There’s little sign of budging on either side of the Medicaid expansion debate as lawmakers prepare to hear dueling proposals to continue the program in an all-day session Saturday.
Medicaid expansion is expected to be one of the major issues of this legislative session. The program extends Medicaid coverage to those who earn up to 138 percent of the federal poverty level and was put into place by lawmakers in 2015 with a sunset of this summer.
Some Republicans, the majority party in the Legislature, want to see work requirements added to the program that provides health insurance to more than 96,000 Montanans.
That’s included in a bill from Rep. Ed Buttrey, a Republican from Great Falls, in addition to more stringent requirements and testing of a person’s financial means to qualify for coverage. That's House Bill 658.
More conservative members of the party are opposed to expansion in any form.
That means Democrats need support from the so-called Conservative Solutions Caucus, a group of about 20 Republicans who have shown a willingness to support Medicaid expansion. Buttrey is a part of that group. In the House, 18 Republicans are already co-sponsoring Buttrey's bill and nine in the Senate have signed on.
Democrats have their own version of a bill to extend Medicaid expansion, which will expire June 30 unless lawmakers act this session. Helena Democratic Rep. Mary Caferro’s proposal will continue the program much in its current form, adding more money for a voluntary workforce development program.
Both bills will be heard by the House Human Services committee in a hearing that starts at 9 a.m. Saturday and is expected to run into the evening hours.
Democrats have said they’re frustrated it took so long to get to this point. The GOP bill wasn’t introduced until Tuesday, while Democrats dropped their bill Feb. 7. Buttrey said his bill took so long because he was getting a lot of input and frequently updating the legislation.
Studies based on early drafts of Buttrey’s bill estimate thousands could lose coverage under work requirements. The bill has been updated since then, with the biggest revision to allow for self-reporting of hours worked.
Another study released Thursday, based on the bill as it was introduced earlier this week, estimates about 50,000 to 56,000 of people could lose coverage. That’s about 52-59 percent of people on the program.
The study was done by the Milken Institute School of Public Health at George Washington University and funded in part by the Montana Healthcare Foundation, which supports expansion.
But Thursday Buttrey said his bill is still being changed, even as it heads toward a hearing, in ways that would address concerns about how many people could lose coverage under work requirements. Buttrey did not clarify what those changes are.
Because Buttrey’s bill was not introduced until Tuesday, it does not yet have a fiscal note. That’s a document produced by the governor’s Office of Budget and Planning that estimates financial effects of the bill and would predict how many people could lose coverage.
"We are already making changes to the bill that I think will alleviate anything that is on the fiscal note," Buttrey said, anticipating what that note might say and pointing out it's prepared by the Democratic governor's staff. "We're always trying to make it better and I think by the time we get to executive action we're open to ideas that people have. I believe it will be the bill to continue the program."
The House Human Services Committee is expected to vote if it will send Buttrey and/or Caferro’s bill to the full House on March 22. It could send both, just one or neither.
Rep. Dennis Lenz, a Billings Republican who chairs the committee, said he’s frustrated at how long it took to get Buttrey’s bill, pointing to issues such as the lack of a fiscal note.
“I’m not happy about it at all,” Lenz said Thursday. "I'm not angry about it, but I wish it would have come out earlier."
The timeline going forward will be more deliberate. Lenz said it will be the Republican party’s game plan to hold off on sending a Medicaid bill — which they predict to be Buttrey’s legislation — to Gov. Steve Bullock until the final days of the legislative session.
That could force Bullock into a position of either signing the bill, vetoing it or calling lawmakers back into a special session to make changes.
"That would be the goal is to push it up to the last day when you're sine die-ing," or adjourning, Lenz said.
House Minority Leader Rep. Casey Schreiner, of Great Falls, objected to that tack.
“I think that’s a great example of irresponsible use of playing politics with the health care of the people of Montana,” Schreiner said. “I would hope there is a little bit more want for this process to be expedited. They've already been slow as it is."
Bullock also said Thursday he's concerned about that possible outcome.
"It's really unfortunate Republicans choose to play Russian roulette with health care for 96,000 Montanans. I hope they will get a bill to me that protects coverage and rural hospitals and get it to me early," the governor said in a statement.