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Republicans want Medicaid expansion without additional costs

FILE - In this Jan. 8, 2019 file photio, Rep. Ed Buttrey, R-Great Falls, talks during a House Rules Committee meeting in Helena. An early version of a bill Buttrey is working on to continue Medicaid expansion in Montana without increasing costs to taxpayers involves increasing some individuals' premiums, collecting fees from tax-exempt religious corporations and taxing hospitals that benefit from the infusion of federal money. (Thom Bridge/Independent Record via AP, File)

Nearly every legislator in Helena agrees: We need to keep Medicaid expansion in Montana. 

But not every legislator agrees how that should be done.

Nearly one in every 10 Montanans depends on Medicaid for dependable, affordable health care. Medicaid expansion has not only been a boon to individuals who now have access to a doctor in a non-emergency, non-catastrophic manner, but it has also been a blessing to employers who may not have been able to afford healthcare coverage to all staff. 

Most state lawmakers also realize that eliminating the program, which draws $600 million to the state, would damage the economy, and potentially leave Montanans who can't afford healthcare in dire shape.

Beyond agreeing that Medicaid should stay, though, there is plenty of debate about whether changes should be made to the program.

Many Democrats argue that few changes are needed because 1-in-10 Montanans using the program demonstrate it's working. Also, the percentage of covered Montanans with health insurance has also increased.

Meanwhile, Republicans want to see the program maintained, but want to put some other requirements on its eligibility, including an asset and means testing, a work requirement, and possible drug testing.

We have to wonder: Where's the proof it isn't working and more bureaucratic hoops need applying? After all, we see every evidence that it is working well. Nearly 100,000 Montanans now have reliable insurance. What's more is that the federal government picks up about 85 percent of the funds for the program, while Medicare, also a federal program, would only cover about 65 percent. 

We have concerns about the ideas that GOP lawmakers are floating to continue the program because we don't understand what problems they're trying to fix. In other words, where's the evidence that there's fraud or deception? In testimony so far, lawmakers have been unable to prove that people who are on the program should not be.

We are concerned that asset and means testing is imperfect, and could make administering the program even more paper-heavy. For example, someone who owns farmland or other non-liquid assets may not be able to afford health insurance, and may need the land to live. And, we'd point out agriculture as an industry is the state's largest economic sector. 

We also believe that lawmakers should take a hard look at the number of people on Medicaid who don't work and why they don't.

According to a 2017 Kaiser Family Foundation report, about three percent of Medicaid recipients do not work for "other" reasons. Six percent are currently looking for work. The remaining 91 percent have reasons that range from being ill, disabled or taking care of family members. Fifteen percent are on Medicaid because they're going to school, ostensibly being trained to get a job so that they wouldn't have to rely on Medicaid. Nearly one-in-three say they're on Medicaid because they're attending to another family member who can't care for themselves.

In other words, the problem of non-working Medicaid recipients is really a non-problem. 

We also wonder about drug testing for Medicaid. While we don't condone drug usage, we wonder how large of a problem this is. And, is the state or federal government willing to conduct drug testing at an estimated cost of $50 per test per person? And even if a person tests positive for drugs, is that reason enough to kick them off health insurance?

Kicking people off Medicaid -- if that's the goal -- means they won't have insurance. It doesn't mean they won't need medical services. And if they don't have medical services, they will force hospitals to treat them in the emergency rooms at very high expense without any reimbursement. For a community like Billings, which thrives on its healthcare, any loss to our hospitals is a loss to the local economy.

In addition to the $600 million the expansion has added to the economy, it has also seen more than 5,900 jobs added. Plus, the expansion has resulted in a net positive impact of $6.5 million to the state's coffers. 

Maybe the most impressive statistic from the report, issued by the University of Montana Bureau of Business and Economic Research, is that the labor force increased from 3.9 to 6.2 percent in the low-income category because workers now had insurance. In other words, some lawmakers' concerns that people who are on Medicaid don't work isn't just a fallacy, statistically, it's just the opposite. More people are going to work because they have health care. If GOP lawmakers concerned with the Medicaid expansion are really so concerned about Montanans staying in the workforce, they should do everything they can to keep the expansion.

For so long we had a broken system that saw more than one in every 10 residents in the state go without health coverage. That gap has shrunk, and economic research shows that what was once broke has been repaired, even if not completely fixed.

Either prove definitively that change is necessary, or keep Medicaid expansion as it is.   

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