HELENA — A leading Republican lawmaker Tuesday unveiled his proposal to revamp and expand Medicaid coverage for the poor in Montana — but said it wouldn’t accept additional federal dollars offered to the states under Obamacare.
Senate Majority Leader Art Wittich of Bozeman said under his plan, most of the 125,000 low-income people covered by Medicaid would get free primary care at federally funded health clinics or contracted physicians, who would be paid a set fee for each patient in the system.
This managed-care system would create cost savings that could be used to expand Medicaid coverage to currently ineligible parents of children in some low-income families, he said.
Childless, able-bodied adults earning below 100 percent of the federal poverty level still would be without Medicaid coverage, but could get access to subsidized, private health insurance policies if they got a job, Wittich said.
“If they’re able-bodied, that says they are able to work, and they should go work,” he said. “This isn’t supposed to be a new welfare program. … We want to incentivize people to work.”
For those without coverage and who earn between 100 percent to 400 percent of the federal poverty line, federal subsidies are available to help them buy private insurance.
Wittich offered his plan as a possible compromise to Democratic wishes to accept federal dollars to expand Medicaid coverage to everyone in Montana earning less than 138 percent of the federal poverty level ($16,100 a year for a single person).
“(Democrats) took an all-or-nothing approach (in 2013), and they got nothing,” he said. “I hope there is a lesson there, and they’ll try to work out some cost-effective reform.”
The 2013 Legislature, controlled by Republicans, rejected Medicaid expansion — leaving many people below the poverty line with no access to low-cost or free health coverage. Republicans are expected to control the 2015 Legislature as well.
The federal health care overhaul passed by Congress in 2010 initially required all states to expand Medicaid to cover everyone earning up to 138 percent of the poverty line.
But a 2012 U.S. Supreme Court decision made Medicaid expansion optional for each state.
Democratic Gov. Steve Bullock has said he’ll propose a new Medicaid expansion plan to the 2015 Legislature but has yet to reveal details.
On Tuesday, the Bullock administration and a Democratic lawmaker working on Medicaid issues said they don’t see much to support in Wittich’s plan.
Kevin O’Brien, Bullock’s deputy chief of staff, said Wittich’s plan would “leave thousands of veterans and working-poor Montanans without health care while continuing to send millions of our tax dollars to other states.”
Rep. Tom Woods, D-Bozeman, who met with Wittich Tuesday, said he’s pleased that Wittich “recognizes that a coverage gap exists, and he wants to do something about it.”
Yet Woods said Democrats aren’t likely to support a plan that bars Medicaid coverage for childless, able-bodied adults below the poverty line.
Woods said he’s working on a plan that would create a state-run, “public option” health plan, and use the federal Medicaid-expansion funds to buy that coverage for those earning less than 138 percent of poverty. Those covered by the plan would have to make minimal co-pays for their medical care.
Wood said the plan would be offered to other health insurance consumers as well.
“It expands the scope of health care reform (and) would provide competition in the health insurance industry, which could bring costs down for everybody,” he said.
Wittich said his plan can help “bridge the gap” for coverage for low-income Montanans, and that insisting on a full Medicaid expansion could yield no plan at all.