Lawmakers in GOP-held Senate Signal Openness to Continuing Medicaid Expansion

Two Republican-sponsored proposals that would have phased out Medicaid expansion for tens of thousands of low-income adults in Montana or attached conditions to its continuation failed to pass the state Senate in back-to-back votes this week.

The vote outcomes suggest an openness among lawmakers in the Republican-controlled chamber to continuing the state-federal health program. 

Montana lawmakers decided in 2015 to expand Medicaid health coverage to adults between 18 and 65 with annual incomes less than 138% of the federal poverty level — about $15,500 for an individual in 2025. The program was renewed in 2019, but with a provision for it to sunset this summer if lawmakers don’t vote to continue it.

The policy has a history of bipartisan support, though its passage first in 2015 and again four years later was hard-fought. A bill from the original sponsor of Medicaid expansion, Rep. Ed Buttrey, R-Great Falls, has cleared the House this session with a mix of Republican and Democratic endorsements and is expected to be scheduled for an upcoming hearing in the Senate.

But many GOP members in the House and Senate have vocally opposed continuing the program in its current form, raising objections about the overall price tag and the general concept of government health care coverage. The program has an annual cost of about $1 billion, 90% of which is paid for by the federal government. The most recent state data tallies that more than 76,000 Montanans are insured under Medicaid expansion.

Republican Gov. Greg Gianforte has said he supports some form of Medicaid expansion but has not thrown his weight behind a specific policy.

The two proposals heard on the Senate floor Tuesday and Wednesday would have taken differing approaches to ending or changing the program. Both received committee hearings in January with a heavy skew to the testimony, triggering only comments from opponents and none from supporters.

A bill sponsored by Sen. Carl Glimm, R-Kila, would have prohibited new enrollment in the program beginning in September of this year, envisioning a slow phase-out over subsequent years. The measure failed to pass by a 10-vote margin on Tuesday, with Republicans and Democrats voting against it. 

On Wednesday, senators considered a bill sponsored by Sen. Jeremy Trebas, R-Great Falls, directing Montana to resubmit its Medicaid expansion proposal — also called an 1115 waiver — to the federal government with stipulations for work requirements and premiums for enrollees. 

In committee hearings and on the Senate floor, Trebas said much of the bill is based on the Medicaid expansion bill that lawmakers passed in 2019 and was signed by Democratic Gov. Steve Bullock. But the premiums and work requirements outlined in that policy never went into effect in Montana because of a changed posture toward the provisions under the Biden administration. 

Trebas, who previously sponsored a bill in 2023 to try to sunset Medicaid expansion, framed his policy on Tuesday as a benefit to state taxpayers and a safeguard against federal changes to Montana’s cost-sharing agreement. If the waivers are not approved, legislators would be tasked with addressing the budget shortfall before a 2027 deadline.

“Pass this so we don’t have to have a special session,” Trebas said. “I don’t think we’re going to have the ability to close a billion-dollar budget gap if something changes at the federal level in a big way.”

Democrats called the measure a backhanded attempt to end the program

“It puts the whole Medicaid expansion program at risk,” said Sen. Janet Ellis, D-Helena.

Trebas’ bill died on a 23-27 vote, a narrower margin than the other GOP measure voted down a day prior. Nine Republicans joined Democrats in opposition to the proposal Wednesday.

The Senate also voted to “indefinitely postpone” consideration on both bills, a sign that they are unlikely to resurface later on in the session. 

Buttrey’s bill, which passed by a wide margin in the House on Monday, had not been scheduled for a hearing before a Senate committee as of Wednesday afternoon. 

This story originally appeared in the Montana Free Press, which can be found online at montanafreepress.org.