Republican senators face the prospect of retreating from their previous public stances in order to support fast-moving legislation that would significantly overhaul the U.S. health care system.
Concerns about the impact on people suffering from opioid addiction, drastic cuts to Medicaid and the lack of robust analysis from the nonpartisan Congressional Budget Office appear to have vanished as the GOP hopes to advance a bill to repeal the 2010 health care law before the fast-track budget reconciliation mechanism they are using expires on Sept. 30.
Lawmakers say any concerns are addressed by the state flexibility included in the proposal from Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina, Ron Johnson of Wisconsin and Dean Heller of Nevada.
“We have a real problem with [opioid abuse] in our state, obviously, which is why I’ve talked a lot about it,” Sen. Shelley Moore Capito of West Virginia said. “What our state would find in a Graham-Cassidy situation would be the flexibility to put an emphasis on that and the dollars behind it as well.”
Capito is one of several lawmakers who expressed serious concerns about prior GOP repeal proposals that would have gutted federal Medicaid funding. Under the Graham-Cassidy model, federal money for the entitlement program would drop by billions of dollars over the next 10 years, according to an analysis by consulting firm Avalere Health.
Capito also worked alongside Sen. Rob Portman of Ohio and others to add billions more in funding for opioid treatment into previous versions of the repeal legislation. No similar measure is currently included in the Graham-Cassidy bill.
Portman, whose state has been one of the hardest hit by the opioid problem, struck a tone similar to Capito’s.
“Giving the states more flexibility is something I generally have been supportive of,” he told USA Today.
Ohio’s governor appears to disagree.
“Graham/Cassidy/Heller/Johnson eliminates the guardrails that protect some of the most vulnerable among us,” Gov. John Kasich tweeted Monday.
Graham/Cassidy/Heller/Johnson eliminates the guardrails that protect some of the most vulnerable among us. 2/— John Kasich (@JohnKasich) September 18, 2017
While the bill would give states significant leeway to spend federal health care money, many would have to grapple with notable funding cuts over the next 10 years, according to several outside analyses.
By the same token, other states — namely Republican-run states that did not expand Medicaid under the 2010 health care law — would see a partial influx in money from the government. But experts have questioned whether some would be able to effectively manage the increased funding.
Democrats argue that Republicans are asking most states to do more with less, and say the legislation would lead to a significant loss of insurance coverage and increased health care costs for the most vulnerable.
That claim will not be verified or refuted by the CBO before a vote. The office said earlier this week that a full analysis of the proposal would not be available for several weeks.
Voting without that report is something the bill’s sponsor previously criticized.
“A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution,” Graham tweeted in May, as the House GOP passed its health care repeal-and-replace bill.
A bill -- finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate -- should be viewed with caution.— Lindsey Graham (@LindseyGrahamSC) May 4, 2017
Niels Lesniewski contributed to this article.