Senate Coalition Advances Medicaid Compromise

HELENA – The Montana Senate endorsed a plan Tuesday to use federal Medicaid funds to buy private insurance for low-income residents, again bucking the will of its Republican leaders.

The surprise move completed a day of drama surrounding plans to use federal money to expand Medicaid to those earning less than 138 percent of the federal poverty level, or about $15,000 for a single person. The plans could cover up to 70,000 uninsured Montanans.

Democrats have been working with some Republicans on a late-developing compromise, modeled after developments in Arkansas, which uses the Medicaid money to help the working poor by private health insurance. They successfully pushed House Bill 623 past an initial vote Tuesday in the Senate — despite strong objections of the chamber’s Republican leaders.

Six Republicans joined 21 Democrats in a 27-23 vote to endorse the plan after a bipartisan coalition crammed the amendment into a Republican leadership bill envisioned as a conservative alternative to help the uninsured. Opponents accused the coalition of “hijacking” the GOP bill, but the chamber’s leaders were foiled in their efforts to block the move.

Gov. Steve Bullock has made it a priority to take the federal money to expand health insurance for the poor. He endorsed the compromise, which calls for a three-year trial effort.

“Montanans from every corner of our state have been asking the legislature to take action and I thank the courageous senators who put politics aside to do right by their fellow Montanans,” Bullock said in a statement. “Today’s vote is a victory for job creation, reform of our health care system and access to affordable health care for our friends and neighbors.”

State Sen. Dave Wanzenried, D-Missoula, said the compromise relies on the new health care exchanges that will be used next year to help the uninsured buy private health insurance. He said the lowest income workers will have their premiums paid with the federal Medicaid money.

“These amendments will ensure that those individuals going on the exchange have a payer source, the federal government,” Wanzenried said. “These amendments don’t expand Medicaid. They just provide a payer source.”

Conservative Republican Senate leaders have opposed any version of the plan all along the way, arguing that the state could eventually be on the hook for a big bill if federal money dries up. They estimate Montana could be paying more than a $100 million per two-year budget cycle by 2020.

Senate Majority Leader Art Wittich, R-Bozeman, said he thinks the move to cram the compromise into the non-Medicaid GOP bill dealing with health care “unconstitutional.”

He called the new measure “the largest expansion of welfare that the state has ever adopted.”

Some Republicans senators said their colleagues who were joining the Democrats were turning their back on voters opposed to the Affordable Care Act.

The measure faces a final vote in the Senate, perhaps on Thursday. It will go to the House which failed, in a 51-49 vote, in its efforts to get enough support Tuesday to “blast” Medicaid expansion out of a Republican-controlled committee where it was stalled.

But supporters of the compromise plan said they are hopeful the measure will get the votes when presented to the House floor. But that is no sure thing, especially with time running out on a legislative session scheduled to end next week.

The program also ultimately hinges on approval from federal officials, who would have to approve a Medicaid waiver. But supporters said the Obama administration is encouraging states to be creative in the way it uses the money to get health insurance to the poor.

“I am just going to take it one step at a time,” Wanzenried said.