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A Rust Belt All-Hands on the Opioid Crisis

A new Senate bill attempts technocratic relief on a lingering crisis that helped give rise to the Trump years.

Four middle-of-the-road senators from the middle of the country are taking another swing at the specter that haunts their lands: still commonplace addiction to powerful opioids. 

“Under current law, hospitals receive the same payment from Medicare regardless of whether a physician prescribes an opioid, or uses a non-opioid for post-surgical pain,” Sam Paisley, aide to Sen. Jeanne Shaheen (D-N.H.), said in a release. “As a result, hospitals rely on opioids, which are typically dispensed by a pharmacy after discharge at little or no cost to the hospital.”

Joined by three Rust Belt colleagues—Sen. Joe Manchin (D-W.V.), Sen. Shelley Moore Capito (R-W.V.) and the retiring Sen. Rob Portman (R-Ohio)—Shaheen is spearheading the “NOPAIN Act” which “would change this policy by directing [Centers for Medicare and Medicaid Services] to provide separate Medicare reimbursement for non-opioid treatments.” Shaheen insisted that “Turning the tide on the opioid epidemic must be at the top of Congress’s agenda.” Shaheen’s New Hampshire may not technically be classified as in the “Rust Belt” but the 2020 campaign saw the surprising resonance of Midwestern candidates in the Granite State; the voters apparently spotted fellow travelers.  

There are several implications.

First, it remains an open question how seriously Portman will act as a free agent, now that he is on his way out of the upper chamber. He has been critical of the party under the direction of former President Donald Trump (all four senators are from states ravaged by the crisis, and which became lynchpin territories for Trump’s appeal). Portman announced retirement in January, in a move that shocked the Ohio establishment; his potential successors include the memoirist J.D. Vance, whose heartland tale of an upbringing amid addiction became a bestseller and film. 

“Centers for Medicare and Medicaid Services sets reimbursement rates… for virtually every covered procedure in the United States,” explained one industry insider. “It’s a flawed system with lots of lobbying, special interests” which compel practitioners to take courses—including certain surgeries and prescriptions—they might not otherwise. Legislation with which the healthcare industry is not closely consulted can become an imbroglio, and a political liability especially for Republicans, who historically have been accused of working hand-in-glove with pharmaceutical companies. 

Such a dynamic was last on display in the fight over Obamacare, which President Biden has pledged to revive and enhance. Former President Trump’s years in power oscillated between a bonanza for healthcare firms, and the upstart politician’s idiosyncratic, warm words for government-controlled systems of medicine in other Western countries. Messing with the status quo can always plausibly be seen as a hockey check to the powers-that-be, especially in a sector so notoriously fraught and lucrative. 

Second, it would seem plain that Sen. Joe Manchin is the man of the moment. The sponsorship of a member who has shown an uncanny ability to survive as a Democrat in the Trumpiest of states bolsters any legislation. And the opposite has also become true. Recently, Manchin pared down the ambitions of outgoing President Trump and some Democrats for a more bountiful COVID-19 relief package. And Manchin’s swing vote opposition sundered the Cabinet hopes of former Office of Management and Budget director nominee Neera Tanden.

Finally, the lingering problems that gave rise to Trump in the first place are on the minds of Democrats and Republicans alike. His restoration is a bipartisan fear as America enters another period of establishment rule.   

about the author

Curt Mills is Senior Reporter at TAC covering national security, the Biden White House and the future of the Republicans. He has reported for The National Interest, U.S. News & World Report, Newsweek, Washington Examiner, UnHerd, the Spectator, among others. He was a 2018-2019 Robert Novak Journalism fellow, and has been a fellow at Defense Priorities and the Claremont Institute. He is a native and resident of Washington, D.C.

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