shortfalls growing over time ― far more than the extra opioid money would restore.
Both Capito and Portman have said Medicaid funding is a critical issue for them, as well ― a position Capito reiterated during an appearance on MSNBC’s “Morning Joe” Thursday morning. But both have suggested they are open to less severe versions of the cuts now in the GOP bill, even though such reductions would still mean significant losses of insurance coverage in their states.
This story has been updated to include a more recent estimate from Frank of what it would cost to address the opioid crisis.