– Even as deaths by opioid overdose rise in Minnesota and around the county, treatment advocates and public officials in the state are looking to Washington with concern that federal spending reductions under President Trump and the Republican Congress could damage efforts to stem the crisis.

The U.S. Senate’s Republican-sponsored health care overhaul, publicly unveiled Thursday and up for a full Senate vote as early as next week, includes major rollbacks in Medicaid funding in the coming years. Medicaid is the nation’s largest insurer for addiction treatment services; the GOP proposal would also lift an Affordable Care Act mandate that insurers cover substance abuse treatment as an essential benefit.

“This is health care: you get treatment, you bill your insurance for it and they pay for it,” said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. “When you have a set amount of money, what happens when that’s gone?”

Abderholden along with allies from Minnesota and other states are traveling to Washington this week where they plan to lobby Congress on the health care bill.

Among Minnesota’s congressional delegation and more widely among the country’s elected officials, there’s been bipartisan support for a heightened federal response to opioid abuse. Earlier this month, Republican U.S. Rep. Erik Paulsen participated in a hearing of Congress’ Joint Economic Committee on the economic effects of the crisis. He said he’d recently spoken to a mother from Maple Grove whose son died after taking a fentanyl analogue that he bought online. She was devastated by how easy it had been to buy the drug, Paulsen said.

“There is a role for Congress to play to make sure that opioids are not so easily accessible,” Paulsen said at the hearing.

But Democratic U.S. Sen. Amy Klobuchar said the GOP health care bill raises concerns of falling federal support for treatment. While the bill would set aside $2 billion to treat people with substance use or mental health disorders, Klobuchar said that wouldn’t make up for the Medicaid reduction; in Minnesota, the program covers 32 percent of the cost of opioid addiction treatment. The issue “has become front and center in the debate on health care,” Klobuchar said.

Trump campaigned on curbing the exploding opioid epidemic, which killed more Americans last year than car crashes. In Minnesota, 402 people died from opioid related deaths last year, up from 344 a year earlier. The president formed the Commission on Combating Drug Abuse and the Opioid Crisis to study the issue, vexing some drug addiction treatment advocates who said the problem had already been extensively researched.

Klobuchar met this spring with New Jersey Gov. Chris Christie, the panel’s leader, to advocate for more aggressively limiting and monitoring the prescribing of opioids. The commission held its first meeting on June 16 and is scheduled to make recommendations to the Trump administration next week.

Hennepin County alone saw 153 people die last year from opioid and heroin overdoses, said Sheriff Rich Stanek. He’s been to Washington to brief federal lawmakers and other officials on Minnesota’s drug problems, and believes the Trump administration takes the problem seriously.

“Law enforcement is very pleased with the level of engagement that the Trump administration has had with our leadership,” Stanek said.

But Mark Thomas, director of the University of Minnesota Center for Addiction Neuroscience, is concerned about Trump’s proposal to cut $5.8 billion from the National Institutes of Health (NIH). He said faculty members at the center receive between $10 million and $12 million a year in research funding from the National Institute on Drug Abuse, which is part of the NIH. Thomas said addressing the opioid epidemic will require more biomedical research on evidence-based brain therapies.

“It’s a change in the brain that produces this uncontrolled drug-seeking and we need to know more about that so we can disrupt it,” Thomas said.

In February, Klobuchar teamed up with a bipartisan group of colleagues to sponsor a bill to curb shipments of dangerous synthetic drugs over the U.S. border. She also co-sponsored legislation to require prescription drug monitoring programs to track data between states.

“I think we could get it done quickly if the administration came behind our bills, but that hasn’t happened yet,” Klobuchar said.

One of Klobuchar’s GOP cosponsors, Sen. Rob Portman of Ohio, has been pushing for a much higher level of federal spending on opioid treatment in the Senate health care bill: $45 billion over the next decade. The level of spending on opioid treatment has emerged as a fault line among Republicans as their congressional leaders try to assemble the votes needed to pass their legislation.

In Minnesota, health care leaders wrote to Klobuchar and fellow Democratic Sen. Al Franken that Minnesota could lose $2 billion in Medicaid funding by 2021 under the Senate legislation, which is similar to the health care overhaul passed by the House in May.

Nick Motu, a vice president of the Minnesota-based Hazelden Betty Ford Institute for Recovery Advocacy, said he’s not against replacing the Affordable Care Act — as long as there remains a guarantee of medical coverage for addiction treatment. He and other colleagues have targeted 35 congressional leaders to speak with about addiction issues when visiting Washington for a town hall on opioids in July.

“The problem is there’s so much clutter, so much noise coming out of D.C. right now,” Motu said. But, he added, “We still have confidence that the addict is not going to be forgotten here.”