On March 20, the U.S. House of Representatives introduced a health care bill, the American Health Care Act, intended to replace former President Barack Obama’s health care law.
Three months later, the U.S. Senate rolled out its own version.
Senate Republicans on June 22 released a draft of the Better Care Reconciliation Act of 2017, a bill that would make drastic cuts to Medicaid, a federal program that helps fund health care for low-income Americans. But it would also provide $2 billion in grants to states for the fiscal year of 2018 to support substance abuse treatment and recovery services.
“It’s by far the largest amount Congress has ever appropriated in one year for opioids,” Republican Sen. Lamar Alexander of Tennessee said in an interview.
However, Republican Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia proposed that the bill allocate $45 billion over 10 years to fight the opioid epidemic. Gloria Johnson, a former Democratic state representative of Tennessee, told The Tennessean that $2 billion is not enough to overcome the epidemic.
Opioid abuse has devastated the United States in recent years. According to the U.S. Department of Health and Human Services, 12.5 million people misused prescription opioids such as OxyContin and Vicodin in 2015. That year, 2 million people had a substance use disorder involving prescription opioids, and more than 33,000 people died of opioid overdose.
Congress has made an effort to fight opioid addiction.
The 21st Century Cures Act, passed by Congress in December 2016, allocates $1 billion in grants to states over two years to combat opioid abuse. These funds will be used to expand access to addiction treatment, improve prescription drug monitoring programs and provide other public health initiatives designed to reduce opioid abuse.
Rep. Marsha Blackburn told The Tennessean that the Better Care Reconciliation Act would build upon last year’s health care bill.
The Senate health care plan would phase out Medicaid expansion, implemented by “Obamacare,” over four years and eliminate it entirely after 2023. Beginning in 2020, Americans would not be able to join the expansion.
As of April 2017, nearly 69 million people in the United States were on Medicaid.
Many people in treatment for addiction rely on the federal program. In fact, Chelsea Carter, program director at Appalachian Health Services in West Virginia, said that about 90 percent of people treated at her clinic are enrolled in Medicaid.
A study by the Urban Institute showed that spending on Medicaid-covered prescription medications used to treat opioid use disorders and overdoses rose from $394 million in 2011 to $930 million in 2016. During that time, states greatly affected by opioid abuse, including Ohio, Kentucky and Maine, experienced a particularly rapid sales growth.
A Congressional Budget Office report estimated that the Senate bill would slash Medicaid spending by $772 billion by 2026. Previously, the office predicted that the House health care proposal would cut Medicaid funds by $880 billion during the same timeframe.
NEW: CBO report issued a report saying Medicaid would be cut by 35% over 20 years under Senate bill.— Andy Slavitt (@ASlavitt) June 29, 2017
When compared with the current law, the Better Care Reconciliation Act would result in 24.7 million more nonelderly people uninsured in 2022, according to a report by the Urban Institute. Nearly 57 percent of these individuals are white and more than 72 percent are in families with at least one full-time worker.
The Congressional Budget Office projected that 22 million more people would be uninsured by 2026 under the Senate bill. Additionally, single individuals would see their average premiums increase by 20 percent in 2018.
After the Congressional Budget Office released its analysis of the legislation, Senate Republicans made revisions to the bill. Released on June 26, the updated version encourages healthy people to sign up for health insurance by temporarily blocking coverage for those with lapsed insurance.
In a June 22 Facebook post, Obama said the Senate health care bill would give huge tax breaks to the rich and to drug and insurance companies. The former president also alluded to a Congressional Budget Office report that estimated that 23 million Americans would lose health insurance coverage by 2026 under the House’s proposed bill.
“I hope our senators ask themselves — what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage?” wrote Obama.
Two congressional Democrats in Tennessee have also spoken out against the Better Care Reconciliation Act. Rep. Jim Cooper said the passing of the legislation would lead to fewer people insured, and Rep. Steve Cohen said the act provides “woefully inadequate funding” to combat the opioid epidemic.
Republican lawmakers have also expressed their displeasure with the bill. On June 27, Capito said in a statement that she opposed the act as currently written, citing cuts to Medicaid and uncertainty about whether the legislation would help those battling opioid addiction.
During a press conference, Republican Sen. Dean Heller of Nevada said the Senate proposal fails to protect the most vulnerable residents of his state, including those on Medicaid. He estimated that half of the funds from Medicaid expansion are used for mental health and opioid abuse resources.
Sens. Ted Cruz of Texas, Rand Paul of Kentucky, Mike Lee of Utah and Ron Johnson of Wisconsin criticized the Senate bill for not overhauling “Obamacare” to a greater extent.
“The bill is just being lit up like a Christmas tree full of billion-dollar ornaments,” Paul said in an interview with Fox News. “And it’s not repeal.”
The Senate planned to vote on the Better Care Reconciliation Act prior to Congress’s July 4 recess, but opposition to the legislation delayed the vote. In the coming weeks, Senate Republicans will tweak the bill to satisfy more of their colleagues.