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Many people see Ohio as ground zero of the opioid epidemic, and it’s easy to see why. So many dead bodies are showing up at county coroners’ offices that they’ve recently had to resort to calling the Ohio Emergency Management Agency and asking for cold-storage trailers to handle the overflow. Things would be considerably worse, however, if not for the expansion of Medicaid that Governor John Kasich accepted as part of the Affordable Care Act.

In Ohio, more than a third of the approximately 700,000 people who enrolled in Medicaid after the expansion began in 2014 reported some drug or alcohol dependence, according to a recent study by the state.

The vast majority did not previously have health insurance.

Asked what the Republicans’ planned cuts to Medicaid would do the people who are using the program to get treatment for their addiction to painkillers and heroin, Dr. Shawn Ryan, president of BrightView Health, a network of drug treatment clinics in Cincinnati, responded, “It would essentially write off a generation. It would be catastrophic.”

Opioid addiction is notoriously hard to beat, which is why we see things like Methadone clinics that have no parallel with recovering alcoholics or cocaine addicts. It’s not unusual for people with an opioid addiction to relapse repeatedly even after getting lengthy treatment, which is why most families couldn’t dream of paying for the cost of all the rehabilitation and counseling efforts that are required. Lack of medical coverage for addiction and mental health is basically a death sentence for most addicts.

The Republicans are having difficulty getting support for their Medicaid cuts from their own Senate caucus precisely because the program’s expansion has been so critical and successful in saving lives in the opioid battle, with Ohio Senator Rob Portman leading the fight to lessen the impact of their legislation.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

…“The opioid issue has been a particular concern of mine and has been for years,” said Mr. Portman, who has been leading the efforts with Senator [ Shelley Moore] Capito [of West Virginia]. “The reality is we have the worst drug crisis that our country’s ever faced, and it’s being driven by opioids.”

So far, however, Portman hasn’t been staunch enough in his insistence on this point. The current draft of the Senate bill calls for even deeper cuts than the House bill that President Trump criticized as too “mean.” All Portman has accomplished on that front is to postpone when the devastating cuts begin to kick in. He also has a proposal to set up a separate revenue stream for treating addiction, but so far he hasn’t won support for it.

The emerging Senate bill, like the one approved narrowly by the House in early May, would end Medicaid as an open-ended entitlement program and replace it with capped payments to states, Republicans said. But starting in 2025, payments to the states would grow more slowly than those envisioned in the House bill.

Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

The opioid epidemic is hitting Pennsylvania nearly as hard as it is hitting Ohio, but Senator Pat Toomey is the one leading the conservative charge to eliminate Medicaid spending and the resistance to Portman’s efforts to mitigate the resulting carnage.

Donald Trump, of course, promised repeatedly to do more to fight the crisis and help people get treatment. And he knows that many of the communities that were most supportive of him in critical Rust Belt states have been the most devastated by opioids. It would seem to be in his self interest not to break those promises, but he isn’t showing any leadership on the issue as the Senate struggles to release its health plan sometime tomorrow.

It’s also a mistake to think that the crisis is limited in any way to Trump’s areas of the country. The opioid crisis is extremely bad in New England and the Mid-Atlantic, and it’s hitting people in even the most affluent communities and school districts in the country.

The problem is big enough that it could single-handedly sink the Republicans’ effort to pass the American Health Care Act. And it should.

Martin Longman

Martin Longman is the web editor for the Washington Monthly. See all his writing at