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 last 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.