Medicaid expansion continues momentum on Montana Senate floor
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With a wide margin, the Senate pushed Medicaid expansion over one of its last hurdles Thursday, albeit with a lengthy debate and questions about why at least one staunch opponent helped get it out of committee.
Majority Leader Tom McGillvray, R-Billings, an outspoken critic of the federal deficit and the cost of Medicaid and Medicare, said he could see the writing on the wall for the program, which covers nearly 80,000 Montanans.
McGillvray said he earlier voted to get House Bill 245 out of committee because he believed it was best for the Senate, given supporters had the votes to 'blast' it out anyway with a procedural move.
'I felt it was the best for the body, it was the best for the Senate, it was the best for keeping our Senate trying to work together, trying to have harmony,' McGillvray said.
McGillvray was among the 21 senators who voted against it on second reading, but 11 Republicans joined all Democrats to pass it with 29 votes.
The bill, one of the key proposals of the 2025 session, was referred to the Finance and Claims Committee, and it will need another floor vote, but it's in Republican Gov. Greg Gianforte's budget.
During the debate Thursday, senators offered statistics about the program's costs and heartfelt, personal testimony about its benefits, but Sen. Carl Glimm, R-Kila, told his colleagues to mark his words about the appetite of the federal government to cut spending.
Montana pays 10% for people insured through Medicaid expansion, and the federal government contributes 90%, but that could change, and if it does, some legislators argue they'll end up in a special session.
'We're going to be back here, and I'm going to tell you, 'I told you so,'' Glimm said.
The program is set to sunset in June 2025 without legislative action.
If the program continues, but the federal match drops, the Legislature would have to appropriate money, the state would have to apply to increase premiums to people in the program, or a combination.
Proponents of Medicaid expansion argue the program is especially critical for rural hospitals in Montana, and Sen. Gayle Lammers, R-Hardin, said 50 critical access hospitals rely on the program, and he said he wanted to ask those who represent rural communities questions.
'Where will your constituents go if their father has a heart attack? When their child is in a car accident or your wife goes into labor?' said Lammers, who carried the bill in the Senate.
Sen. Shane Morigeau, D-Missoula, described one of the people the program helps, a man who cuts cords of wood for a living, asks for no help because he's prideful, and is a simple person.
The man is frugal, and his splurges are eating lunch at the local drive-thru in the hometown where Morigeau grew up.
He said the same man has diabetes, and he's had a harder time in recent years. He has lost a toe as a result, and has spent days in the hospital fighting infection, trying to save his foot.
'This guy is my dad,' Morigeau said, after a long pause. 'You know, without rural hospitals, I don't think my dad would be here.'
Sen. Dennis Lenz, R-Billings, voted against Medicaid expansion Thursday, but he said he had wanted to have a more robust discussion about how to make the program better.
Instead, he said, the decision seemed made from the start, and he said it was time to move on from the topic.
'Medicaid has sucked the air out of the room here,' Lenz said. 'For somebody like me, with respiratory issues, I need more air.'
Lenz said he and McGillvray debated about who would help send it to the floor from committee, and McGillvray ended up with the short straw — and the hate mail that came with it, but accolades too from people who might have been surprised.
'So anybody online, you can send the nastygrams to me,' Lenz said.
In support of the program, Sen. Cora Neumann, D-Bozeman, said she appreciated senators taking health care and the budget seriously. Neumann said 20 other states have reached out to Montana about the way it has structured Medicaid expansion 'to get our best practices.'
'The Montana Medicaid model is a major winner that we should all be proud of,' Neumann said.
A group of nine Republicans has worked with Democrats in the Senate this session, and that group, minus Sen. Shelley Vance, R-Belgrade, supported the bill, and Sens. Greg Hertz, R-Polson, Mike Cuffe, R-Eureka, and Mike Yakawich, R-Billings, also supported the bill.
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