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Montana politics, elections and legislative news

Montana Republicans' Health Plan Explained, Criticized

Montana Capitol.
Eric Whitney

A group of nine Montana state lawmakers has put out an alternative to Democratic Governor Steve Bullock’s plan to expand Medicaid. They call it the Healthy Montana Family Plan, and it aims to cover more people, without the long term expense of Medicaid expansion.

Medicaid expansion "really will put the state’s finances in a pickle come 2019," says Sen. Fred Thomas of Stevensville, a co-author of the Republican plan. "You’ll either need to raise taxes, or you will need to reduce funding for schools in Montana."

Thomas chairs the Public Health, Welfare and Safety Committee. The eleven-page plan released Wednesday isn't designed to provide health coverage for 70,000 low income Montanans, the way Bullock’s proposed Medicaid expansion is, but he claims it will cover an additional ten to fifteen thousand people without requiring any more state or federal money.

“I’m saying by reforming Medicaid there’s a lot of savings in the whole program by reforming it, dialing it down. We’re thinking five-ten percent savings is probably the lower end side of the projections. It’s a lot of money. It’s plenty of money to take care of these additions, in general," Thomas says, adding, "we haven’t had all this penciled out and costed out, I’ll be very up front with you on that."

The plan begins by re-focusing Medicaid on its original targets, the working disabled, children and low-income parents, as well as one group that has not been targeted before: low-income veterans who are waiting for the VA to process their applications.

“If we can supply a bridge in there through Medicaid to take care of some of them while they’re waiting to get taken care of by the VA, maybe that’s a good target market, if you’re under the federal poverty level, too, of 100 percent or less." 

Thefederal poverty level for an individual is $11,670.

The Republican plan includes some “tweaks” to help people get federally-subsidized health insurance via Obamacare instead of Medicaid, such as tax credits to help people reach the federal poverty level, at which they qualify for subsidized private insurance.

A policy group that supports the governor’s Medicaid expansion plan is very critical of the Republican alternative. Heather O’Loughlin is co-director of the Montana Budget and Policy Center:

“We’re still reviewing this plan, but we believe this plan will not provide the coverage to all those that are eligible, and therefore Montana loses out on the higher federal [Medicaid] match, and billions in federal dollars that Montanans really deserve."

The Medicaid expansion would extend benefits to people who make up to 138 percent of the federal poverty level. The federal government would pay the entire cost at first, and the state would eventually pay up to ten percent. O’Loughlin says turning down that money leaves a lot of people with no coverage.

“For example, we estimate there’s about 15,000 Montanans that are between the ages of 45 and 64, who are generally childless, that are not yet eligible for Medicare, and under this plan, many of those Montanans would not be eligible for health care coverage.”

Senator Fred Thomas says these childless, able-bodied adults can qualify for subsidized private insurance instead of Medicaid, if they just earn a little more money.

“Anyone that’s in that predicament, we’re gonna encourage them to get another job, get the extra hours, and qualify for the exchange, by bumping their income up a little bit.”

And if covering more Montanans does require more money from the state budget, Thomas says it’ll be a small amount, not the hundreds of millions of dollars the Medicaid expansion would require.

“Well let’s say that the legislature looked at this and said, okay we’re short five million bucks. The legislature could take it out of the general fund, which has a $365 million ending fund balance projected for July."

Even though Republicans in Congress are committed to repealing the Affordable Care Act, the Montana Republicans who drafted this plan are counting on the health insurance exchanges created by the ACA. Thompson doesn’t see a contradiction there. He expects the new Republican Congress to make sweeping changes to “Obamacare," and the Supreme Court may alter it significantly this spring.

“But in the meantime, we can’t make policy based on what we don’t know they’re going to do. We don’t know what the Supreme Court’s gonna say, and we don’t know what the congress and the president are going to come to terms on in the future, if that happens."

At this point, the Republican Healthy Montana Family Plan is just a policy document – not actual legislation. The Governor’s Medicaid expansion plan is currently being drafted. Both proposals would have to pass the Senate Public Health Committee – where Fred Thomas, who co-wrote the Republican alternative, also happens to be the chairman. 

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