 | begin quote from:GOP Rift Over Medicaid and Opioids Imperils Senate Health Bill
Senator
Patrick J. Toomey of Pennsylvania on Tuesday. Mr. Toomey and other
conservative Republicans are determined to hold the line on federal
spending.
WASHINGTON — A growing rift among 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 Trump had urged Republican senators to write a more generous bill than a House version that he first heralded and then called “mean,”
but Republican leaders on Tuesday appeared 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 Patrick J. Toomey of Pennsylvania, are
determined to hold the line on federal spending, pitting two Senate
factions against each other.
Senator
John Cornyn of Texas emerged from a contentious closed-door lunch with
Republican senators on 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.
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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 conservatives. 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, Mr. Portman cannot vote for the bill, he said,
adding, “Any replacement is going to have to do something to address
this opioid crisis that is gripping our country.”
GraphicThe Senate Is Close to a Health Care Bill, but Do Republicans Have the Votes?
How senators have different priorities on health care.
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.
Two
Democratic senators from states plagued by opioid addiction, Bob Casey
of Pennsylvania and Joe Manchin III of West Virginia, said the
Republican proposal for federal grants would not come close to
mitigating the harm caused by the bill’s Medicaid cuts, pushed just as
overdose deaths are soaring. From 2005 to 2014, according to the latest data available, opioid-related hospital visits increased nearly 65 percent, to 1.27 million emergency room visits or inpatient stays a year.
While
the proposed money for drug abuse treatment is relatively modest
compared with spending for other items like Medicaid and premium tax
credits, without it, hundreds of thousands of addicts would go without
treatment, advocates say. The issue holds outsize political importance
for senators like Mr. Portman, who has made advocacy for treatment
legislation a calling card with voters at home.
“The
opioid issue has been a particular concern of mine and has been for
years,” said Mr. Portman, who has been leading the efforts with Senator
Capito. “The reality is we have the worst drug crisis that our country’s
ever faced, and it’s being driven by opioids.”
Senator
John Barrasso, Republican of Wyoming, 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 Mr. 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 on 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. Senator 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,” Senator 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.”
Several
Republican senators, including Orrin G. Hatch of Utah, the chairman of
the Finance Committee, have indicated they would like to exempt disabled
children from the caps.
Senator
Collins’s concerns cover almost the entire landscape of Republican
problems: the loss of care for Medicaid recipients, the worries of
states with especially high health care costs, and money for opioid
treatment (8 percent of all births in her state, Maine, were to addicted
mothers last year, she said). Then there are her complaints about the
process.
“First,
we haven’t seen the bill,” Ms. Collins said. “Second, it has yet to
receive a score from the Congressional Budget Office. And third is the
process we are using.”
That
process — an arcane budget procedure that Republicans denounced when
Democrats used it to pass just a small part of the Affordable Care Act —
could make some provisions vulnerable to Democratic challenges to the
bill. Not knowing which provisions will stay and which could be removed
on the Senate floor makes evaluating the substance of the bill that much
harder.
Republican
aides speculated that the restrictions on the growth of Medicaid, among
other issues, could be altered later by Senate Republican leaders, in a
bid to pick up support from the moderates.
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 Mr. 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. The Senate bill, like the House measure, would
provide billions of dollars to states to help stabilize insurance
markets, which Republicans say are tottering in many states.
The
Senate bill would also allow states to opt out of many federal
insurance standards. Republican leaders said they wanted to protect
people with pre-existing conditions, but it was not immediately clear
how they would do so.
Democrats
stepped up their protests over the secrecy of the bill-writing process
on Tuesday, and some Republicans chimed in. Senator Mike Lee, Republican
of Utah, was a member of a health care working group formed by Senator
Mitch McConnell of Kentucky, the majority leader, but even he was vexed
by the process.
“It
has become increasingly apparent in the last few days that even though
we thought we were going to be in charge of writing a bill within this
working group, it’s not being written by us,” Mr. Lee said in a video on Facebook.
“It’s apparently being written by a small handful of staffers for
members of the Republican leadership in the Senate. So if you’re
frustrated by the lack of transparency in this process, I share your
frustration.”
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Tuesday, June 20, 2017
GOP Rift Over Medicaid and Opioids Imperils Senate Health Bill
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