McConnell asks Ohio and Pa. senators to craft compromise on Medicaid, a key to addiction treatment in their states and Ky.

Senate Majority Leader Mitch McConnell
(Photo by Andrew Harrer, Bloomberg)

Senate Majority Leader Mitch McConnell of Kentucky has asked fellow Republican Sens. Rob Portman of Ohio and Pat Toomey of Pennsylvania "to come up with a compromise between GOP conservatives and moderates on capping Medicaid spending and rolling back the ACA's Medicaid expansion to low-income adults," Harris Meyer reports for Modern Healthcare. "That's a key disagreement holding up Senate Republicans' version of ACA repeal-and-replace legislation."

Pennsylvania, Ohio and Kentucky were among the states that expanded Medicaid under the Affordable Care Act, extending coverage to more than 700,000 low-income adults in the larger states and 470,000 in Kentucky. That expansion has enabled an estimated 150,000 Ohioans and 63,000 Pennsylvanians to get addiction treatment, Meyer reports.

The Kentucky Cabinet for Health and Family Services said it didn't have current data available on short notice, but a recent report for the Foundation for a Healthy Kentucky said 41,146 Kentuckians on the Medicaid expansion had received substance-abuse treatment through the second quarter of 2016.

From 2014 to 2015, drug-overdose deaths in Kentucky rose 19.3 percent, to 1,297. Meyer notes that the other two states "experienced record spikes in drug overdose deaths in 2015—a 20.5 percent increase in Ohio, to 3,050, and a 30 percent jump in Pennsylvania, to 3,500.

"McConnell's assignment puts Portman and Toomey in a very tough and highly visible spot," Meyer writes. "Substance-abuse providers, lawmakers, and policy experts in Ohio and Pennsylvania warn that phasing out enhanced federal funding for Medicaid expansion would effectively end coverage for hundreds of thousands of people—including many with substance abuse disorders—because the states couldn't afford to continue the expansion on their own." The same is true in Kentucky.

Also, Meyer reports that providers told him "The commercial health plans that Republicans want to offer as a substitute generally don't offer benefits for substance-abuse treatment that are nearly as good as what Medicaid offers."

Nationally, Medicaid provides coverage to more than 650,000 non-elderly adults with addiction, among the estimated 3 million people who are addicted, according to the Kaiser Family Foundation.

Ending the Medicaid expansion "would be nothing short of disastrous for my state," Republican state Rep. Gene DiGirolamo, who chairs the Pennsylvania House's human services committee, told Meyer. "If the expansion goes away, people with drug and alcohol addiction will show up at hospital ERs, go back on the street, and end up tragically dead or in jail."

Andrew Albrecht, CEO of The Counseling Center, a drug- and alcohol-treatment center in Portsmouth, Ohio, just across the Ohio River from Kentucky, told Meyer, "The Medicaid expansion is the single biggest thing that's happened to our agency. Prior to expansion, we had to ration care. If the expansion ended, we'd have to make some really tough decisions about how many men we could treat." Since the 2014 expansion, the center has enlarged to 72 beds from 16.

Portman, Ohio's Republican senator, "has called for moderating or at least delaying the repeal" of Medicaid expansion, Meyer reports. "Toomey is pushing for rapid repeal of the extra federal funding" while saying that the House's proposed Medicaid changes "probably" are "a little too sudden" and that he would be open to a "conversation about easing the transition."

The bill passed by the House would end the expansion in 2020 and "allow states to opt out of the ACA's required coverage for essential health benefits such as mental health and substance abuse treatment," Meyer notes. "In addition, it would allow states to let insurers price plans based on applicants' pre-existing conditions, such as drug addiction. These provisions likely would reduce access to addiction treatment, experts say."

Ohio expanded Medicaid in 2014 under Republican Gov. John Kasich; Pennsylvania did it in 2015 under Democratic Gov. Tom Wolf. Kentucky did it under then-Gov. Steve Beshear, a Democrat, in 2014; Republican Gov. Matt Bevin is seeking a federal waiver to cut back the program.

Meanwhile, McConnell's top deputy, Texas Sen. John Cornyn, told KFYO Radio in Lubbock that the Senate would pass a health bill by the end of July, CBS News reports. But then the House and Senate would have to reach a compromise, and Sen. Richard Burr, R-N.C., who dislikes the House bill, told Greensboro and Winston-Salem's WXII-TV, "I think it's unlikely that we will get a health-care deal." Asked if the Senate would pass a health bill, he said, "I don't see a comprehensive health-care plan this year."

A poll May 16-22 by the Kaiser Family Foundation found that 55 percent of Americans had an unfavorable view of the House bill, while 31 percent viewed it favorably. Asked about Medicaid, 58 percent said the program is either “very” or “somewhat” important to them and their family – including a majority of Democrats (64 percent) and independents (57 percent) and nearly half (46 percent) of Republicans.