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MEDICAID EXPANSION STATES

The Montana lawmakers who decide health care budgets and policy for our state are well covered themselves.

Under state law, each of our 100 representatives and 50 senators is entitled to the same insurance benefits as a state employee. The Gazette requested information from the Montana Department of Administration on the legislators' insurance benefits and learned that:

  • For a $30 per month premium, a legislator gets medical, prescription medication, basic vision, dental and basic life insurance.
  • Among 150 lawmakers in the 2019 session, 105 have enrolled in state plan benefits.
  • The state of Montana contributes $1,045 each month for each legislator's coverage.
  • The 45 lawmakers who waived state plan coverage may still be reimbursed up to $1,054 per month for premiums the legislator pays for certain types of disability and life insurance.
  • The legislators are eligible for these benefits for all 24 months of their House term and all 48 months of their Senate term.
  • State employees are eligible for the state plan benefits at $30 per month premium if they work 20 or more hours per week and are considered regular, temporary or seasonal employees.

We are pleased that our elected representatives have access to comprehensive health insurance year round. We think every Montanan should have uninterrupted access to affordable, quality health care so it is available when they need it.

Until the Affordable Care Act took effect, 20 percent of Montanans under age 65 had no health insurance; it was one of the highest uninsured rates among the 50 states. Then some low- and middle-income Montanans got affordable private insurance through the ACA marketplace, and the uninsured rate decreased slightly. Montana launched its Medicaid expansion on Jan. 1, 2016, and cut the uninsured rate to about 7 percent.

This has been a great benefit to very low income adults, including parents, caregivers and folks needing mental health or addiction treatment. Most Montana hospitals saw a decrease in their charity care and bad debt write offs since 2016. The change was especially critical for small rural hospitals that had operated with negative margins and local subsidies.

Lawmakers are entitled to 24 months of insurance coverage, although they only have to work 90 days every two years. They also receive a modest salary and per diem during the session.

Yet some Republican lawmakers insist that the poorest among us must prove that they worked 20 hours every week to maintain their taxpayer-funded health insurance. Over the next several weeks, our legislators will decide the fate of the 96,000 low-income Montana adults now covered by the state's 2016 Medicaid expansion. If the Legislature does nothing, Medicaid expansion will expire July 1.

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On Feb. 7, Rep. Mary Caferro, D-Helena, introduced House Bill 425 that would remove the sunset provision and continue the successful Montana HELP program. On Tuesday, Rep. Ed Buttrey, R-Great Falls, introduced House Bill 658 that includes requirements for Medicaid expansion enrollees to work at least 20 hours a week, and for all 96,000 of them to report their work hours or exemption quarterly, along with filing various new forms and passing an "assets test." Both Caferro's and Buttrey's bills are scheduled for a committee hearing on Saturday.

This work requirement fixation persists despite data showing that the vast majority of Montana enrollees already work and that employment among Montana's low-income workers has increased since Medicaid expansion started. Montana already requires Medicaid expansion enrollees with income above poverty level to pay 2 percent of their monthly income as a premium.

Legislators, don't deny your constituents the health care access that taxpayers provide for you. Vote to renew the HELP Act — without mandating more bureaucracy.

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