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As we've heard, one of the issues causing concern among some Republican senators is what the health care bill would mean for states dealing with problems related to opioid addiction. The Senate bill has funding in it to help, but it may not be nearly enough to counteract the cuts the bill makes to Medicaid. NPR White House correspondent Tamara Keith reports.
TAMARA KEITH, BYLINE: In late May, several senators went to the floor of the Senate to talk about people in their districts affected by the opioid crisis. West Virginia Republican Shelley Moore Capito talked about Shelley Carter (ph).
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SHELLEY MOORE CAPITO: She told me her drug habit began when she was 12 years old.
KEITH: Capito's state has the unfortunate distinction of having the highest per capita death rate from opioids. Thirty-six per 100,000 people died from overdoses on heroin, fentanyl and other opioids in 2015. But Chelsea Carter is one of the lucky ones.
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CAPITO: Her story, Chelsea's story, is an example of the progress that can be made by fully committing to fighting the drug epidemic and that there are victories and that there are programs that work.
KEITH: Carter has been in long-term recovery since 2008.
CHELSEA CARTER: I've came a long way from where I was nine years ago, sitting in a jail cell.
KEITH: She went from facing jail time to treatment, grad school, and is now the program director at Appalachian Health Services. She estimates about 90 percent of the people that come into her clinic for treatment for substance use disorders are on Medicaid, the federal program for the poor that West Virginia chose to expand under the Affordable Care Act. The Senate bill would phase out that expansion, and so Carter's watching the debate closely.
CARTER: We are losing people daily to this. I'm treating generations of drug abuse. And with the people dying of opiate drug overdoses every day, I just don't see how we could cut funding from something that's saving lives.
KEITH: Yesterday, Senator Capito announced she opposes the health care bill in its current form. She cited cuts to Medicaid and concerns about what the bill would mean for people dealing with opioid addiction. There's a pretty direct correlation between states with high overdose death rates and Republican senators expressing reservations about the bill.
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DEAN HELLER: It doesn't protect Nevadans on Medicaid and the most vulnerable Nevadans.
KEITH: Senator Dean Heller from Nevada came out early against it.
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HELLER: On Medicaid expansion, probably half - half of the dollars that were spent on that was on mental health and opioid abuse.
KEITH: Heller and others could still change their minds or be persuaded by changes to the bill. And one lever Senate Majority Leader Mitch McConnell could employ is increasing funding in the bill for grants to help states respond to the opioid crisis. Currently the bill would give states $2 billion to deal with opioids in 2018. Senator Rob Portman from Ohio, who also opposes the bill in its current form, is pushing for that fund to go up to $45 billion over the next decade. But even 45 billion wouldn't be enough, says Harvard health economist Richard Frank, who previously served in the Obama administration.
RICHARD FRANK: It is one part of trying to compensate from taking people's insurance away, but it doesn't cover nearly what the needs are from these populations.
KEITH: Things like treatment for hepatitis C, HIV, car accidents, emergency room visits, lifesaving rescue drugs.
FRANK: My estimate is that we're talking 180 billion over 10 years, not 45 billion.
KEITH: The Congressional Budget Office estimates that in 2026, there would be 15 million fewer people covered by Medicaid than under current law. The White House and some congressional Republicans cast doubt on the estimates of the CBO. And supporters of the bill argue states would have more flexibility to tailor Medicaid coverage to the needs of their populations. Michael Botticelli, the last drug czar under President Obama, says love it or hate it, Obamacare did allow a lot more people to get treatment. Botticelli now heads the Grayken Center for Addiction Medicine at Boston Medical Center.
MICHAEL BOTTICELLI: You know, we're in the greatest health crisis that we've had since the height of the AIDS epidemic. And we've seen the dramatic gains that we've been able to make and that people are able to make with Medicaid coverage.
KEITH: Botticelli finds it hard to believe senators he worked with to help combat the opioid epidemic would consider voting for this bill. And at this moment, it's still an open question as to whether they will. Tamara Keith, NPR News. Transcript provided by NPR, Copyright NPR.
