Health Care Overhaul Linked to Budget Talks

By Beacon Staff

HELENA – Montana Republicans in charge at the Legislature — largely opposed to the federal health care law — might also consider getting the state completely out of Medicaid.

Sen. Dave Lewis, who chairs the Senate Finance Committee, is among those who want to cut projected state spending by roughly $360 million. The Helena Republican said bucking mandates under the federal health care law will be a big part of the conversation.

Lewis said it is probably not politically feasible to get out of Medicaid this legislative session. But he said it should be studied as a possibility for down the road.

“It is going to break the bank,” Lewis said of Medicaid.

Medicaid largely serves low income families, disabled people and provides nursing home coverage for the elderly. It is funded mostly with federal money, with states providing matching funds.

Nonpartisan experts from the National Conference of State Legislatures told lawmakers Monday that the federal health care law impacts many areas of state government.

They said the mandated expansions in Medicaid helped keep the cost of the federal bill down because the uninsured would otherwise be given more expensive tax credits to buy insurance in the private market.

Several other states are considering opting out of Medicaid altogether — although it comes with a big cost. The state money alone that goes into the program isn’t enough to provide the services, such as nursing home care, people have come to expect, lawmakers were told.

“It’s the nuclear option,” Lewis said of axing the program entirely.

Sen. Dave Wanzenried, D-Missoula, cautioned Republicans not to go too far and turn their back on federal money that keeps hospitals, doctors and others in the state afloat.

“If you want to absolutely pull the plug on the economy in this state, pull the plug on that money,” he said. “What are we going to do about health care in the United States? Nothing at all?”

Republicans will be bringing two bills to committee hearings on Wednesday, originally scheduled to coincide with a vote in Congress, that push back against the federal health care law in other ways. Those hearings will continue as planned even though the U.S. House has canceled its planned vote that day on the repeal of the health care law following the shooting of one of its members.

Sen. Jason Priest, who is carrying a bill that would force the attorney general to join the lawsuit, said even the experts can’t say exactly how the federal law will affect the state and its finances down the road.

“I think that argues for caution in implementation of this law,” he said. “I think Sen. Lewis is right — we can’t leave any stone unturned.”

Another GOP bill to get a hearing Wednesday would prohibit any Montanan from being forced to participate in the changes or be fined for not doing so.

State Auditor Monica Lindeen, who will be asking lawmakers to approve the establishment of a state insurance exchange in her office, told lawmakers Monday it makes sense to move forward with those plans.

The exchange is designed under the law as a place for the uninsured to buy private health insurance. Lindeen said if the state doesn’t set it up under its own rules the federal government will set one up for the state.

“It’s always an advantage to develop a Montana solution instead of a federal solution,” Lindeen said.