If backers of LR-122 succeed on Nov. 6, the U.S. Supreme Court ruling on the federal health care reform act may not be the last word on the matter in Montana.
The Patient Protection and Affordable Care Act, derided by opponents as Obamacare, represented one of the most significant overhauls in the nation’s health care system in 50 years.
Under the new federal law, individuals must buy health insurance or pay a tax penalty when filing their federal tax returns.
It is this so-called “individual mandate” that riled many Republicans in the state Legislature and prompted them to put LR-122 on the ballot. Sen. Art Wittich, the Bozeman Republican who sponsored the legislation, said he believed “it was the state’s obligation to put this issue before the voters and allow them to have a say in it.”
In March 2010, President Obama signed the ACA into law, saying it would help control health care costs, expand insurance coverage and improve the health care delivery system.
The ACA requires insurance companies to pay at least 80 percent of premiums for medical care, cover people regardless of pre-existing conditions, and allow young adults to be covered by their parents’ insurance until the age of 26.
The measure’s origins
Although the high court upheld the ability of the federal government to penalize those not purchasing insurance by requiring them to pay an additional tax, it also ruled that states could opt out of another element of the law: expanding Medicaid availability to anyone 133 percent above the federal poverty line. That provision aimed to cover another 17 million Americans.
Montana lawmakers will have to decide whether to expand the state’s Medicaid program, but LR-122 targets the individual mandate part of the law.
Beginning in 2014, people without coverage would pay $95 or 1 percent of taxable income, whichever is greater. That tax grows to $695 or 2.5 percent of taxable income in 2016.
After that, the penalty would increase annually by the cost-of-living adjustment.
LR-122 will give Montana voters a chance to support or oppose the idea.
The ballot measure came after the Republican-controlled Legislature passed a similar bill that was vetoed by Gov. Brian Schweitzer.
Because the Legislature lacked the votes to overturn the veto, they voted to put the same proposal on the ballot with LR-122.
LR-122 would prohibit the state and federal governments from requiring the purchase of health insurance or imposing a penalty, tax, fee or fine on those who don’t buy it. This position would put the state in conflict with the Supreme Court decision from June.
Feds hold the cards
If it passes, “someone would go to court and challenge it right away,” predicted Jim Lopach, a longtime professor of political science at the University of Montana.
Lopach said even if the referendum becomes the law of Montana, it wouldn’t end the individual mandate.
“It’s like a game of cards,” he said. “Federal law trumps state law. State law can’t trump federal law.”
According to Lopach, federal law was set when the Supreme Court upheld Congress’ power to enact most provisions of the Affordable Care Act.
The U.S. Supreme Court ruled that the individual mandate in the ACA is constitutional under the taxation powers given to Congress by the U.S. Constitution.
Despite that ruling, Wittich said it’s important to put LR-122 before the voters because they should have a say as the state begins implementing the health care law.
“We drafted this 18 months ago so that the people of Montana had a right to provide their voice as to whether or not the mandate was legal,” he said.
Opponents of the ballot measure said it has nothing to do with law and everything to do with politics.
“It’s intended to get people riled up about the health care act when they don’t need to be riled up about it,” said Rep. Dick Barrett, D-Missoula. “They should actually recognize that it’s done good things for Montana, and the individual mandate is an important part of it.”
Barrett was quick to list the new law’s benefits: Montanans with pre-existing conditions can get insurance, more young people can remain on their parent’s insurance, and patients are guaranteed that their insurance will cover at least 80 percent of their premiums.
Even though LR-122 focuses on the individual mandate, Wittich said the way the public votes on the measure may affect the debate over how Montana responds to the law.
“I think there’s an important role for the states as to how Obamacare will be implemented and if it will be implemented,” Wittich said.