The upcoming Montana Legislature will face a number of challenges in 2019 and none as large as Medicaid expansion and how to continue to fund the program. It will undoubtedly be difficult to again find bipartisan support for the state’s so-called Health and Economic Livelihood Partnership (HELP) Act, a compromise bill passed in 2015.
The stakes are high and ramifications are far reaching. But, first, it’s useful to explore how we got here in the first place. Why are we — just four years later —bracing for another health care fight in Helena?
Well, when state lawmakers passed the legislation — an essential piece of former President Barack Obama’s Affordable Care Act — part of the compromise was approving it on a trial basis with the expectation that Medicaid expansion would provide coverage for an additional 45,000 Montanans. Since then, far more residents than anticipated have enrolled in the program with an estimated one in 10 Montana residents getting access to health care through the bill.
On its face, that’s a good thing. More health care for more people. But with participation about twice as high as forecasted, the program is also costing a lot. With the state just one year removed from a budget crisis in which many agencies, especially those in the Department of Public Health and Human Services, slashed spending, the big question is how to continue paying for the program.
One idea that voters just resoundingly rejected was Initiative 185, which would have levied a hefty tax on tobacco and vaping products, to continue Medicaid expansion in perpetuity. The proposal was supported by the Montana Hospital Association and opposed by tobacco companies, which spent millions to defeat it. The initiative failed 53-47 percent.
Besides the roughly 100,000 Montanans who use Medicaid expansion, hospitals and health care workers will be keeping an eye on its fate during the 2019 session. Kalispell Regional Healthcare officials told the Beacon earlier this year that if expansion sunsets, it would cost the hospital “$13 or $14 million.” Other Montana hospitals would face similar reductions.
So far, more Republican lawmakers are discussing “fixing” the legislation rather than eliminating it altogether.
Sen. Bob Keenan, R-Bigfork, opposed I-185, emphasized Medicaid expansion’s rising costs and wrote in an op-ed: “The bottom line is I-185 would lock into place an immensely expensive program before we have a chance to fix it.”
Former Rep. David Moore, R-Missoula, who supported expansion in 2015, wrote in his own op-ed: “Medicaid expansion has been good for Montana families, but it needs to be studied, changed and updated.”
Those changes may include work requirements, new tests to determine eligibility and possibly drug tests.
For Democratic Gov. Steve Bullock’s part, he released a preliminary budget last week that would fully fund the health insurance program through tax increases on hotel rooms, rental cars, tobacco and liquor, which Republicans have deemed dead on arrival.
Whatever the changes, I doubt eliminating the program gains any traction. What was once toxic among the electorate is now popular. In the recent midterms, three red states — Idaho, Utah and Nebraska — approved Medicaid expansion for their low-income residents.
As the two parties hash out their differences in the upcoming session about what continued expansion should look in Montana, they should probably make it permanent this time around. It’s not worth fighting about every four years.