HELENA — In dramatic fashion, Senate Democrats and a handful of Republicans Tuesday defied the body’s GOP leadership to cram a Medicaid proposal into a bill that would use federal dollars to buy private health insurance for thousands of uninsured, low-income Montanans.
The same coalition then endorsed the measure on a 27-23 vote, setting up a final vote Thursday and a possible showdown in the state House over whether the contentious Medicaid proposal may head directly to Democratic Gov. Steve Bullock for his signature.
“Given how things work around here, nothing is certain,” said Sen. Dave Wanzenried, D-Missoula, who led the charge to amend the bill on the Senate floor. “But I think the bill works the way that it is now.”
If the positive Senate vote on House Bill 623 holds up Thursday, the Republican-controlled House would then decide whether to accept the bill in its current form and send it to the governor for his approval.
If not, the measure would go to a House-Senate conference committee, where anything could happen — including the death of the bill.
A series of razor-thin votes in the Senate Tuesday marked the latest chapter in the 2013 Legislature’s bitter battle over whether to substantially expand Medicaid, the state-federal program that pays medical bills for the poor.
Most of the Legislature’s Republican majority, including its leaders, have been adamantly opposed to the Medicaid expansion, saying it will expand a welfare program and ruin the state financially.
“Are we going to go down the slippery slope, and be like Greece?” asked Sen. John Brenden, R-Scobey, during debate on the bill Tuesday afternoon. “How much more can we afford? The government will bail us out? Well, who’s the government? We are. This bill will bankrupt the state with costs that you won’t believe.”
Yet a core group of five Republican senators teamed up with the chamber’s 21 Democrats Tuesday to amend and pass the Medicaid bill — and also win a critical fight over Senate rules to allow the amendments in the first place.
One of them was Sen. Ed Buttrey of Great Falls, who said the proposal does not expand Medicaid but rather simply would use the expanded federal Medicaid money starting next year to buy health insurance for thousands of Montanans earning less than 138 percent of the federal poverty level — about $15,400 for a single person.
“There’s a section here (in the bill) that ensures it can never become Medicaid expansion,” Buttrey said. “This is not Medicaid expansion. If it expands anything, it’s the private-sector insurance exchange.”
In its current form, HB623, sponsored by Rep. Liz Bangerter, R-Helena, directs the state to ask for federal approval to use federal Medicaid dollars to pay for private health insurance. It says Montanans who meet the income requirements also must be working or actively seeking work.
Bullock originally proposed expanding Medicaid, with federal money, to provide the coverage directly to 70,000 Montanans. Republican-controlled legislative committees have killed that proposal, but the governor said recently he’s open to other options.
On Tuesday, he hailed the Senate vote as “a victory for job creation, reform of our health care system and access to affordable health care for our friends and neighbors.”
“Montanans from every corner of our state have been asking the Legislature to take action, and I thank the courageous senators who put politics aside to do right by their fellow Montanans,” he said in a statement.
HB623 started out as a Republican alternative to Medicaid expansion, proposing to use state money to help poor Montanans get on health insurance exchanges, which are Internet marketplaces where people can buy private insurance with the help of federal subsidies.
On the Senate floor Tuesday, Wanzenried proposed a 19-page amendment that rewrote the bill to use the federal Medicaid money for essentially the same purpose.
Sen. Jason Priest, R-Red Lodge, immediately challenged the amendment as invalid, saying it didn’t fit within the title of the bill. The Republican-controlled Senate Rules Committee met and decided he was right, on a 9-6 party-line vote.
But moments later, in an extremely rare move, the full Senate voted 27-23 to overturn the Rules Committee. Buttrey and fellow Republican Sens. Taylor Brown of Billings, Bruce Tutvedt of Kalispell, Llew Jones of Conrad, Jim Peterson of Buffalo and Ron Arthun of Wilsall joined 21 Democrats to allow the amendments to be considered.
A tense, sometimes acrimonious debate on the amendments and bill followed, leading to a pair of dramatic votes.
Priest called the bill “a back door to Medicaid expansion” and said it was part of a “deal” struck by its supporters — a remark that prompted the day’s chairman, Sen. Jon Sonju, R-Kalispell, to gavel him out of order, after Democrats objected to Priest’s comment.
Senate Majority Leader Art Wittich, R-Bozeman, ripped into the proposal, saying the bill had been “hijacked” and was a ticket to government-controlled health care.
“I feel like I’m in an 'Alice in Wonderland' world, where up is down and down is up,” he said. “`Oh, this isn’t expansion?’ Here’s what’s going to happen, folks: Everything in health care is eventually going to be a government facility, with government employees."
Sen. Eric Moore, R-Miles City, accused fellow Republicans of betraying voters to whom they’d promised that they wouldn’t support or expand “Obamacare.”
Brown, Buttrey, Jones, Peterson and Tutvedt and all Senate Democrats voted for the amendment that overhauled the bill, approving it 26-24, and Sen. Alan Olson, R-Roundup, joined the same five Republicans on the final vote for the bill.
Wanzenried said afterward that he thinks some senators responded to public support for the proposal, expressed in the past few weeks.
“There were a lot of people watching and tuned in last night,” he said, referring to a hearing on his similar proposal in a House committee, which declined to act on the bill. “Between the time that hearing ended and noon today, I had almost a thousand emails. …. Most of them were for doing something with Medicaid dollars for the state.”