Trumpcare Will Be a Disaster for Opioid Epidemic

By cutting Medicaid, the new health care bill will exacerbate the crisis – and Republican plans to add more aid won't do nearly enough

"Without Medicaid I wouldn't be here today," said one opioid survivor. Credit: Leonard Lessin/Getty

Every corner of the nation – in wealthy suburbs, posh newly revitalized urban areas, and depressed former coal towns alike – is being touched by the opioid and heroin crisis, which has brought lawmakers in this bitter hyper-partisan Washington together just last year. That's why Democrats, doctors and first responders feel betrayed that the Senate Republican insurance bill proposes a drastic rollback to the federal programs that have proven the most effective to helping stem the crisis. 

While the Republican talking point is that their proposal represents a reform that doesn't cut Medicaid spending, that assertion isn't passing the smell test – let alone the calculations – of the nation's fact checkers. The proposal calls for slashing Medicaid funding by $772 billion over a decade, which the Congressional Budget Office says would decrease enrollment by 16 percent for people under 65. That would have real life consequences because Medicaid is treating about 30 percent of the nation's addicts, though in some of the state's hardest hit by the epidemic that number is more like 40 or 50 percent of those struggling with addiction.

"Without Medicaid I wouldn't be here today. Without Medicaid I wouldn't have a family. Without Medicaid, I would be dead. And I'm sorry I'm emotional but it's the truth," a tearful 25-year-old West Virginia resident, Shelby Valentine, said as she joined Democrats at a press conference opposing the proposed cuts at the Capitol on Tuesday. Her state's senators know that she's not alone, though she's a survivor – which is increasingly rare in the state that lost 818 people to overdoses last year alone.

"In my state, we're the number one. We're ground zero. We have more people that have been affected through legal drugs, opioid addiction, than any other form that we've ever had hit our state," West Virginia Democratic Sen. Joe Manchin told reporters at the Capitol. "We didn't grow up with this, it was not out there. The legal pharmaceutical manufacturers were not producing this product. This came of age in the Eighties, and when it came of age it became a business model. I understand there was some good intentions and some need of really some severe cases we have like cancer and end of life comfort. This thing became a business. And it has been exploited to the extent that we have never seen before."

For Manchin, like every other Democrat, the GOP insurance bill is a nonstarter, but he's actually got an ally in his opposition from his Republican counterpart in the Senate. Shelley Moore Capito is currently opposed to the bill, partly because it cuts rural hospitals, cuts Medicaid and doesn't do enough to address the opioid crisis. She and Ohio Sen. Rob Portman have been trying to get party leaders to boost opioid funding in the bill from its current $2 billion to $45 billion, but she says she hasn't gotten a response to her request from McConnell and other party leaders.

"I haven't heard," Republican Sen. Shelley Moore Capito tells Rolling Stone. "I think that's an issue, obviously, for me, but not the only one."

But Democrats say even if GOP leaders toss another $45 billion to opioid prevention and treatment programs, the bill would still tie the hands of the nation's doctors, nurses and first responders because the cuts to Medicaid are so deep. They fear McConnell is now going to spend the July 4th recess trying to buy votes of senators like Capito using the $200 billion in deficit reduction the CBO says the bill provides.

"One-off carve outs…are we only going to deal with opioids? Are we also going to deal with alcohol? Are we also going to deal with other drug addictions? What about cancer? What about diabetes?" Democratic Sen. Mark Warner tells Rolling Stone. "You don't take close to 800 billion dollars out of Medicaid that serves not only poor individuals but two-thirds of the folks in nursing homes. Many, many children with disabilities, people with addiction and pit one challenge group against the other. I think that would be short-sighted if there was only the opioid relief and there wasn't the other kind of more comprehensive drug and other alcohol rehabilitation."

Other Democrats are glad some Republicans are addressing the opioid crisis, but they argue just a new tranche of money isn't going to do the trick.

"The folks who are experts in this, tell me that in the vast majority of cases, you have to integrate the opioid treatment into the overall plan of care for people. Because so often an opioid addiction relates to other physical or behavioral health challenges," Democratic Sen. Sheldon Whitehouse tells Rolling Stone.

"I think it's hard to do, I mean I'm delighted they're interested in finally throwing some money at the problem. But when you put that up against the destruction that they want to do to Medicare, I don't think it balances out. It looks an awful like, to quote Dick Durbin, 'putting that lace collar on the pit bull.'"

While Democrats are glad the GOP leader had to pull its health effort this week, they know McConnell is a master legislator who now has $200 billion in projected saving to toss around skeptical rank and file Republicans, which is why they're girding for battle.

"The wheeling and dealing will be to tried to buy votes essentially, not in a nefarious way, but simply politically try to make the bill more palatable," Democratic Sen. Richard Blumenthal tells Rolling Stone. "I still regard this fight to stop the bill as uphill, because they have the majority. And as long as the majority leader can command dollars as well as persuasion, he has a path forward."