Some senators are concerned about how the Senate Republicans health care bill would affect treatment for opioid addiction.

ROBERT SIEGEL, HOST:

As we’ve heard, one of the issues causing concern among some Republican senators is what the health care bill would mean for states dealing with problems related to opioid addiction. The Senate bill has funding in it to help, but it may not be nearly enough to counteract the cuts the bill makes to Medicaid. NPR White House correspondent Tamara Keith reports.

TAMARA KEITH, BYLINE: In late May, several senators went to the floor of the Senate to talk about people in their districts affected by the opioid crisis. West Virginia Republican Shelley Moore Capito talked about Shelley Carter (ph).

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SHELLEY MOORE CAPITO: She told me her drug habit began when she was 12 years old.

KEITH: Capito’s state has the unfortunate distinction of having the highest per capita death rate from opioids. Thirty-six per 100,000 people died from overdoses on heroin, fentanyl and other opioids in 2015. But Chelsea Carter is one of the lucky ones.

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CAPITO: Her story, Chelsea’s story, is an example of the progress that can be made by fully committing to fighting the drug epidemic and that there are victories and that there are programs that work.

KEITH: Carter has been in long-term recovery since 2008.

CHELSEA CARTER: I’ve came a long way from where I was nine years ago, sitting in a jail cell.

KEITH: She went from facing jail time to treatment, grad school, and is now the program director at Appalachian Health Services. She estimates about 90 percent of the people that come into her clinic for treatment for substance use disorders are on Medicaid, the federal program for the poor that West Virginia chose to expand under the Affordable Care Act. The Senate bill would phase out that expansion, and so Carter’s watching the debate closely.

CARTER: We are losing people daily to this. I’m treating generations of drug abuse. And with the people dying of opiate drug overdoses every day, I just don’t see how we could cut funding from something that’s saving lives.

KEITH: Yesterday, Senator Capito announced she opposes the health care bill in its current form. She cited cuts to Medicaid and concerns about what the bill would mean for people dealing with opioid addiction. There’s a pretty direct correlation between states with high overdose death rates and Republican senators expressing reservations about the bill.

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DEAN HELLER: It doesn’t protect Nevadans on Medicaid and the most vulnerable Nevadans.

KEITH: Senator Dean Heller from Nevada came out early against it.

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HELLER: On Medicaid expansion, probably half – half of the dollars that were spent on that was on mental health and opioid abuse.

KEITH: Heller and others could still change their minds or be persuaded by changes to the bill. And one lever Senate Majority Leader Mitch McConnell could employ is increasing funding in the bill for grants to help states respond to the opioid crisis. Currently the bill would give states $2 billion to deal with opioids in 2018. Senator Rob Portman from Ohio, who also opposes the bill in its current form, is pushing for that fund to go up to $45 billion over the next decade. But even 45 billion wouldn’t be enough, says Harvard health economist Richard Frank, who previously served in the Obama administration.

RICHARD FRANK: It is one part of trying to compensate from taking people’s insurance away, but it doesn’t cover nearly what the needs are from these populations.

KEITH: Things like treatment for hepatitis C, HIV, car accidents, emergency room visits, lifesaving rescue drugs.

FRANK: My estimate is that we’re talking 180 billion over 10 years, not 45 billion.

KEITH: The Congressional Budget Office estimates that in 2026, there would be 15 million fewer people covered by Medicaid than under current law. The White House and some congressional Republicans cast doubt on the estimates of the CBO. And supporters of the bill argue states would have more flexibility to tailor Medicaid coverage to the needs of their populations. Michael Botticelli, the last drug czar under President Obama, says love it or hate it, Obamacare did allow a lot more people to get treatment. Botticelli now heads the Grayken Center for Addiction Medicine at Boston Medical Center.

MICHAEL BOTTICELLI: You know, we’re in the greatest health crisis that we’ve had since the height of the AIDS epidemic. And we’ve seen the dramatic gains that we’ve been able to make and that people are able to make with Medicaid coverage.

KEITH: Botticelli finds it hard to believe senators he worked with to help combat the opioid epidemic would consider voting for this bill. And at this moment, it’s still an open question as to whether they will. Tamara Keith, NPR News.

