Medicaid Expansion Poised for Extension
House Bill 245 was opposed by several Flathead Republican lawmakers who wanted work requirements and objected to federal spending, but proponents of the bill warned of the impacts on businesses and rural hospitals if Medicaid expansion failed
By Maggie Dresser
Medicaid expansion will likely continue providing healthcare access for 80,000 people following months of controversy over whether to extend the program’s sunset, which was set to expire on June 30.
In a 29-21 vote last week, the Republican controlled Montana Senate passed House Bill 245 sponsored by Rep. Ed Buttrey, R-Great Falls. The bill went through a Senate Finance and Claims Committee hearing on Feb. 25 and will likely be signed by Gov. Greg Gianforte.
“If we don’t renew this program, the consequences could be severe,” said Sen. Gayle Lammers, R- Hardin, who carried the bill on the Senate floor at a Feb. 20 hearing. “Fifty of Montana’s critical access hospitals rely on Medicaid expansion to keep their doors open. For those of you who represent Montana’s most rural communities – ask yourself this – where will your constituents go if your father has a heart attack, if their child is in a car accident, or when your wife goes into labor?”
Until the expansion program launched in 2015, Medicaid historically applied exclusively to the elderly population, disabled individuals, children and pregnant women. With the separate Medicaid expansion, 90% of which is funded by the federal government, adults at 138% of the federal poverty level are covered.
Leading up to 69th Legislative Session, healthcare representatives and business leaders in the Flathead Valley stressed the serious financial consequences the state would face if lawmakers failed to reauthorize the program.
While voting against the expansion would affect the 80,000 recipients, it would also impact 10% of the workforce. In 2023, 35% of private businesses in Flathead County and 47% of businesses in Glacier County employed Medicaid expansion enrolled workers, according to a Montana Department of Labor and Industry (DLI) report.
“Workforce is the number one challenge that businesses are facing today,” Montana Chamber of Commerce CEO Todd O’Hair said at the Feb. 25 Senate Finance and Claims Committee hearing.
According DLI data, 94,990 Medicaid Expansion enrollees in 2023 held payroll jobs, representing 16% of Montana’s private sector employees. Without Medicaid expansion, it would cost employers an estimated $430 million to $1.1 billion to cover health insurance costs.
“If you run a ranch, a restaurant, a grocery store, or you’re in a construction company, you need healthy workers who can show up every day,” Lammers said.
Opponents of the bill believe that Medicaid expansion work requirements are too loose, despite 2022 survey data that revealed 71% of Medicaid expansion enrollees in Montana are working.
“Those hours required are only 20 hours a week and the age is only 19 to 55,” Republican state Sen. Carl Glimm, R-Kila said. “Typically, people don’t retire at 55. If you’re over that, you don’t have to work those requirements. Also, being in drug treatment qualifies as a work requirement.”
Officials have also warned that without Medicaid expansion, rural hospitals would struggle to survive.
The Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires hospitals provide emergency care to an individual regardless of their ability to pay or their insurance status, would likely cause private insurers to raise prices to cover those costs that would have otherwise been covered by Medicaid.
“If somebody shows up in an emergency room and they’re pregnant or they have an emergency condition, we take care of them regardless of the ability to pay without Medicaid,” Billings Clinic-Logan Health Co-CEO Kevin Abel said last year. “The concern is – would we have to work with other private insurers to beef up the payments to cover those additional uninsured?”
Healthcare officials estimate that without Medicaid expansion, Logan Health would be at risk of losing $68 million while rural hospitals would likely not have been able to recover from the losses.
Several Flathead lawmakers opposed the program’s federal spending, calling Medicaid expansion an “economic and moral failure.”
“When people are responsible for their own healthcare and pay for it themselves, they can live the lifestyle they choose,” Sen. John Fuller, R-Kalispell said. “But when people are dependent on others to pay for their healthcare, those who pay for that benefit are entitled to and will impose lifestyle choices upon the recipients – thus begins the road to totalitarian and dictatorial rule.”
Republican Senate President Matt Regier of Kalispell doubted Medicaid’s benefits and told his fellow lawmakers that government should not be responsible for healthcare programs.
“We need to have a conversation of what is state government,” Regier said. “What programs are beneficial for the people of Montana. There’s the taxpayer on the other side of this – it’s not just the enrollees of this program.”