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Senate Republicans could add opioid funding to “skinny” Obamacare repeal bill

Republicans leaders are scrambling for votes.

US Capitol Bill Clark / Getty Images

Funding to combat America’s opioid crisis could be added to a scaled-down “skinny” Obamacare repeal bill that Senate Republicans are expected to vote on at the end of this week, according to health care lobbyists and Senate aides.

The situation is fluid, and not even an initial draft of the so-called “skinny repeal” legislation has been released publicly. But a push is underway to add the opioid funding to the bill, five sources have told Vox, as Republican leaders search for any health care package that can win the support of a bare majority in the Senate.

Adding opioid funding to the bill either has or is close to having the support of 50 Republican senators, these sources say. But their efforts could also be complicated by the Senate’s budget rules. The Senate’s bill must save as much money as the House’s Obamacare repeal legislation did — more than $100 billion — which will make it more difficult for GOP leadership to add new spending to even the scaled-down bill.

So nothing is set in stone. Senate leaders are expected to unveil their final bill at the end of the Senate floor debate.

For those reasons, the exact amount of funding isn’t known, either. Two Republican senators, Rob Portman of Ohio and Shelley Moore Capito of West Virginia, had pushed for $45 billion to be added to an Obamacare repeal-and-replace bill that currently does not have the support to pass the Senate.

Outside experts had previously said the $45 billion wouldn’t be enough to offset the deep cuts to Medicaid in the repeal-and-replace bill. But the “skinny repeal” bill is not expected to touch Medicaid.

The addition of opioid funding would likely shore up the support of senators who previously had been worried about those Medicaid cuts and would funnel money to combat the deadliest drug overdose epidemic in US history. More than 30,000 Americans are now dying annually from opioid overdoses.

Senate leaders have said they want to use a pared-down repeal bill only to enter negotiations with the House for a more robust repeal-and-replace plan. In that case, the addition of opioid funding to the skinny repeal bill would be purely symbolic and serve to open up the Medicaid program to cuts again during conference negotiations.

But some lobbyists and congressional aides believe the prospects for a bigger Obamacare repeal-and-replace bill are dimming, and the scaled-down bill might be the only bill that Republicans can pass out of Congress and send to President Trump’s desk.

Skinny Obamacare repeal looks like the end game for the Senate

The idea of “skinny” repeal — eliminating only the law’s individual and employer mandates, as well as its tax on medical device companies — has surfaced only because Senate Republicans look painfully short on votes for repeal-only or repeal-and-replace legislation.

The path doesn’t get any easier. A revised version of the Senate repeal-and-replace plan, with concessions to both conservatives and moderates, still failed handily on a procedural vote, with nine Republicans opposing it. The Senate’s parliamentarian has also blown significant holes in the legislation, deeming several important provisions to be in violation of the Senate’s budget rules.

The final conclusion for Republicans might be that the only consensus, even within their own party, is to repeal just Obamacare’s unpopular pieces — its mandates and taxes — plus some unobjectionable additions like this funding sought for the opioid crisis.

That reality, and the overwhelming desire among Republicans to move on from health care, could win out.

“I still think we will just pass (or try to) whatever the Senate can possibly squeeze out as is,” a House Republican aide told me Wednesday. “Everyone, especially Trump, just wants this over. A conference and then two more votes ain't that.”

Repealing the individual mandate alone carries huge policy risks. Health insurers have long said that a compulsion for people to buy insurance is necessary in order for the law to work, after it required that insurers cover everyone and charge everyone the same premiums no matter their health.

Without such a mandate, healthy people could forgo coverage while sick people would continue to buy insurance, driving up costs for insurers, who in turn increase premiums, sending the market into a death spiral. The Congressional Budget Office estimated repealing the mandate by itself would lead to 15 million fewer Americans having health insurance 10 years from now.

But the mandate remains deeply unpopular with the American public, and repealing it would allow Republicans to undo a policy they view as an existential infringement on personal freedom.

It would also notch a win of some kind on Obamacare repeal that they can try to sell to the conservative base, while allowing Congress to move on to other issues.

“There’s a plausible scenario where House leadership takes the skinny repeal and puts it directly on the House floor to ensure that we get a win on health care this year, even if it’s an incremental step,” the first House aide told me, “and then moves on.”

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