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NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

The Congressional Budget Office said Monday 22 million more people would be uninsured over the next decade under the Senate health care bill. Maine Sen. Collins later said she would oppose the bill.

ARI SHAPIRO, HOST:

The Supreme Court’s announcement that it would take up the travel ban is one thing that makes this a big week for President Trump – another, Senate Republicans’ effort to pass a replacement to the Affordable Care Act, or Obamacare, by July Fourth. NPR national political correspondent Mara Liasson joins us from the White House to talk about that. Hi, Mara.

MARA LIASSON, BYLINE: Hi, Ari.

SHAPIRO: Let’s start with the score that just came out this afternoon from the nonpartisan Congressional Budget Office which says 22 million more people would be uninsured over the next decade under the Senate legislation. Tell us more about what the CBO says.

LIASSON: The CBO says that that amount will lose coverage over the next decade. That’s almost identical to their scoring of the House bill. They also talk about how premiums will go up for lower-income, older, poorer Americans. And the White House immediately issued a statement attacking the CBO, saying it’s proven that in the past that it’s incapable of predicting insurance coverage. But this is a blow to the bill, and the president promised several times that under his watch, health care would get cheaper, better, and there would be no Medicaid cuts. And so far, the Senate bill does not live up to those criteria.

SHAPIRO: And just in the hours since the CBO score came out, we’ve already seen reactions from some senators who might have been on the fence before. Tell us what’s happening here.

LIASSON: That’s right. We know that Susan Collins is the first Republican senator to come out and say definitively she is a no vote. She says she will vote no on the motion to proceed, which is the procedural rule that allows the bill to go to the floor. She’s a moderate senator from Maine. It’s a rural state, and as she said in some tweets, it has a lot of vulnerable Americans. And a lot of Mainers are on Medicaid. I think she said something like 1 in 5 residents of Maine are on Medicaid, and she’s worried about those deep cuts.

There’s a pool of other senators who have expressed reservations – Dean Heller of Nevada, Rand Paul of Kentucky, Mike Lee of Utah. Mitch McConnell, the Republican leader in the Senate, can only afford to lose two senators to pass this bill. And so he’s already lost one with Susan Collins, and we’re really watching those other senators.

SHAPIRO: So walk us through the political strategy here. Mitch McConnell has said it is so important to him to have a vote this week before the July Fourth recess, but if the votes aren’t there, could there be reason for him to postpone a vote, let people go home and come back when they’ve had more time to think about it?

LIASSON: They could, but part of his strategy was to not do that because if they go home, they’re going to face a lot of angry constituents the way they did in the previous breaks. And he doesn’t want that to happen because it might be even harder for him to get the votes when they come back.

One of the things that he’s telling them is, look; every Republican has promised for seven years to repeal Obamacare. This is it. This is the only bill that you’re going to get a chance to vote for that does that. If you don’t do that, you are going to anger the base of the Republican Party, and it will be impossible for us to proceed with anything else, any other priorities for Republicans like tax reform.

He’s also going to tell them that Medicaid is going to be transformed. That is a – would be a generational achievement for conservatives. This is something they’ve wanted to do for a very long time – is, you know, shrink entitlements. And he’s going to try to sell it to them. He also has a pot of money to bargain with. He might tell Susan Collins he’ll put more money in for opioid abuse or rural health care. Mitch McConnell is legendary for being somebody who can get the votes, keep his Republicans together. This is a big challenge for him, but most people think he has a few more cards up his sleeve.

SHAPIRO: You talked about Susan Collins. Tell us about Dean Heller of Nevada, who’s another interesting player in this debate.

LIASSON: Yeah, Dean Heller is a really interesting player because he’s the only Republican from a state that Clinton won who’s up for re-election in 2018. He came out on Friday at a press conference with the governor of his state saying – he practically said he was a no. And a pro-Trump super PAC has threatened to run a million-dollar ad buy against Heller in his own state. He’s already facing a tremendous amount of social media and advertising from people who want him to vote to save Obamacare. So he’s really being hit from the right and the left. We also hear he might want to run for governor in 2018, and maybe he’s not so concerned about the pushback from his fellow Senate Republicans.

SHAPIRO: NPR’s Mara Liasson, thank you.

LIASSON: Thank you.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.