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 conservative Republican senators like Mr. Toomey and Ted Cruz of Texas. 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.
Without some opioid funding, Mr. Portman said, he could not vote for the bill: “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”
Republicans hold 52 seats in the Senate and can afford to lose only two of their members if they hope to pass the bill, which is opposed by all Democrats and the two independents.
Two Democratic senators from states plagued by opioid addiction, Bob Casey of Pennsylvania and Joe Manchin III of West Virginia, said the Republican proposal for federal grants would not…