Montana’s Medicaid expansion hangs on Colstrip deal

In the meantime, a group of five Republicans who are co-sponsors of the bill but voted against it Thursday said they want to make a point about other balls still in the air during the final days of the legislative session. Republicans hold a majority in the Legislature, 30-20 in the Senate and 58-42 in the House.

“I want to see how some other issues play out before we get too far along,” said Sen. Tom Richmond, a Republican from Billings who signed onto the expansion bill but voted no Thursday. “We have some issues with one of my bills and we’ll see what that’s going to be a little later on.”

Richmond said that included his Senate Bill 331, which would let NorthWestern Energy, the state’s monopoly utility company, buy 150 megawatts of interest in the Colstrip Power Plant while prohibiting the state’s Public Service Commission from oversight of the $75 million in increased costs the move would mean for ratepayers.

Another of the no votes on Medicaid expansion Thursday was from bill co-sponsor Sen. Duane Ankney, a Republican from Colstrip who has been a vocal supporter of Richmond’s bill.

“We work hard for a lot of our bills, and we see absolutely no support on the other side of the aisle for a lot of our natural resource bills,” Ankney said. The Colstrip bill has already passed the Senate on a 27-22 vote, but Gov. Steve Bullock, a Democrat, has said he has concerns over what it proposes. The bill had a hearing in a House committee this week, but has not been voted on there.

Bullock said Thursday after the vote that “Republican senators should be ashamed.”

“The 96,000 Montanans who rely on Medicaid expansion don’t have votes to trade. The only choice they have is whether they get the health care they need or whether they can put food on the table for their families,” Bullock said in a statement.

The question of what to do with Medicaid expansion, which will sunset this summer unless lawmakers act, has dominated much of this year’s legislative session.

Republicans who are members of the so-called Solutions Caucus joined with all Democrats in the House to pass the bill on a 61-37 vote at the end of March. A Senate public health committee killed the bill last week, but it was brought back the same day and reassigned to a Senate finance committee, which passed it out to the full Senate on Monday.

The program extends Medicaid coverage to those earning up to 138 percent of the federal poverty level. That’s $17,236 for an individual and $29,435 for a family of three. About 96,000 Montanans are covered under the program.

“This is not the bill to use as leverage,” said Senate Minority Leader Sen. Jon Sesso, a Democrat from Butte. ” … There is just too much good associated with this bill that it shouldn’t be used as leverage for other legislation that is just as important to their sponsors.”

Sesso said Democrats would reach out to all five Republican co-sponsors who voted against the bill Thursday: Richmond, Ankney and Sens. Brian Hoven of Great Falls, Jeff Welborn of Dillon, and Russ Temple of Chester to see what their objections are.

Before the bill stalled Thursday, it was amended several times during more than two hours of debate — including the addition of a 2025 sunset on the expansion program. Another amendment would change state law to have the revenue department provide information to the state health department to verify the incomes of people on the program. The amendments are still on the bill while it sits in the Senate pending action.

Democrats originally had their own version of the bill that expanded Medicaid without the addition of work requirements. But Republicans, even those who would never vote for expansion, began drawing a line in the sand more than a year ago that if the program were to continue, it would need work requirements added.

After the Democrats’ bill was voted down earlier this session, Buttrey’s bill was amended to significantly ease reporting requirements for hours worked or exemptions to the work requirement. That changed the estimate of the number of people who could lose coverage under the requirements from 59,000 to about 4,000. There was also an amendment to lift a clause that would have immediately ended the program if a court found work requirements invalid. Now the bill says if the U.S. Supreme Court strikes down work requirements, Montana’s program would drop them and sunset in 2025.

Democrats said those changes were enough to get their support.

Buttrey’s bill has also been amended to lift a premium tax on the Montana State Fund that would have paid for some of the state’s share of the program. Instead a fee on some hospital outpatient revenue was increased to make up the difference.

Sen. Jason Small, the Busby Republican carrying the bill in the Senate, said Thursday that expansion has dramatically altered the landscape for accessing health care in Montana. He emphasized the positives for Native Americans, who because of the bill have been able to access doctors in ways they haven’t before and seen the level of care at Indian Health Services facilities move from what was called “life-and-limb” status to providing preventive care.

Sen. Jen Gross, a Democrat from Billings, said expansion has meant an improvement for people who need health care.

“It means our loved ones can see their doctor before conditions become chronic or terminal, and they can be seen before more costly treatments are required,” Gross said.

Some Republicans spoke in strong opposition to the bill Thursday, including Sen. David Howard, of Park City, who called the program a step toward socialism.

“You can only steal wealth from working citizens in American and Montana. This takes working citizens’ hard-earned income and gives the money to what the state believes (are) the people that have a need,” Howard said. “… A vote no for this bill is a vote for the citizens of Montana.”

Senate President Scott Sales, a Republican from Bozeman, said he objected to the bill because of the costs at the state and federal level. He said the ballooning national deficit can’t be ignored forever.

“We need to get back to the point where we live within our means to some degree. Just because the federal government’s going to give us a bunch of ‘free’ money that they created (out) of thin air doesn’t mean in the long run this is going to be a good bill for anybody.”

Rep. Mary Caferro, a Democrat from Helena who carried her party’s expansion bill that was tabled in March, said Thursday after the Senate vote it was expected but not the final word on expansion this session.

“We’re not leaving this building without Medicaid expansion continuing,” Caferro said.