HELENA — Once again, health care will be a contentious issue at the Montana Legislature — and the biggest battle is likely to be over whether Montana approves new, federally funded health coverage for 60,000 people in the state.
Most Democrats and health care providers are solidly behind the proposal to expand Medicaid for low-income Montanans in 2014, funded by the federal health-care reform bill.
“We’re talking about a billion dollars a year of new economic activity in the state, largely affecting the health care industry,” said incoming House Minority Leader Chuck Hunter, D-Helena. “I think that is a very telling story that is hard to ignore.”
Supporters of the expansion say it will improve people’s health, help the state’s economy and cut costs, because those with insurance are more likely to visit a doctor or clinic than show up at a hospital emergency room for high-cost care.
But they’ll be up against a Republican majority clearly skeptical, if not downright hostile, toward the idea of expanding government health coverage and the reach of “Obamacare.”
“I have to wonder about the wisdom of increasing reliance on a federal government that can’t seem to get its financial house in order,” incoming Senate President Jeff Essmann, R-Billings, said in a typical comment.
The federal government is funding nearly all the costs of Medicaid expansion from 2014 to 2017 and most of the costs for ensuing years. However, the state Legislature must approve the expansion and any state cost of administering it.
It’s estimated the expansion would bring $210 million a year in federal funds to the state over the next 10 years.
A wild card in the Medicaid and health care debate is Gov.-elect Steve Bullock, a Democrat, who has refused to say whether he supports expanding the program.
In an interview before Christmas, Bullock would say only that the Medicaid expansion may be a “great opportunity to look at how we’re actually providing medical services” and save costs. But he hasn’t offered any details on what he may propose or support.
Medicaid expansion won’t be the only health care issue before the 2013 Legislature. Other items on the agenda include:
-- Whether Montana should be able to review health insurance rate increases. State Auditor Monica Lindeen, who is Montana’s insurance regulator, is proposing a law to give her that power. Montana is one of only three states without such authority.
-- Bills to restrict liability for medical providers, making it harder to sue them for damages.
-- Adding more spots to the WWAMI program, which subsidizes costs for Montana students attending medical school in neighboring states.
On Medicaid, outgoing Gov. Brian Schweitzer has included the expansion in his budget proposals to the 2013 Legislature. A bill to enact the expansion is being drafted and would appropriate $5 million in state funds to administer it.
The expansion would offer government-funded health coverage to all people earning up to 138 percent of the federal poverty level, or $15,400 for a single household and nearly $21,000 for a two-person household.
Medicaid is the state-federal program that provides health coverage for the poor and disabled. It currently covers about 105,000 Montanans, mostly the elderly in nursing homes, pregnant women, children, and mothers with young children.
Most people added to Medicaid under the expansion would be childless, able-bodied adults with jobs, but with incomes below the eligibility threshold.
Sen. Mary Caferro, D-Helena, who supports the expansion, says lower-income workers who’d get coverage under the expansion are in industries like tourism, agriculture, retail sales and day care.
“These workers are the backbone of Montana,” she said. “They make Montana what it is.”
Among those supporting the expansion are hospitals, the Montana Medical Association and the Montana Primary Care Association, which represents health clinics that serve low-income citizens.
Health industry officials say extending new coverage to 60,000 people will improve citizens’ health by making it affordable for the newly covered to see a physician regularly, and cut down on charity care — the cost of which is now shifted to those who have insurance.
“(Physicians) believe getting appropriate health care at the right time, from the right person, is good overall for Montana,” said Jean Branscum, executive director of the MMA, which represents doctors. “It would move them into an environment where they could see a primary-care doctor, have a healthier life, lessen the cost-shifting and have more preventive care.”
Hunter says the money coming into the state from the federal government will also be a huge economic boost for Montana. If Montana rejects the money, it will go to other states, he adds.
“Why, as a businessperson, would you want to turn down the benefits of that, and let the other states around us enjoy in that boom?” he said.
Yet many Republican lawmakers are not convinced that the Medicaid expansion is a good idea.
Sen. Jason Priest, R-Red Lodge, who chairs the Senate Public Health Committee, says he’s surprised the hospitals and others in the medical community want to expand a program that they routinely complain is broken, because it doesn’t adequately reimburse them.
Expanding the eligibility for Medicaid also will encourage people not to work, so they can keep their income low enough to qualify for health coverage, he says.
“It’s a whole new group of people we’re making dependent on government and creating a disincentive to work,” he said. “It’s hard enough to find workers in this state right now.”
Priest says he’s not a “hard no” on the idea, but that supporters of the Medicaid expansion need to answer a host of questions, such as how much it will cost the state and how it might affect employers.