Montanans fill Capitol to debate competing Medicaid expansion bills

Rep. Ed Buttrey, R-Great Falls, listens to opponents of his bill that would extend Medicaid expansion on March 16, 2019. (Shaylee Ragar/UM Legislative News Service)

(UM Legislative News Service) Montanans filled the state Capitol Saturday to testify during an all-day hearing on two competing bills that would extend Medicaid expansion, some of them arguing to keep the program as is, some arguing for more requirements for enrollees and others arguing against the program completely.

Republican Rep. Ed Buttrey of Great Falls and Democratic Rep. Mary Caferro of Helena are carrying competing Medicaid expansion bills, which were heard back-to-back Saturday. With nearly 100,000 Montanans enrolled on the state-federal partnership program, and its expiration date looming in June, expansion is one of the most contentious issues this session.

Caferro’s House Bill 425 would keep the program similar to how it works now, but would eliminate the program’s expiration date and add some fees for hospitals and healthcare centers that benefit from the program. Buttrey’s House Bill 658 would also make Medicaid expansion a permanent program, but it includes stricter eligibility requirements for recipients.

People wanting to testify filled the Capitol’s old Supreme Court chambers and waited to say their piece.  

“As you can see,” Caferro said, while gesturing to the packed room, “this is an amazing issue we have before us.”

At noon, more than 400 people filled the building to participate in a rally of support for Caferro’s bill.

Medicaid expansion is government subsidized health insurance for low-income and disabled citizens. An expansion program was first passed into law in 2015, and was carried by Buttrey. The federal government has been matching state contributions to the program at 100 percent, but that rate lowers to 90 percent in the coming year.

Lawmakers are trying to decide how to pay for that 10 percent gap and what the program will look like going forward.

Buttrey said expansion has been successful in the state, and he wants that to continue. But, he said, he also wants to ensure that recipients of the subsidy are “actively participating in the future of our state.” His bill would include work requirements and asset testing, meaning enrollees would need to report to the government that they have a job or are looking, and what kind of property they own. Based on these reports, the state could determine some recipients are no longer eligible to stay on the program.

Some lawmakers argue the program is too big and unsustainable. Rep. Mark Noland, R-Bigfork, spoke in opposition of Caferro’s bill.

“We do not have enough money to provide all of the services that are asked of us,” Noland said.

Others argue that the additional requirements in Buttrey’s bill are impractical and unfair.

Kate Clyatt, a seasonal farm worker, testified that she doesn’t know many family farm employers who provide benefits like health insurance or pay enough for employees to by their own insurance plans.

Clyatt also said being a seasonal worker may affect her eligibility for expansion if her job doesn’t fall within the stipulations of the work requirement mandate.

“I don’t want to lose coverage because my work schedule doesn’t conform to a 9-to-5 job,” Clyatt said.  

Rep. Mary Caferro, D-Helena, is carrying HB 425, which would renew Medicaid expansion and end its sunset. March. 16, 2019. (Shaylee Ragar/UM Legislative News Service)

Gov. Steve Bullock supports Caferro’s bill, and has spent much of the session promoting the social and economic benefits of expansion. He is not in favor of work requirements or asset testing. A George Washington University study showed that one-in-three enrollees would lose coverage if work requirements are implemented.

Another argument from opponents of Buttrey’s bill addresses its non-severability clause, meaning if one section of the bill is found to be unconstitutional, the entire bill is void.

Al Smith, a representative of the Montana Trial Lawyers Association, said there a number of sections in HB 658 that would likely be challenged if it’s passed into law, making it a risky piece of legislation.

“This is just a bad policy piece to have in there,” Smith said.

Some Montanans want Medicaid expansion to end altogether. A number of people used the failure of I-185, an initiative that would have taxed tobacco to pay for permanent Medicaid expansion, as proof that voters do not want any form of Medicaid.

“I would think carefully about trying to override the will of the voters,” the CEO of the Montana Policy Institute, Brent Mead, said.

The tobacco industry spent more than $17 million campaigning against the initiative.

Rep. Dennis Lenz, R-Billings, is chair of the House Human Services Committee and said members will vote on both bills at the end of this week.

Shaylee Ragar and Tim Pierce are reporters with the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, the Montana Broadcasters Association and the Greater Montana Foundation. Shaylee can be reached at shaylee.ragar@umontana.edu.