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What Portman and Capito Want in Obamacare Repeal Debate

Concerns about Medicaid appear to go beyond funding for the opioid crisis

Sen. Rob Portman has been seeking additional funding to fight opioid abuse. (Tom Williams/CQ Roll Call file photo)
Sen. Rob Portman has been seeking additional funding to fight opioid abuse. (Tom Williams/CQ Roll Call file photo)

Did two Republicans from states with populations hit particularly hard by the opioid abuse epidemic raise their asking price for supporting the GOP health care reconciliation draft?

Regardless of the answer to the question, Senate GOP leaders now have to address concerns about Medicaid expansion being rolled back far beyond the estimated cost of drug treatment.

Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia were known to want $45 billion in dedicated funding for drug abuse treatment for the population currently served through Medicaid expansion, and those dollars needed to be outside the current Medicaid structure so that treatment could continue during any eventual wind-down of the expansion under the 2010 health care law.

But, as Capito made clear in her statement announcing opposition to the most recent draft, there also came to be questions about Medicaid cuts itself.

“As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers,” the Republican from West Virginia said.

The two senators seemed likely to eventually get the $45 billion they sought, given the Congressional Budget Office score of the discussion draft showed that roughly $188 billion would be available for use elsewhere. The need for $4.5 billion per year over the next decade for that current Medicaid population was derived from a study published by the Journal of the American Medical Association.

On Thursday morning, Politico reported that Portman and Senate Majority Leader Mitch McConnell of Kentucky had what was described as a “heated exchange” earlier in the week, particularly about Medicaid.

Portman and Capito were among the GOP senators to publicly announce their opposition only after McConnell decided to pull back from calling a vote on the motion to proceed to the health care reconciliation vehicle, suggesting that they might have still been negotiating up until the point of the change in plans.

When Senate Democrats met with reporters before the Republicans made the decision not to go forward Tuesday, Sen. Robert Menendez said that GOP expressions of concern about opioid crisis were ringing hollow.

And the New Jersey Democrat was not just pointing to the $2 billion funding level, which Capito, Portman and others seemed sure to increase to $45 billion or more.

“Ending Medicaid expansion, and Medicaid as we know it beyond Medicaid expansion, is just really for many people going to be a death sentence,” Menendez said.

Ohio’s GOP Gov. John Kasich made the rounds in Washington to make what he described as an “intellectually honest” case about the significance of the expanded Medicaid benefits in the Buckeye State, going beyond the opioid treatment considerations.

When Kasich was at the National Press Club Tuesday, the governor didn’t want to talk about how Portman might vote on what was then the current version of the Republican health care bill.

“I’ve told him how important I think all this is,” Kasich said, cutting off a reporter in mid-question when asked about his discussions with Portman about the bill. “I don’t cast his vote.”

What the Ohio governor wanted to talk about was the effect on his state and others of the legislation, which he said was “not good enough to shove… in a closet somewhere.”

Kasich said what was provided for Medicaid funding was not really adequate, but under the House version his state could have been able to “struggle through” with some flexibility, but not the Senate version.

The bill as it is now “would leave a lot of people in a really difficult situation,” he said.

“We’ll see what happens when the card goes in the box — or however they vote in the Senate,” said Kasich, who previously served in the House.

— Griffin Connolly contributed to this report.