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Americans often complain about how far Washington debates seem to be removed from the lives of real people. But Washington’s health care debate and the nation’s opioid crisis became quite real to me in new ways after a city councilman in the Ohio town where I grew up made national news by raising a provocative question: Does the city have to respond to calls from repeat opiate overdose patients?

Morality aside — and that’s pushing a lot aside — that’s a good question, especially in a town whose local governmentis struggling to make endsmeet.

Middletown, Ohio, my old hometown, is faced with that challenge. The oncethriving factory town that I recall has become a textbook case of postindustrial job loss. With that, it has one of the highest opioids overdose rates in a state whose overdose rate currently ranks fourth nationwide, according to the Centers for Disease Control and Prevention.

The city of about 50,000 has already seen almost 600 overdoses so far thisyear. That’s more than all of 2016. Ambulance crews say they’re responding to as many as four or five calls a day.

And the cost is soaring. Addiction treatment programs cost more than $2 million, or 10 percent of the city’s annual tax revenue, spokesmen say.

Fearing a fiscal train wreck, Councilman Dan Picard has asked the city’s law department to investigate whether the city has a legal obligation to respond with ambulance service to repeat opiate overdose patients.

If it does not, Picard has informally suggested a three strikes policy: The first two times that someone overdoses, they would have to pay the city back for the cost by performing community service. If they overdose a third time without having repaid their debts from the first two, no ambulance would come.

That’s pretty drastic. The thought of barring ambulance crews from an overdose patient who hasn’t paid all of his or her fees reminds me of another unsettling story. Back in 2010, network news showed firefighters in rural Obion County, Tenn., who were ordered to stand aside and let a home burn to the ground. The homeowner hadn’t paid a $75 fee to receive fire coverage provided by the nearby town of South Fulton.

But Picard’s suggestion quickly went viral, attracting “hate mail, national news coverage and overloaded voice mail and email in-boxes,” wrote city manager Doug Adkins in his blog.

Except, Adkins went on to point out, “nothing has changed ... at all ... whatsoever. We are responding to every call and rendering aid as needed. We give Narcan where it is appropriate. Period.” Narcan, also known by the generic name Naloxone, blocks the effects of opioids in overdose patients.

Yet one of the reasons why Picard’s idea went viral is that it coincided the Senate considering a Republicanbacked measure to repeal and replace the Affordable Care Act, also known as Obamacare.

In his quest to secure 51 votes, Senate Majority Leader Mitch McConnell added $45 billion in additional funding to combat the opioid crisis. The move aimed to attract the votes of moderate Republican Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

The initial version of the bill provided only $2 billion in state grants to address the crisis. But both Portman and Capito were even more concerned about the deep cuts that original legislation would make to Medicaid, cuts that the Congressional Budget Officeestimates would take $772 billion from Medicaid and coverage away from 15 million people.

Ohio’s Republican Gov. John Kasich said last week that he warned Portman that even the $45 billion wouldn’t come close to making up for the damage caused by the Medicaid cuts in the bill.

An earlier analysis by Richard Frank and Sherry Glied of New York University also estimated that the Senate Republican bill would cost 2.8 million Americans help with their drug use disorders and almost 1.3 million with serious mental disorders, if those Obamacare benefits were not restored.

That puts Congress in a position not unlike leaders back in Middletown and other towns in similar predicaments. Both have to make life or death decisions about their resources in the face of an opioid crisis, except the local folks happen to live and work closer to those who need the help.

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