Two Republican Medicaid expansion bills advance, one from Democrats is tabled

Yahoo

29-01-2025

The Montana State Capitol in Helena on Wednesday, April 26, 2023. (Photo by Mike Clark for the Daily Montanan)
Medicaid expansion saves lives and saves money, proponents said — an estimated $27 million the last biennium, according to Rep. Ed Buttrey, sponsoring one bill to continue the program.
'Our program is a budget savings to the general fund, which is something that is pretty amazing,' Buttrey, R-Great Falls, said.
Buttrey made his comments last week introducing his bill to continue Medicaid expansion, and it's among at least four addressing the issue this session.
This week, at least two Republican bills are still advancing, including Buttrey's and a separate bill that directs the program's phase out.
However, a key proposal from Democrats to increase its reach died Tuesday.
Medicaid expansion started in the state in 2015 and was reauthorized in 2019, but it's slated to sunset this summer without legislative action.
In committee Tuesday, Rep. James Reavis, D-Billings, said he was pleased to support Buttrey's bill, House Bill 245, given the personal testimony heard the previous week.
Reavis cited a Montanan who had a stomachache and only went to the doctor because of Medicaid — and learned they needed emergency surgery.
He said one woman with Hodgkin lymphoma told him she was alive only because of the program.
'The testimony we heard from last week's hearing was powerful, emotional and compelling,' Reavis said.
The House Human Services committee voted 14-7 to advance HB 245, which Buttrey characterized as a continuation of the current Medicaid expansion program.
The program currently covers nearly 80,000 Montanans living below 138% of the federal poverty level — or up to about $21,000 for a single adult, around minimum wage.
Although the committee approved Buttrey's bill to keep the program going, it tabled House Bill 230, which would have augmented Medicaid expansion to include things like a customer service component and reopening some of the offices of public assistance that had closed for budget reasons in 2017.
Rep. Mary Caferro, D-Helena, sponsored the bill, along with more than four dozen other legislators, and her attempt to amend it by paring back some of its additions failed in committee Tuesday.
Legislators voted 12-9 to table it, although some expressed support for taking up improved customer service in another form, a theme in public comment.
In an earlier hearing, Michelle Lewis, of Butte, testified to the difficulties of trying to navigate eligibility, having turned in at least 50 pages of documentation, plus information on wages and bank statements.
'Improving the hotline experience is really important,' said Lewis, in support of 'continuous eligibility' and better customer service.
A separate bill on Medicaid expansion, Senate Bill 199 from Sen. Jeremy Trebas, R-Great Falls, was heard Monday, but the Senate Public Health, Welfare and Safety committee had not taken action on it Tuesday.
Trebas described it as the 'most sustainable' of the options on the table, one he said would maintain the status quo from 2019 but ensure 'community engagement,' or a requirement that people on the program also work.
No one spoke in support of it, but Trebas said he believes it aligns with the direction the new Trump administration is going with work requirements.
After the House committee meeting Tuesday, Rep. SJ Howell, D-Missoula and vice chairperson of the Human Services committee, said Democrats are likely to propose individual components of expanding the program, such as continuous eligibility and better customer service, as separate legislation.
However, Howell also said if SB 199 is approved, they are concerned it could put a complete halt to Medicaid expansion because the bill is strictly tied to a work requirement.
The feds have approved waivers that allow work requirements, but if a waiver isn't approved in the timeline the bill lays out, Howell said the bill might compromise expansion altogether. Howell said most work requirements have been struck down in federal court, and the bill doesn't allow for that outcome.
'That is playing with fire for 80,000 Montanans,' Howell said. 'We can't predict what's going to happen in Congress, we can't predict how quickly or slowly things will move, and that could end the program.'
Gov. Greg Gianforte has included Medicaid expansion in his budget for the upcoming biennium. However, his office has said he wants 'strong work requirements for able-bodied adults without dependents,' KFF has reported.
The debate over Medicaid expansion is taking place in the wake of significant economic benefit to the state reported by economists and the health care industry, but it's also underway in the midst of concern in Montana about cost and the federal debt.
'When I was younger, the novel idea for health insurance was get a job,' said Senate Majority Leader Tom McGillvray, R-Billings, in a meeting with reporters on Tuesday.
