Medicaid expansion bill advances in Montana House

Yahoo

10-02-2025

The Montana state capitol pictured after a late-night Senate vote on Jan. 9, 2025. (Micah Drew/Daily Montanan)
The Montana House took a key vote Friday to approve Medicaid expansion 63-37 with bipartisan support, albeit with debate about its long-term viability.
Rep. Ed Buttrey, R-Great Falls, described House Bill 245 as a partnership between health care interests and economic development. Buttrey said it is necessary to help keep Montanans working and small hospitals operating.
The bill would continue Medicaid expansion, which is supporting nearly 80,000 Montanans. Buttrey said more than 20,000 businesses employ workers who participate in the HELP Act, or Health and Economic Livelihood Partnership Act.
'These businesses are the backbone of every Montana community, and they rely on our program to provide them with a healthy, trained and reliable workforce,' Buttrey said.
The Montana Legislature adopted Medicaid expansion in 2015 and continued it in 2019, and the program will sunset at the end of June without legislative action.
Some lawmakers argued the program is a necessary safety net, but some argued it will cost Montana too much in the future.
Rep. Jane Gillette, R-Three Forks, said Medicaid Expansion is too costly, and she encouraged new legislators, or others getting community pressure, to support other bills that she said aim to improve critical access hospitals instead, or small rural facilities.
'I know you will be a hero in your hometown for voting for those bills,' Gillette said.
Rep. Bill Mercer, R-Billings, said the problem with the bill is the pattern in Washington, D.C. Currently, Montana pays $1 for every $9 the federal government pays, and Mercer said Montana wants that 'free money.'
But he said Congress will eventually change the match so states will be shouldering a lot more. If it runs up to 38% instead, as is typical, he said, the state will feel political pressure to continue the program, but it won't have the money.
'It is a financial burden that we could not afford to bear,' Mercer said.
Other lawmakers argued Montana can't afford to give it up.
Buttrey said in states that haven't implemented expansion, small hospitals have closed, including 15 critical access hospitals in Texas, nine in Tennessee and seven in Georgia.
'We've done a good job for our small, rural hospitals, and it has made a big difference,' Buttrey said.
He also said if the federal match drops, Montana law already protects taxpayers because the program's continuation is contingent on legislative action, premium increases, or both.
Rep. Donavon Hawk, D-Butte, said he had to file for medical bankruptcy years ago, and he did not realize that Medicaid expansion could have helped him.
However, he said with support from the program, he has been able to adopt and care for his niece and nephew.
'It was all because of Medicaid expansion,' Hawk said.
Rep. Jerry Schillinger, R-Circle, argued some hospitals might be helped, but he sits on the board of his local hospital, and he believes it's a 'corporate bailout' for big facilities.
'It certainly hasn't been a benefit to ours,' Schillinger said.
In response, Buttrey pointed to data showing how small hospitals in the state have been helped, receiving reimbursements through Medicaid expansion rather than having to provide charity care. He also said 84% of Montanans support the program.
Without the program, he said, small hospitals seek loans to keep their doors open, or they pass medical levies, 'which increase property taxes.'
Buttrey and Rep. Dave Bedey, R-Hamilton, also pushed back against some of Gillette's claims, such as that critical access hospitals are worse off under Medicaid expansion.
'Interesting set of unsubstantiated facts provided,' Bedey said.
Buttrey also said the Montana program includes work requirements, although so far, the federal government has not approved waivers to allow them.
Rep. Terry Falk, R-Kalispell, proposed an amendment to have Montana once again apply for a waiver to put those requirements into action.
'I think a safety net is important,' Falk said. 'I think compassion, though, doesn't always mean a complete giveaway.'
Buttrey, however, recommended the debate over whether Montana apply for a waiver take place separate from his bill. He argued the amendment could lead to unnecessary legal challenges.
Buttrey also said 83% of people on the program work, are caretaking for family, or are in school; 10% are disabled and unable to work; and the balance are either retired or looking for work, citing data from the Department of Labor and Industry.
The amendment failed on a 35-65 vote.
In pitching the program, Buttrey said it saves lives, returns dollars to the general fund, and puts people to work. He said no rural hospitals have closed under Medicaid expansion.
'Why are we having this debate? This debate is ideological. It's not based on the merits of the program, which are significant,' Buttrey said.
The bill will head to the Senate if it passes in the House on third reading.