For a state hit hard by a national heroin epidemic and one that’s fighting back with Medicaid expansion dollars, Ohio is home to one in six Americans who could lose access to drug addiction and mental health services if President Donald Trump and Republicans in Congress take another crack at repealing the Affordable Care Act.

Though the GOP replacement plan has stalled in the House, Ohio would have lost more than most for two reasons: it’s among 32 states that accepted Medicaid expansion as part of President Barack Obama’s signature health care law and opioid-related overdose deaths are twice as common in Ohio as the national average.

Health care economists Sherry Glied of New York University and Richard G. Frank of the Harvard Medical School estimate that 1.3 million Americans could lose mental health and drug addiction services accessed today through Medicaid-funded and private health insurance gained under the Affordable Care Act. That includes 220,000 Ohioans.

In short, 4 percent of Americans live in Ohio, which is home to 17 percent of ACA enrollees at risk of losing drug and mental health treatment under the failed GOP plan, largely because it would have begun unwinding Medicaid expansion in 2020.

Pro-repeal lawmakers led by Trump argued that the replacement plan, the American Health Care Act, would have given flexibility back to the states on how to spend federal health entitlements for the poor, which the nonpartisan Congressional Budget Office reckons would have been cut by $880 billion.

But there’s bipartisan consensus in Ohio that the plan would have devastated the poor, who consequently are the most likely to overdose, according to a recent analysis by the Akron Beacon Journal/Ohio.com.

Republicans deviate

Republican Gov. John Kasich supports repealing the Obama-era health care program. But he said it must be achieved through Democrats and Republicans working together, and without leaving tens — if not hundreds — of thousands of low-income Ohioans with no access to drug addiction treatment.

“Phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug addicted, mentally ill and working poor who now have access to a stable source of care,” Kasich said this month.

U.S. Sen. Rob Portman of Cincinnati joined three fellow Republicans in petitioning Senate Majority Leader Mitch McConnell of Kentucky to reject the GOP plan as drafted. In the face of tea party conservatives demanding austerity and deep cuts to entitlement programs, Portman has advocated more funding to fight drug addiction. He said the GOP plan “could result in a reduction in access to life-saving health care services” for Medicaid recipients, “especially those with opioid and mental health treatment.”

It’s unclear if Trump and Republicans controlling Congress will move onto tax reform or take another swing at the repeal plan, produced in a month to replace a Democratic health care law negotiated over a year.

White House Budget Director Mick Mulvaney threatened Thursday that Trump would abandon the ACA repeal effort if the House failed to act, thus abandoning a major GOP campaign promise to undo the Affordable Care Act. Republicans touted that pledge in the past three federal elections, shifting the balance of political power to the right in Washington and state capitals.

Democrats fight back

Ohio Democrats, meanwhile, have emphasized that GOP plans to repeal Obama’s health care program will hurt the state’s fight against addiction.

Sen. Sherrod Brown of Cleveland underscored the issue in a confirmation hearing for Georgia Gov. George Perdue, Trump’s pick to head the U.S. Department of Agriculture.

“My state has more opioid deaths than any other state in the country,” Brown said. “There are 200,000 — right now, there are 200,000 — Ohioans that are getting opioid addiction treatment that are on the Affordable Care Act. I know that’s not your issue, though it’s your party’s issue and the president’s issue. If something happens and that insurance is taken away, as it would be with the House bill for all those people who have opioid addictions and are getting treatment, I would ask you if you would you go back to [Office of Management and Budget] and the White House to protect funding used in the battle against opioid addiction in rural Ohio and rural America?”

“The sad thing about that as you well know, Senator,” Perdue replied, “is that much of this is in rural areas of despair. So I will obviously be an advocate for the betterment.”

On a call with reporters Friday morning, Congressman Tim Ryan of Niles joined the mayor of Chillicothe and a Franklin County commissioner — both Democrats — and Dr. Matthew Noordsij-Jones, who has advocated for single-payer health care in the past, to highlight the ACA repeal’s impact on addiction treatment.

Also Friday, days before her departure from the Ohio House to serve as deputy law director for Summit County, Akron Democrat Greta Johnson wrote a “Dear John” letter criticizing Kasich for not declaring the opiate epidemic in Ohio an emergency.

“Last week in my district, two children, aged two and six, overdosed on opioids in separate incidents,” Johnson wrote in calling Kasich a hypocrite for demanding federal funding at least remain at its current level while not putting more of the state’s $2 billion rainy day fund into his budget to fight addiction. “What will it take for this state to take a unified approach to stop talking about it and start doing something about it?”

Doug Livingston can be reached at 330-996-3792 or dlivingston@thebeaconjournal.com. Follow on Twitter: @ABJDoug .