Medicaid Expansion Bill To Become Law

HB 658, likely the most contested bill in the 2019 Montana Legislative Session – referred to commonly as the Medicaid Expansion Bill - passed the Senate on a vote of 26-24. The Senate bill included a number of amendments that were then sent back to the House, who confirmed it by the same 61-35 vote tally.

The primary difference between the House and Senate versions was the addition of a sunset clause. Originally, HB 658, carried by Rep. Ed Buttrey (R) of Great Falls, was titled “An act generally revising healthcare laws and permanently expanding Medicaid.” That however was not the case. In the Senate version the bill was amended to include a sunset clause of June 30, 2025. Setting the program – which provides one in every 10 Montanans with health insurance – up for another legislative showdown in six years.

Also added to the Senate bill was a fee on outpatient services provided at hospitals. The fee would be used to offset the costs associated with the bill which will be 90 percent funded by the Federal Government and 10 percent funded by the state. Originally, Medicaid expansion in Montana passed under the HELP Act in 2015. At that time, the program was 100 percent funded by the Federal Government and has been tapered off to the 90 percent margin over the years. Under the Affordable Care Act the U.S. government will continue to fund the program at 90 percent indefinitely or until the law changes.

Responding to questions from The Glasgow Courier and reported in the April 3 edition, Sen. Mike Lang (R – Malta) had initially indicated he would support the measure pending certain amendments. He never actually stated which amendments he needed to see in the bill, but he had stated the bill would have “winners and losers” referring to a fear for long-term care funding.

At press time, Lang had not responded to an email asking for comment on his vote. He did say in a video on social media that he was opposed to the bill due to its large fiscal requirements and the people it purports to help.

“We are making this thing available to people that are able bodied to work,” said Lang, “but they are not working.”

According to a study commissioned by the Montana Healthcare Association, 70 percent of enrollees covered under Medicaid expansion are employed and another 12 percent are disabled. A separate study by the Bureau of Business and Economic Research showed that labor force participation for enrollees increased since the passage of Medicaid expansion in 2015, increasing by 8.5 percent.

The bill that passed the Montana Senate does include work requirements for people able to work between 19 and 55. Those on the program who are unemployed but able bodied must complete 80 hours of community engagement and job-related training a month to maintain benefits.

Lang said later in the video, “The best healthcare plan is to have a good job. When you’re working you’ll feel good about yourself and you’ll find a way to take care of yourself.”

Lang also pointed out, that 65 percent of his district voted against Medicaid expansion in the last election. That vote, however, was to establish a tobacco tax to fund Medicaid expansion in the state, and did not address Medicaid expansion as a whole.

Measure I-185 was bitterly fought by tobacco companies in Montana and many local representatives actively wrote letters and campaigned against the measure citing concerns over a “new” tax. The initiative would have increased the tobacco tax to two dollars a pack and add a tax on vaping to fund Medicaid expansion. The tobacco companies saw to it that the measure was the most expensive campaign in Montana history, spending over $26 million to defeat it.

With the passage of Medicaid Expansion anyway, the funding for the measure will come from the general fund and the newly imposed hospital utilization fee. The bill will now head to Gov. Steve Bullock’s (D) desk where it is expected to be signed into law.