MORGANTOWN, W.Va. — Shelley Moore Capito is the most popular politician in a deep-red state that loves President Donald Trump and distrusts big government. And yet the West Virginia Republican is threatening to torpedo the GOP’s best shot at dismantling Obamacare, one of Trump’s top domestic priorities.

The first-term senator has emerged as one of the staunchest holdouts against Senate Republicans’ bid to overhaul the nation’s health care system, voicing concerns about the bill’s consequences for older Americans and rejecting swift funding cuts for a Medicaid program that’s played a key role in combating her state’s opioid epidemic.


Those objections, voiced by at least a half-dozen other moderate Republicans, foiled Senate leadership’s plans to speed a repeal bill to a vote. And it’s left Majority Leader Mitch McConnell just weeks to end a deepening impasse, with no signs that the weeklong July Fourth recess has brought the GOP closer to uniting its conservative and moderate factions around a repeal plan.

But if Capito is feeling the heat in a state that Trump won by more than 42 percentage points, she isn’t showing it. Back here in West Virginia, where more than 30 percent of families rely on Medicaid, she doesn’t hesitate at the prospect of casting the vote that kills the GOP’s repeal effort.

“I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” the 63-year-old lawmaker said in an interview. “So that gives me strength. If I have to be that one person, I will be it.”

Capito’s resolve illustrates how intractable the debate over replacing Obamacare has become for a Republican Congress nearly seven months into a repeal effort that GOP leaders initially hoped would take just weeks.

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Her record, meanwhile, illustrates why Republican leaders thought they could get repeal done quickly: Capito voted more than 40 times to dismantle Obamacare as a House member. As West Virginia transformed from a Democratic stronghold into a reliably Republican state, Capito won her Senate seat in 2014 by one of the largest margins in state history. The following year, she voted with virtually all Senate Republicans for a bill repealing major parts of Obamacare — without a replacement — that they knew President Barack Obama would veto.

Capito remains perhaps the most well-liked and politically secure lawmaker in a state where more than two-thirds of voters backed Trump for president, polls show. And yet, with the GOP on the precipice of tearing down Obamacare, she appears further than ever from budging on the Senate bill.

West Virginia has big health care problems, she said, and the GOP’s current proposal doesn’t do enough to address them, even after Republican leaders agreed to earmark $45 billion over a decade to fight the opioid crisis. Addiction experts say that sum falls well short of what’s needed to reverse the epidemic.

Capito harbors deep concerns about rolling back funding for Obamacare’s Medicaid expansion amid the opioid epidemic. More than 40 percent of funding for drug abuse and mental health treatment in the state comes from Medicaid expansion covering low-income adults.

She’s also alarmed at projections that the legislation could leave thousands more in West Virginia without coverage or paying far more for it. West Virginia has long ranked among the country’s sickest states, placing near the bottom in life expectancy as well as obesity and tobacco use. But it’s what’s happened over the past few years, as heroin swept across the state and created a full-blown health emergency, that complicated Capito’s path to “yes” on any repeal bill.

In 2015, West Virginia counted 725 fatal drug overdoses, the nation’s highest rate by far. That number climbed to 879 last year, the vast majority of which involved at least one opioid.

“We are the No. 1 state with the problem of heroin addiction and opioid addiction,” said Kevin Knowles, a Martinsburg city councilman.

Knowles became the area’s first recovery-services coordinator last year, taking on responsibility for connecting residents with rehab facilities, running support groups and serving as the primary lifeline for addicts across hundreds of square miles in the state’s easternmost region. He runs the operation on a $70,000 annual grant — just enough to hire two additional employees.

Martinsburg and surrounding Berkeley County are among the state’s hardest hit by an opioid epidemic that’s spread indiscriminately through the community. Last summer, a candidate for Berkeley County sheriff needed to be revived twice in 12 hours from apparent opioid overdoses.

The GOP repeal effort “would affect this state tremendously, in a negative way,” said Knowles, a Democrat.

Outside his office, Knowles erected a Christmas tree over the holidays on which residents could hang ornaments memorializing friends and family lost to addiction. More than 50 ornaments now hang there, each bearing at least one name.

State and federal resources for the opioid fight here are already stretched thin. There are no treatment centers within a three-hour drive, and finding recovery facilities willing to take uninsured patients suffering from addiction is incredibly difficult. If Medicaid’s expanded coverage is rolled back and the program’s funding is capped as part of the GOP’s repeal bill, addiction counselors worry the area will lose what grant money it does receive to fight the drug crisis.

“It does come down to money,” said Peter Callahan, a psychotherapist who’s heading an effort to build a detox center in Martinsburg. “We’re close to D.C., we’re close to Baltimore, and we have no services.”

In Cabell County to the west, Huntington Mayor Steve Williams estimates it would take $100 million a year to adequately fight opioids in just his county alone.

“We have the single largest public health policy crisis in the nation,” said Williams, a Democrat and a fierce critic of the Senate bill. “You’re either all in, or if you’re anything less, then you’re all out.”

That Capito still opposes the repeal bill, even after Republican leaders added the extra funding for opioids, has heartened those trying to beat back the crisis. And so far, even Republicans in the state are holding off going after one of their own.

“I think Sen. Capito is finding the best approach,” West Virginia GOP Chairman Conrad Lucas said, adding that he believes Capito recognizes how important it is for the state that Republicans dismantle Obamacare.

But Capito is questioning whether Republicans can pass a bill on their own. On Thursday, after a long day with Democratic Sen. Joe Manchin as they accompanied Energy Secretary Rick Perry around the state, she made a case for working with Democrats on a compromise bill focused on fixing the health care system’s flaws. McConnell last week also suggested Republicans could soon turn to fixing Obamacare — presumably with help from Democrats — if they can’t repeal it.

“Collaborating with Democrats on the other side, to me, is not an exercise in futility,” Capito said, noting that she has spoken with Manchin and other Democrats about tackling health care together. “That may be where we end up, and so be it.”

Speculating further than that, she added, is premature. Senate Republicans could quickly strike a deal, pass a bill and follow through on their seven-year repeal pledge before the month is out.

“I think that remains to be seen,” Capito said. “That’s the eye of the needle, and I think it’s being tried to be threaded. But I’m not sure.”