Medicaid expansion success meets legislative skepticism

Health coverage for 96,000 Montanans is in jeopardy. The only legislation that can keep their coverage going after June 30 was killed (for now) on a Thursday tie vote in the Senate with only four Republicans in favor of continuing the Medicaid expansion program. Attempts to reconsider that vote were defeated Friday 24-26, and again Saturday 24-26.

Senate Republicans have tried to tie the fate of the health care bill, House Bill 658, to Senate Bill 331, which was introduced to partially exempt NorthWestern Energy from Montana's consumer protection law. Even some GOP senators who are sponsors of HB658 voted against the bill last week. Both bills are now stalled as a Tuesday deadline looms for transmitting legislation between chambers.

SB331 was heavily amended in the House energy committee Friday afternoon, and passed out of committee. Those amendments were not posted on the legislative website as of Saturday morning, so the public could not see the changes. As reported in Saturday's Gazette, the House committee amendments appeared to eliminate the language that called for circumventing Public Service Commission scrutiny of costs that can be passed on to NWE's 370,000 Montana electric ratepayers. It's unclear why those amendments were made and if they will remain on the bill.

Eight former PSC commissioners (Democrats Tom Schneider, Greg Jergeson, Ken Toole, Bob Raney, Gail Gutsche and John Vincent and Republicans Brad Molnar and Travis Kavulla) joined Republican Commissioners Roger Koopman and Tony O'Donnell in expressing "grave concerns" about SB331 because it "puts the utility in charge of determining utility rates."

Now is the time to communicate with your legislators if you care about the health of Montanans and the cost of electricity for NWE customers.

Medicaid expansion simply made very low income Montanans eligible for coverage regardless of age or disability. Prior to 1996, Montanans between the ages of 19 and 64 couldn't get Medicaid even if they had zero income — unless they were pregnant or certified disabled. These folks still got sick and injured and came to their local clinics and hospitals for treatment they couldn't afford. So our Montana community hospitals and clinics provided care without compensation. Medicaid pays less than most private insurance, but Medicaid expansion reduced write offs and operating losses for most Montana hospitals. That is why our Montana community hospitals agreed to be taxed to cover the state's 10% share of Medicaid expansion treatment costs. Paying the tax means that hospitals as a group will get better compensation than they would if Medicaid expansion ends. With Medicaid expansion, the hospitals have less need to shift costs of uncompensated care to their privately insured patients.

On Saturday, The Gazette asked Bullock if he had agreed to link HB658 to any other legislation. "No, I've not agreed," he replied.

Bullock also pointed out that the failure of HB658 would create a $58 million hole in the biennial budget bill. Some of the 96,000 Montanans now covered by Medicaid expansion are also eligible for traditional Medicaid, which the state is required to fund at a rate of 35% of care costs vs. the 10% state share for the expansion enrollees. 

“I join Montanans across the state in reminding the handful of Republican Senators, who are playing Russian roulette with the health care of nearly 10% of Montana’s population, that they are voting on people's lives,” Bullock said. “There is still time to do the right thing and get this done — for our neighbors, for our communities and for our economy.”

We call on concerned Montanans to contact their lawmakers now. Please tell your senators to pass HB658 to continue a highly successful health program for low-income workers, parents and people in need of addiction treatment or mental health care.

Messages for lawmakers may be left by phoning 406-444-4800 or by going to leg.mt.gov and clicking on "message a legislator." 


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