Medicaid expansion clears crucial Senate vote; Hi-Line Republican casts tie-breaker

(Montana Free Press) A high-stakes bill renewing Montana’s expanded Medicaid program through 2025 sputtered forward in the Senate Monday, picking up the single vote it needed to clear the body 26-24.

If the coalition of Senate supporters — all 20 Democrats and six Republicans — holds when the bill comes up for its third and final reading Tuesday, that will likely give the measure the support it needs to get to the desk of Gov. Steve Bullock, who has called renewal a top priority.

Russ Tempel, R-Chester, the single senator who changed his position since the 25-25 vote that stalled the measure last week, didn’t speak during the floor debate and declined to answer questions from a reporter following Monday’s vote.

“No matter how the vote goes, I’ll lose favor with some constituents, friends and relatives,” he wrote in a column published by the Havre Herald April 14.

House Bill 658, sponsored by Rep. Ed Buttrey, R-Great Falls, passed the House on a 61-39 vote March 30. If the bill clears the Legislature and is signed into law, it will renew the program created by the 2015 HELP Act, which extends a program providing health coverage to nearly 100,000 low-income Montanans.

The bill began as a Republican proposal, but has been embraced by Democrats since their preferred renewal option, Rep. Mary Caferro’s House Bill 425, was killed in a legislative committee in March. HB 658 includes, among other provisions, work requirements designed to make extending the program more palatable for fiscal conservatives. While HB 658 initially would have made expansion permanent, the version that passed the Senate includes a new sunset clause, which would force lawmakers to take another look at the program in 2025.

“Four years ago we passed a good law together,” Senate Minority Leader Jon Sesso said in urging the passage of renewal Monday. “The evidence is very clear that it’s worked, and that it’s worked well.”

“People are counting on us,” Sesso said.

Senate Majority Leader Fred Thomas, R-Stevensville, who had tried to delay Monday’s vote, argued against the measure.

“While many people want Medicaid expansion in the state, we also want our jobs and opportunity bills to pass, too,” he said. “And this may be our only opportunity.”

Some Republicans, including Colstrip Sen. Duane Ankney, had sought to use the threat of scuttling Medicaid renewal as a way to pressure the governor and other Democrats to support natural resource measures — most notably a “Save Colstrip” bill that has been opposed by environmentalists.

Ankney told reporters after Monday’s vote that Republicans haven’t been successful in using the Medicaid bill as negotiating leverage on the Colstrip bill, Senate Bill 331, and other issues, though he thinks they could have gotten more concessions if they’d been able to hold Medicaid expansion back longer.

“I would have really, really liked to have been a green light on that one,” he said, referring to the colored buttons lawmakers use to cast votes, “but I just felt it was a little premature.”

Ankney and three other Republican senators, Brian Hoven of Great Falls, Jeff Welborn of Dillon, and Tom Richmond of Billings, initially signed on as cosponsors for the renewal bill, but voted against it Monday.

“I’m just not sure this is the best solution,” Hoven said in debate. “While I certainly support the objectives, I think there might be better ways.”

If the bill clears its third reading in the Senate Tuesday, it will head back to the House to give representatives a chance to weigh in on changes made in the Senate, including the new sunset clause.