The 63rd Montana Legislature ended last week. One issue that received a large amount of attention this session was Medicaid expansion. There have been some bills that address this topic. HB 590 was tabled in the House Human Services Committee, and two last motions to bring it to the House floor were unsuccessful. HB 623 passed the House and was so significantly changed in the Senate that the House referred it to committee when it returned. It stalled there.
Health care can bring out a lot of emotion. Everyone needs medical attention at different times in their lives, and the cost of the care can be very high. How and who pays for the costs can bring a variety of opinions. Expanding Medicaid coverage in Montana may sound good on the surface, but will it really achieve the goal of better health for low-income people?
Several nonpartisan organizations have done extensive research on Medicaid that shows it does not produce as it promises. Manhattan Institute for Policy Research has an article in its March 2012 publication. It refers to an extensive University of Virginia study that examined outcomes for 893,658 individuals undergoing major surgical operations from 2003 to 2007. The study found that Medicaid patients were 13 percent more likely to die after surgery than those with no insurance.
The reason given for this is poor quality, poor access and poor financing. Severe underpayment of doctors and hospitals, late payments, and excessive paperwork prevent many Medicaid recipients from gaining access to basic and specialist health care. This leads to significantly worse health outcomes. The Urban Institute and Heritage Foundation are two other organizations that have researched Medicaid not delivering what it promises. An online search will give you access to their reports.
Other issues with Medicaid revolve around funding. The federal government has offered to initially fund most of an expansion. With federal sequestration, a $16 trillion debt and borrowing more than 40 percent of what it spends, it appears that federal funding of Medicaid will not be there in the future. That would leave Montana with the responsibility of funding millions of dollars in a questionable program.
For these reasons the Legislature has rejected Medicaid expansion. HB 623 in its original version was a good alternative. It would have revised laws related to health care and health insurance. It would have established a council on health care reform, improved access to health care, established grants for people to purchase health insurance, and given incentives for doctors to locate in Montana. The Senate amended most of the content out of this bill and inserted a form of Medicaid expansion.
I have received hundreds of messages giving me an opinion on Medicaid expansion this session. By a three-to-one margin they have asked me to not expand it. Montanans want responsible use of their tax dollars, and it appears they don’t view Medicaid expansion as the prudent thing to do.
Keith Regier is a Republican representative from Kalispell.