Medicaid expansion bill survives – but GOP says it still won’t support expansion

2013-04-02T15:45:00Z 2013-09-02T08:26:13Z Medicaid expansion bill survives – but GOP says it still won’t support expansionBy MIKE DENNISON Gazette State Bureau The Billings Gazette
April 02, 2013 3:45 pm  • 

HELENA — In a dramatic turn of events Tuesday, a coalition of Senate Democrats and five Republicans resurrected and then narrowly endorsed a bill to expand Medicaid in Montana — but GOP senators supporting the move said they’re not for expansion.

Instead, they said they’re looking for a “Montana-made solution” to extend more affordable health coverage to the poor. The Medicaid expansion bill needs to stay alive as a possible vehicle for that solution, they said.

“What my constituents are saying is, they want to keep this discussion alive, they want a Montana solution to provide health care to our constituents … and at the same time, not create a long-term liability for the state,” said Sen. Jim Peterson, R-Buffalo.

Peterson was one of five Republican senators who joined all 21 Democrats in the Senate to endorse Senate Bill 395 on a 26-24 vote, advancing a measure that would expand federally funded Medicaid to cover 70,000 low-income, uninsured Montanans.

That vote set up a final vote that could occur as soon as Wednesday to send the bill to the House, which so far has bottled up Democratic Gov. Steve Bullock’s proposal to expand Medicaid.

Bullock praised the Senate’s action late Tuesday, saying a majority of senators “put politics aside and voted to create 13,000 jobs, provide affordable health care to 70,000 Montanans and reform our Medicaid system.”

Yet what may happen to that bill in the House remained unclear — as the House refused Tuesday, for a second time, to resurrect Bullock’s similar proposal to expand Medicaid.

“It is one of the most important policy debates, if not the most important policy debate, we’re going to have this session,” said House Minority Leader Chuck Hunter, D-Helena, in urging the House to bring his House Bill 590 to the floor for debate. “It really needs to be decided on by more than (10) members in this House.”

Ten Republican members of the House Human Services Committee had voted last Wednesday to kill the bill, on a 10-6 party-line vote.

On Tuesday, 15 Republicans in the full House joined 37 Democrats in voting to move HB590 from the committee to the floor for further action — but 60 votes are needed to remove a bill from a committee in the House, so the motion failed.

Minutes later, the House voted 60-40 to advance a different measure that Republicans have advertised as an alternative proposal that could help low-income Montanans buy private health insurance.

The flurry of votes Tuesday further muddied the political waters on Medicaid expansion, one of the biggest and most contentious issues before the 2013 Legislature.

Bullock and fellow Democrats want the Legislature to approve the expansion, which would provide government-funded health coverage for 70,000 low-income Montanans beginning in 2014.

Montanans earning up to 138 percent of the federal poverty level — $15,400 for a single person — would be eligible for Medicaid under the full expansion. The federal government has promised to pay virtually all of the expansion’s cost through 2016 and then gradually reduce its support to 90 percent by 2020.

Hospitals, physicians, other medical providers, the Montana Chamber of Commerce, unions and other business groups and businesses are supporting the expansion.

Most Majority Republicans, however, have opposed the expansion, saying it’s part of “Obamacare,” which they oppose, and will end up costing the state millions of dollars down the road.

A Senate committee had voted to kill SB395, an expansion bill, last week. But Tuesday, the full Senate took up the issue, with bill sponsor Sen. Dave Wanzenried, D-Missoula, asking the Senate to reject the committee recommendation and bring the bill to the floor.

On that vote, six Republicans joined 21 Democrats in defiance of Republican leadership, setting up a two-hour debate on the bill Tuesday afternoon.

Wanzenried and fellow Democrats said his measure would not only expand Medicaid but also enact reforms of the health care system. It’s also the only bill still standing that can extend Medicaid to as many as 70,000 Montanans who need affordable coverage, he said.

“I don’t want expansion without reform, but I don’t want reform without expansion,” he said. “If we choose to walk away from this, just south of 50,000 Montanans will have no health insurance whatsoever.”

Republicans opposing the measure said the reforms are not a serious effort, and that expanding Medicaid will put the state on the hook for multimillion-dollar obligations in the future.

“If this (bill) lives, that this becomes a leverage point at the end of the session,” said Sen. Jason Priest, R-Red Lodge. “This is a seriously weak effort in trying to hoodwink this body into voting for reforms that do not seriously reduce costs. … This is really a half-baked effort.”

Senate Majority Leader Art Wittich, R-Bozeman, also said that those supporting the measure were “lemmings about ready to jump off the cliff.”

Republicans who supported it, however, said they didn’t want to rely only on a separate measure, still in the House, as the only vehicle to reform Medicaid and perhaps make it easier for low-income Montanans to buy health coverage.

“I don’t support Medicaid expansion; I don’t think it’s a long-term solution,” said Sen. Ed Buttrey, R-Great Falls. “I don’t think we can afford it. But I can’t put my faith in one bill solving it. Because if that happens, we may do nothing. We’ve got to come out of here with a solution.”

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