On the opening day of the session, McGillvray told fellow lawmakers the federal health care programs Medicaid and Medicare are $1.1 trillion in the red, 'hemorrhaging money,' and Montana can help.
'Every legislator in this room has an obligation and an opportunity to do something about that at the state level,' McGillvray said to the Senate. 'We need to take action.'
Montanans, though, lined up this month to tell legislators to back the bills to continue Medicaid expansion — and to oppose one to phase it out.
Bailey Torgerson, of Bozeman, said she has had diabetes since she was two-and-a-half years old, and Medicaid expansion helped her pay for things like a $10,000 insulin pump and afford to go to college.
Torgerson, who gave testimony via a video presentation during discussion of HB 245, said she and her husband are now able to sign onto a program besides Medicaid.
Buttrey said that's the case with most people insured through Medicaid expansion — they're insured for 22 months on average, debunking the myth that once people are on the program, they never leave.
Buttrey also said the program is budget neutral through the Affordable Care Act, funded by rate cuts to hospitals and other revenue sources, and Montana will send dollars to the federal government as a result whether it funds expansion or not.
Sen. Carl Glimm, R-Kila, is sponsoring Senate Bill 62, which would phase out Medicaid expansion. Glimm's bill squeaked out of the Senate Public Health, Welfare and Safety committee on a 6-5 vote with Sen. Mike Yakawich, R-Billings, joining Democrats to oppose it.
Glimm described it as a 'soft unwind' rather than a hard stop, allowing people who are qualified to stay on the program, preventing new people from enrolling, and removing those who become unqualified.
'It eventually would shrink the rolls of Medicaid expansion,' Glimm said.
The federal government pays 90% of the program to the state's 10%, and an economist recently reported the money from the feds translates into $775 million of economic activity in Montana.
At a hearing last week, no one expressed support for Glimm's bill. Opponents said it would hurt farmers, vulnerable patients, tribal families, college students and rural Montanans.
Carole Lankford, with the Confederated Salish and Kootenai Tribal Council, said she has made it a priority to ensure the most basic needs of her constituents are met. She said the bill would have 'catastrophic' consequences for tribal health.
'It will cause a reduction in jobs and may force the closure of tribal health facilities,' Lankford said. 'Health care costs will go up, which will be felt by many families, including children.'
A recent report on the impacts of Medicaid expansion on Indian Country in Montana said it has improved mortality rates, extending a person's life 1.4% compared to the period prior to expansion. It said 40% of tribal members stopped skipping routine medical care because of cost.
Jasmine Krotkov, representing the Montana Farmers Union, said many farmers and ranchers are self-employed, and they don't have access to coverage from employers.
Medicaid expansion has supported not just them, Krotkov said, but it has allowed rural health providers to offer more services, benefiting all Montanans.
'Farming and ranching families who get the health care they need can return to work and school more quickly, and stay in the workforce longer, and stay productive,' Krotkov said. 'Rural Montanans have a right to live full, secure and productive lives.'
The legislation to continue Medicaid expansion drew similar support.
The debate over expansion is taking place following redetermination in Montana, the process to confirm that people on the program were qualified for it.
Caferro's bill would have addressed some of the shortcomings that came to light through the process — and eliminated the existing work requirement — and at least a couple of ideas from her bill could reappear as separate legislation.
Some Montanans said they waited hours for help on the phone in their attempts to keep their insurance, but never heard responses to their questions. Some said they filed paperwork multiple times, but never heard back from the Department of Public Health and Human Services.
Buttrey's bill keeps a work requirement intact, and he said he anticipates the Trump administration would approve it. However, both he and Caferro said people insured through Medicaid expansion do work.
In his presentation, Buttrey outlined data from a Montana Department of Labor and Industry report regarding the number of people on Medicaid who work: 72% are actively working; 4% are in school; 7% are caretaking; 2% are retired; 10% are acutely ill or disabled and unable to work; and 3% are looking for work. The report lists 2% as 'other.'
Buttrey also said his bill would require approval for Medicaid expansion from the legislature every time it meets in case the state decides it can't afford it at some point.