Personal stories, politics and big money: Medicaid expansion bills have first hearings

Posted at 8:02 AM, Mar 17, 2019
and last updated 2019-03-18 17:06:00-04

HELENA — Supporters of Montana’s expanded Medicaid program packed the Capitol Saturday, to rally for its extension and testify for one or both of the bills that would continue the $800 million-a-year plan that provides medical coverage to nearly 100,000 low-income adults.

“Medicaid is working,” said Rep. Mary Caferro, D-Helena, sponsor of the bill that extends the program in its current form. “It’s not socialized medicine; it’s a public-private partnership. … I hope everybody else can see the value in our investment when they invest in people’s health.”

Caferro made a plea to the House Human Services Committee to approve her House Bill 425.

Rep. Mary Caferro, D-Helena

But the panel, controlled by Republicans, on Saturday also heard House Bill 658, the GOP alternative from Rep. Ed Buttrey, R-Great Falls, that would renew the program but place some restrictions on eligibility.

“I think that we can make the system even better,” Buttrey said as he opened the hearing on his bill. “That we can get more people self-sufficient, that we can create more jobs and we can do so in a way that applies and assures to the taxpayers of Montana that their money is being spent in the most responsible way possible.”

The most controversial element of Buttrey’s bill is its requirement that most participants in the program perform 20 hours a week of “community engagement,” which is a job, volunteer work or other activities. The bill requires participants to self-report their community-engagement hours and has numerous exemptions for people who won’t have to do it.

Rep. Ed Buttrey, R-Great Falls

But opponents of the Buttrey bill said the requirements inevitably would lead to thousands of people not getting coverage, because they would find the new forms too difficult to deal with.

“Community engagement will cause people to lose coverage,” said Mary Dalton of Helena, who directed the state Medicaid program when the expansion began in 2016. “Not because they don’t want to work, but because it is so administratively complex to get through, some people will throw up their hands and give up.”

Still, moderate Republicans — whose votes are needed to pass any Medicaid expansion bill — are largely behind the Buttrey bill, saying the program needs some additional restrictions to control the cost and ensure that those getting the mostly free coverage are truly in need.

The House Human Services Committee plans to vote next Friday on whether to advance either bill.

HB658 also would require stronger verification of enrollees’ residency and charge a fee to those who qualify because of their low income but also own large amounts of property.

The expanded Medicaid coverage is open to adults earning up to 138 percent of the federal poverty level, or about $17,200 a year for a single person. The federal government pays 90 percent of the cost of the program.

The 2015 Legislature approved the program, but set a June 2019 expiration date, setting up this year’s debate over whether to extend it.

One of the Republicans who testified for Buttrey’s bill Saturday was Rep. Nancy Ballance of Hamilton, who co-chairs the House Appropriations Committee and voted against the 2015 bill that first authorized the program.

She said Medicaid expansion is needed to bring health coverage to those in poverty and suffering from things like drug addiction, and that HB658 includes many things that Republicans said they wanted in the program.

“I can no longer let the Republican ideology stand in the way of doing the right thing,” she said. “The system needs reform, it needs change. .. Well, here we are folks — this is the bill that has those things that (Republicans) said you had to have.”

Republicans from the party’s conservative bloc led the testimony against the bills, saying Medicaid expansion is too expensive for the state and is increasing a federal debt that has surpassed $21 trillion.

Sen. David Howard, R-Park City, called Medicaid expansion a “socialist-type program” and noted that Montana voters rejected Initiative 185 last fall, that would have extended the program and helped finance it with a big increase in state tobacco taxes.

“The key thing that we need to understand is that Montana has already voted for this,” he said. “They voted down 185. That’s a very important thing for me.”

But supporters of Medicaid expansion far outnumbered the opponents on Saturday, as they shared personal stories about how the expanded coverage had helped them, their family or their patients.

Jennifer Show, nurse practitioner, Fort Belknap

Jennifer Show, a nurse practitioner on the Fort Belknap Indian Reservation, said Medicaid expansion has helped tribes across the state greatly expand their health-care offerings to impoverished Native Americans, because their patients now have coverage that pays the bills.

“I can’t speak enough about what Medicaid expansion does for us,” she said. “It has done wonders, and it’s more than just Indian Country. These are your most sensitive population, these are your most vulnerable people in your guys’ districts, that this affects.”

Joanna Waley, a dentist at a clinic in Livingston that serves low-income patients, told of a patient whose teeth had been pulled but, with Medicaid expansion, was able to get dentures. Once that happened, he was promoted from the kitchen of a well-known restaurant to be its on-floor manager and then recruited away to work in another high-end restaurant, she said.

“Without teeth, people are relegated to back-room stocking, dishwashing or simple unemployment,” she said. “It’s hard to get a job if you do not have front teeth.”