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2019 Legislature: Medicaid expansion is the high-profile issue

Posted at 4:47 PM, Dec 26, 2018
and last updated 2018-12-26 19:53:25-05

This is the first of a three-part series previewing the 2019 Montana Legislature

HELENA – When it comes to Montana’s 2019 Legislature, there can be little doubt which issue tops the agenda, in sheer size, impact, and political passion: Medicaid expansion.

The $600 million-a-year program provides virtually free health coverage to nearly 100,000 low-income adults in Montana, but is set to expire in June.

Democratic Gov. Steve Bullock, a vocal advocate of the program, is asking the Legislature to extend Medicaid expansion in its current form, including the state’s approximate $60 million-a-year share of the cost. The federal government covers the remainder.

But leaders of the Republican-controlled Legislature say if they agree to extend the program, it will come with some changes.

“That program needs to be more affordable for the taxpayers,” says Senate President Scott Sales, R-Bozeman, who voted against the initial approval of Medicaid expansion in 2015. “I believe it needs to have a lot more sideboards put on.”

MT Senate President Scott Sales, R-Bozeman

Some of those “sideboards,” or additional requirements for those getting coverage from the program, could be an asset test, work requirements or a drug test, Sales told MTN News.

Bullock says he’s ready to talk to legislators about “the best path forward” for Medicaid expansion, but told MTN News he’s not inclined to agree to onerous requirements that will cost more money to administer, just to kick people off the program.

“What we’ve seen in some other states is that it actually costs more to implement the work requirements and all the monitoring than it does to provide the benefits,” he says.

The governor says 70 percent of Montanans covered by Medicaid expansion already are working.

He also says the program essentially serves as a subsidy for many businesses in the state, by providing government-funded health coverage to those who aren’t covered by their employer. Overall, the expansion has been a huge benefit to the state, Bullock says.

Gov. Steve Bullock

“Montanans have seen great successes (with Medicaid expansion) … dropping our uninsured rate from 20 percent down to 7 percent, the $300 million of new personal income that’s been brought into our state, and we haven’t lost one rural hospital,” he says.

Senate Minority Leader Jon Sesso, D-Butte, echoes the governor’s view, saying the evidence is “overwhelming” that Medicaid expansion has been positive for Montana.

“I’m confident that the Legislature will get a reauthorization bill over the finish line,” he told MTN News.

Still, the fate of Medicaid expansion is fraught with political baggage and history.

Most of the Republican majority in both houses of the Legislature voted against Medicaid expansion in 2015, including those who are now the GOP’s top leaders at the 2019 Legislature. The expansion passed four years ago with the approval of a coalition of Democrats and moderate Republicans.

And, in November, Montana voters rejected a ballot measure to extend Medicaid expansion and fund most of the state’s share with higher tobacco taxes.

Even the moderate Republicans who supported the 2015 expansion opposed the ballot measure, saying they, too, wanted a chance to examine and perhaps adjust the program during the 2019 Legislature.

Bullock is asking the Legislature to approve a lesser tobacco tax to help fund the program, saying tobacco-users need to pay their fair share of tobacco-related health costs.

But GOP leaders say voters rejected the tobacco tax in November, and that their majority is not going to approve one.

Sales says the GOP majority is not trying to be “punitive” toward those covered by Medicaid expansion, but rather wants to make sure the program is actually helping people get ahead and eventually get off what most Republicans see as a form of welfare.

For example, a drug test would determine whether someone covered by Medicaid needs to be in a drug-rehab or other program that gets them off drugs, he says.

“All these social safety-net programs are to try to benefit people and get them in a better place,” Sales says. “(Medicaid expansion) is not going to look like its current form. It’s going to get a lot of attention.”

Next: The battle over state spending and taxes