When the Affordable Care Act became law and survived a challenge in the U.S. Supreme Court, states across the country had the choice to expand Medicaid coverage to include people making up to 138 percent of the federal poverty level.
The 2013 Montana Legislature rejected the proposed expansion, which would have covered about 70,000 state residents. An attempt in 2014 to get the expansion on the state ballot was unsuccessful, and proponents of the expansion, including Gov. Steve Bullock, set their sights on the 2015 Legislature.
Now, with the legislative session underway, Medicaid expansion is once again on the agenda. Rep. Pat Noonan, D-Butte, in conjunction with Bullock, is sponsoring House Bill 249, which would create the Healthy Montana Plan to expand health care for low-income Montanans.
Any Montanan making 138 percent or less of the federal poverty level would qualify for health care coverage under the Healthy Montana Plan, which is modeled after the Healthy Montana Kids Program.
“The Healthy Montana Plan is a made-in-Montana way to utilize federal funds to expand health coverage to 70,000 Montanans, including 9,500 veterans and their family members,” Bullock said in a prepared statement. “An overwhelming majority of Montanans – including a majority in the Legislature – support this effort to use our tax dollars to extend coverage to our neighbors instead of providing coverage to uninsured in other states. It’s time that the Legislature allows a full debate, and an up-or-down vote on this important issue.”
Federal funding for the plan would be available to pay 100 percent of the cost for the first three years, and this funding sits at the heart of the debate around expanding such coverage.
Montana Sen. Scott Sales, R-Bozeman, said in an interview last week that he and a cohort of conservatives in the Legislature would continue to fight the expansion and HB 249.
“I don’t think it’s a good idea,” Sales said. “The country’s $18 trillion in debt. I have three grown kids. I have enjoyed the prosperity of America, and in good conscience I can’t sell their liberty and their treasure down the road any further.”
So far, HB 249 has been referred to the House Human Services Committee.
Of those who support expanding Medicaid coverage, the argument falls on the line that Montanans are paying federal taxes, and that money should come back to the state.
Jason Spring, CEO of North Valley Hospital in Whitefish, said even if Montana doesn’t expand the coverage range, taxpayers would end up footing the bill anyway.
If someone can’t afford insurance, he said, they wait until they are very sick and come to the emergency room, where they will receive treatment regardless of being able to pay.
It ends up costing more, he said, and health insurance premiums increase and health care costs increase as a result.
“We pay more. It is a hidden tax on health insurance premiums, to pay for those who aren’t insured,” Spring said. “Now we’re actually paying taxes as part of the Affordable Care Act to the federal government that aren’t being returned to us because the Legislature isn’t expanding it.”
North Valley writes off $2.5 million annually for charity care. Bad debt accounts for about $3 million annually, meaning the care costs that the hospital believes the clients should be able to pay but they don’t.
If Medicaid coverage was expanded or a compromise was reached at the Legislature about widening the range of those who qualify, the higher costs of insurance and health care could decrease, he said.
“We’re talking about people that would benefit, and at the local level would help us cover those costs that we’re paying now, and hopefully over time reduce that hidden tax in insurance,” Spring said.
The Flathead would see a healthier community overall, he added, because preventative care would increase. It would also relieve some burden off the businesses, because employees would be sick and miss work less often.
“Frankly, (it’s) the humane thing to do, to make sure people get health care early and don’t end up sick and dying because they couldn’t afford health care,” Spring said.
Flathead County Health Officer Joe Russell also said expanding coverage like that in HB 249 would benefit the community, especially the clientele at the Flathead City-County Health Department.
About 60 percent of the people who visit the department’s health clinic are uninsured, Russell said, and they pay out of pocket for treatments on a sliding scale based on income. If they had insurance coverage, they could go to the local hospitals or local health care providers, and preventative care could become a mainstay.
“There’s a lot of good benefits to that, especially that class of working people that might end up with more comprehensive medical insurance,” Russell said. “From a public health perspective, the more people that seek care early, get into a preventative health realm, they’re going to be healthier.”
If an expansion package is approved at the Legislature, many clients may choose to stay with the health clinic, Russell said, because its services, such as dental care, fit well with Medicaid-type coverage.
On his end, Sales said he understands that people need health insurance but doesn’t believe expanding the health care system in its current form is the answer.
“It’s a broken system,” Sales said. “But we need to reform it. We don’t need to expand.”