Advocates push for Medicaid expansion in Montana, KRTV, December 10, 2014
HELENA -- Medicaid expansion failed in the 2013 Legislature, but Governor Steve Bullock (D) has labeled it one of his top priorities in 2015.
On Tuesday, advocates for expansion outlined who they say will benefit, and how they plan to make it happen.
At a legislative summit hosted in Helena by the Democratic-leaning Montana Budget and Policy Center and the Partnership for Montana's Future,
Tara Veazey, Bullock's health and families policy director, offered the situations of some hypothetical Montanans among the 165,000 who now lack health coverage. To qualify for Medicaid now, she said, a single person with two children may only earn 52 percent of the federal poverty level, or about $10,000 annually.
But if that person earned, say, $18,000, she'd make too much for Medicaid - but not enough to qualify for the subsidies available under the Affordable Care Act, also known as Obamacare.
And non-disabled adults without children do not qualify for Medicaid at all.
"That's a really nice way of saying, there are a lot of working poor people in Montana who are just completely out of luck," Veazey said.
The "gap" comes because the ACA was designed to complement Medicaid expansion in the states, with its architects not envisioning that states would have the right to opt out of the expansion.
Expansion would also provide coverage for 20,000 Native Americans in the state, many living in urban areas, said Kevin Howlett of the Confederated Salish and Kootenai Tribes Health Service. The federal government's Indian Health Services, he said, isn't getting it done.
"When you're getting your care in a tribal clinic or an Indian Health clinic, you;re getting care that is rationed." he said. "Indians get rationed care - one of the big arguments against the Affordable Care Act to begin with, but yet we live with it."
Other than the Veterans Administration, he said, IHS is the only federal agency that provides health care (although, strictly speaking, health care is also provided by the Department of Defense and the Federal Bureau of Prisons.)
"We've all heard the stories and horror stories associated with VA health care," Howlett said. "I'll tell you, Indian Health Service is worse. It is worse. People die. They don't get access to care."
Advocates are counting a major outpouring of support from thousands of people across the state, who will be urged to call and email their legislators and show up on specific lobbying days at the Capitol.
The Montana Hospital Association supports Medicaid expansion, and its president Dick Brown, rejected assertions that the expansion would be a "windfall" for hospitals, though he did say that it would help the "Critical Access" hospitals, those that are crucial in more than 40 Montana towns.
He said Medicaid only reimburses hospitals for about 70 percent of their costs. But in many cases, those costs would otherwise go unpaid - or, more accurately, be paid ultimately by those with insurance.
A running tally on the group's website says that Montana has missed some $463 million in federal payments because of its failure to expand Medicaid.
Opponents and skeptics of expansion have noted that it would not solve some of the other ongoing problems with Medicaid including fraud, poor heath outcomes and an absence of meaningful cost controls. One Montana hospital administrator said recently that Medicaid patients have a very high rate of failing to show up for appointments. That costs the hospitals money, earns them no reimbursement and does nothing to help anyone's health.
The Bullock administration says its Medicaid proposal will be different this time. Private companies will be contracted to administer it, along the lines of its successful implementation of the federal Children's Health Insurance Program (CHIP), called Healthy Montana Kids here. And Bullock said last month when he unveiled his proposed budget that the funding would come from federal "performance bonus funds" related to the CHIP program and ultimately mean a net gain of $55 million for the state over two years.
Republicans have been skeptical of those claims and others, noting that the federal share of the costs will eventually drop to 90 percent, leaving Montana more and more obligations as health care costs keep rising.
Chris Shipp, executive director of the Montana Republican Party, called expansion a "top-down policy."
"This is a proposal that's coming from Washington, D.C.," he said. "It's been incorporated in from Obamacare; and of course we have a wide variety of problems with our health care system, but these proposals for Medicaid expansion just aren't going to work for Montana families. ... The state of Montana is going to be faced with increasing costs and decreasing funds coming from the federal government, and that's something that's just not sustainable long-term."
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.