The Atlanta Journal-Constitution
Rift on Medicaid, opioids imperils GOP health bill
Senate Republicans clash as leaders push for vote next week.
A growing rift WASHINGTON — between Senate Republicans over federal spending on Medicaid and the opioid epidemic is imperiling legislation to repeal the Affordable Care Act that Senate leaders are trying to put to a vote by the end of next week.
President Donald Trump had urged Republican senators to write a more generous bill than a House version that he first heralded, then called “mean,” but Republican leaders appeared Tuesday to be drafting legislation that would do even more to slow the growth of Medicaid toward the end of the coming decade.
And conservative senators, led by Sen. Patrick Toomey of Pennsylvania, are determined to hold the line on federal spending, pitting two Senate factions against each other.
Sen. John Cornyn of Texas emerged from a contentious closed-door lunch with Republican
senators Tuesday saying that he hoped the Senate would be able to meet the deadline of a vote before July 4. “But,” he added, “failing that, I’ve always said we need to get it done by” the end of July.
The emerging Senate bill, like the one approved narrowly by the House in early May, would end Medicaid as an open-ended entitlement program and replace it with capped payments to states, Republicans said. But starting in 2025, payments to the states would grow more slowly than those envisioned in the House bill.
Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.
But that, too, is running into opposition from conservative Republican senators like Toomey and Ted Cruz of Texas. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.
Without some opioid funding, Portman said, he could not vote for the bill: “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”
Republicans hold 52 seats in the Senate and can afford to lose only two of their members if they hope to pass the bill, which is opposed by all Democrats and the two independents.
“The opioid issue has been a particular concern of mine and has been for years,” said Portman, who has been leading the efforts with Capito. “The reality is we have the worst drug crisis that our country’s ever faced, and it’s being driven by opioids.”
Sen. John Barrasso, R-Wyo., who serves on a group shaping the final bill, said: “We need to address the opioid crisis in America. I want us to find a bipartisan solution with adequate funding.”
But Republican leaders would not commit to Portman’s proposal.
The Medicaid and opioid issues are far from the only ones dividing Republican senators, who have been kept largely in the dark about a bill they are supposed to finally see Thursday. Republican leaders are determined to keep their seven-year promise to unravel President Barack Obama’s signature health care law, but the near-unanimity they need on a replacement is proving elusive.
The House bill would allow per-capita Medicaid payments to states to grow along with the prices of medical goods and services, starting in 2020, with an extra allowance for older Americans and people with disabilities. Toomey and several other conservatives have been pushing for a slower growth rate, to reflect increases in the overall Consumer Price Index, starting in 2025. Medical prices have historically grown faster than the overall index.
“I think that’s a problem,” Capito of West Virginia told the website Axios, reflecting the misgivings of a state that relies heavily on the program. “I think that sort of defeats the purpose of keeping people on, and at a level at which the program can be sustained.”
A bill this large, with so much in flux days before it is to receive a vote on the floor, is largely without precedent in the Senate.
Senior Republican senators said six weeks ago that they would start afresh in writing a bill to undo Obama’s health care law, but the legislation they are developing is similar in many respects to the bill passed by the House.
The Senate bill would eliminate penalties for people who do not have insurance and larger employers who do not offer it to employees — eviscerating the individual and employer mandates that were hallmarks of the Affordable Care Act.