HELENA – The momentum behind expanding Medicaid in Montana came to a grinding halt last week when Republicans voted down three measures to accept $6 billion in federal money over the next eight years.
Those opposed to Democratic Gov. Steve Bullock’s Access Health Montana bill argued against extending government’s reach under an Obamacare provision that allows states to decide whether to expand the low-income health care program. Under the Affordable Care Act, Montana lawmakers could choose to offer Medicaid coverage to 70,000 more Montanans whose incomes fall below 138 percent of the federal poverty level.
Republicans said accepting federal money to expand Medicaid would increase people’s dependency on government and throw more money into a program with numerous flaws.
“The federal government has got a $17 trillion debt,” Rep. Austin Knudsen, R-Culbertson, told House members. “Do we in this chamber want to be involved in pushing the federal government closer to that precipice by saying, ‘Sure, we’ll take your free federal money’?”
The Democratic House minority leader fired back.
“Those tax dollars are going to go somewhere,” said Rep. Chuck Hunter of Helena. “They’ve already been collected. They’ve already been set aside.”
Despite the negative votes, Democrats vowed to continue fighting to keep at least one of the three bills alive.
Hunter, who is carrying House Bill 590 for the governor, said Medicaid expansion is not dead. If the bill were to come to a vote on the House floor, he said it might pass.
“Of all the bills that are up in the Legislature this session, this is the one that has the most direct impact on the most Montanans,” he said.
House Democrats could try to force a vote on the floor, but that would require the support of 21 Republicans. They attempted that last week minutes after the House Human Services Committee tabled the bill, but only 10 Republicans voted alongside the House’s 39 Democrats. The motion failed.
Meanwhile in the Senate, an unusual procedural vote this week brought Medicaid expansion bills back to life. The Senate voted 26-24 to advance the measure.
Hearings on the measures last week were among the longest this session. More than 60 people spoke in favor of the governor’s proposal, including doctors, insurance companies, chambers of commerce and individuals with emotional stories about how Medicaid has helped their lives.
Genoa Carver Dillon traveled from Billings to tell lawmakers how her mother had to learn to walk, talk and breathe again after a traumatic brain injury.
“During her rehabilitation, the costs incurred by my family were devastating,” she said. “There is no way that my family could afford this level of care without the assistance that Medicaid provides.”
A member of the conservative Americans for Prosperity group and five individuals spoke against the bill, expressing many of the same concerns Republicans shared on the House floor. They argued that Medicaid needs reform and that the federal government cannot be trusted to uphold its end of the bargain.
As Montana legislators weigh their options, lawmakers nationwide grapple with similar pros and cons. Each state must decide whether to implement the expansion. The offer is popular among Democrats, although eight Republican governors have also endorsed it.
Robert Saldin, an associate professor of political science at the University of Montana, said Medicaid expansion is showing divisions in the GOP across the nation.
“There are good faith reasons to be concerned about this,” he said. “It’s not just crude, hard politics.”
If Montana implements the expansion, the federal government will pick up the tab until 2017. The state will then kick in some money until it pays 10 percent of the bill in 2020. Montana’s share amounts to more than $500 million over the next eight years, according to a report prepared by the UM Bureau of Business and Economic Research.
Saldin said Medicaid continues to eat up larger portions of state budgets, which could limit the amount of money states can spend on other items like education.
At the same time, other Republicans see the expansion’s potential. The federal government is offering states a significant amount of free money under the Affordable Care Act, which would go to other states if Montana lawmakers chose to forgo those funds, Saldin said.
“It would be foolish for Montana not to pass this,” he said, adding that states will find it hard to resist such a compelling offer.
Some Republican legislators want to postpone the decision for two years. House Bill 604 would establish a committee to look at Medicaid expansion and ways to reform the system.
Democrats say stalling would kill the expansion, and in the meantime, those 70,000 people would continue to go uninsured.
If lawmakers voted for the expansion during the 2015 Legislature, the federal government would foot 100 percent of the bill for about one year before the state had to kick in some money. If legislators implemented it now, the federal government would pay the entire tab for three years.
“Two years from now the case becomes a little less compelling for accepting this money because right now it’s all federal money,” Saldin said.
Another Republican measure proposes to create a council to study health care. It would also provide grants to low-income people to purchase private coverage on the federal insurance exchange.
The bill’s sponsor, Rep. Liz Bangerter, R-Helena, said lawmakers cannot leave Helena without making some sort of progress on health care. She voted alongside Democrats who tried to revive the governor’s Medicaid expansion bill on the floor because she said she wanted to hear ideas from both sides on the best way to create a healthier Montana.
“I wouldn’t promise I would vote for expansion, but I wouldn’t promise I would vote against it,” she said. “I would be interested in the debate.”