Good morning, friends. This edition of the newsletter is a little late and your correspondent is a lot sunburned, thanks to a holiday weekend spent on a New Jersey beach not closed to the public.
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— Aubrey Whelan
The future of the GOP's healthcare bill — and the future of Medicaid — is resting, in part, on how senators plan to tackle the opioid crisis. And whatever they decide will likely hit hardest in states that, like Pennsylvania and New Jersey, expanded Medicaid under Obamacare.
After a secret drafting process (one that included Pa.'s own Pat Toomey), the Senate healthcare bill dropped two weeks ago, with Senate Majority Leader Mitch McConnell aiming for a vote before Congress went on recess for July 4. (They're off until Monday.) In the week in between, healthcare activists mobilized, the Congressional Budget Office concluded 22 million more people would be left uninsured under the bill, and several moderate Republican senators said they wouldn't support it — a seeming death knell for a bill that, with a razor-thin GOP margin in the Senate, could afford to lose only two votes. It's been tabled until after the recess, and President Trump isn't exactly speaking up for it.
This is basically exactly what happened with the House's healthcare bill, though, which was resurrected a month later with an amendment that got conservative senators on board, and so McConnell and company are searching for compromises that can get moderates on board. One of the ways they might do that? Expanded funding for battling the opioid crisis, where Medicaid spending has more than doubled over the last five years.
The Senate bill, with its plans to push more of the cost of the Medicaid expansion to states and cut the program by $772 billion over 10 years, was roundly criticized in the Philadelphia region, my colleague Don Sapatkin wrote last month. And Gov. Wolf has said the state can't afford to pick up the tab for the Medicaid expansion, which covered some 700,000 Pennsylvanians. (I wrote about a healthcare activist with MS who went two years without treatment before getting coverage under the expansion here.)
And then there's the opioid epidemic sweeping the country, an enormously complicated issue, to which the Senate bill allotted $2 billion over 10 years. In Pennsylvania, 175,000 people got addiction treatment under the Medicaid expansion and private insurance plans from the Affordable Care Act. (While we were all on the beach earlier this week, Sapatkin, the star of this morning's newsletter, broke down a couple recent studies on addiction and Medicaid spending and how that fits in with the Senate bill.)
Moderate senators have said the bill's allotment for addiction spending isn't nearly enough, and last week McConnell agreed to kick them an extra $45 billion. But even that might backfire, POLITICO reported, because the same moderates are still fuming over the larger Medicaid cuts. And, Sapatkin reported Monday, the cost of treating opioid addiction and its related diseases could quadruple even the increased allotment. Whatever happens in the days ahead — and it's really anybody's guess — Senators are in for a very uncomfortable recess.