Let’s talk about the role that the opioid crisis plays in this health care bill debate. Many places that went strongly for President Trump are also in the throes of a heroin crisis. Among these are West Virginia and Ohio, both Trump states with senators who have said they are wary of potential cuts to Medicaid funds that are helping cover the cost of addiction treatment.
Shelley Moore Capito of West Virginia and Rob Portman of Ohio are two key votes that have been silent thus far on how they’ll vote on the “skinny repeal” option. “Skinny repeal” doesn’t touch Medicaid, but it does get rid of the individual mandate, and some worry that fewer Medicaid-eligible people will discover their eligibility because of this. There’s talk that Republicans could add opioid-specific funds to the bill, though it’s unclear how much. Portman has said he’s open to the “skinny repeal,” so long as he has a guarantee that a replacement option will be in the works. Moore Capito said she “did not come to Washington to hurt people” in a statement earlier this month but voted this week to advance debate on the health care bill.
Dan’s earlier post about whether the “skinny repeal” will be popular brings up an interesting point about the Affordable Care Act: Most of the law’s provisions have polled highly throughout its existence — in fact, the individual pieces have been more popular than the law overall. Why? Most of the items in Dan’s list below are about increasing coverage for Americans (e.g., expanding Medicaid or covering pre-existing conditions) or taxing businesses or wealthier people (e.g., the employer mandate or the Medicare payroll tax). The reason the ACA has polled poorly overall at times is a lack of support for the individual mandate — the part of the law that forces most Americans to buy insurance or pay a fine.
Americans seem to like the law as long as they don’t have to pay for its benefits. Put another way, opposition to the ACA hasn’t been an ideological objection to larger government — it’s been an objection to paying for larger government. The problem, of course, is that for there to be more services, there must be a way to pay for those services. The mandate is that payment mechanism. That’s part of the reason why many policy experts argue that “skinny repeal,” which eliminates the mandate, would be a policy disaster.
