MTPR

'Capitol Talk:' Gov. Stumps For Clean Medicaid Expansion Bill, MMIW Bills Advance

Feb 1, 2019

Gov. Bullock says the state of the state is pretty good; Republicans want to tweak Medicaid expansion; Both parties appear ready to address the crisis of missing and murdered indigenous women; And the apparent cover-up of an aide's firing over sexual harassment raises questions of how seriously Governor Bullock — and NYC Mayor Bill de Blasio — take that issue. Learn more now on "Capitol Talk."

Sally Mauk: Welcome to "Capitol Talk," our weekly legislative analysis program. I'm Sally Mauk and I'm joined by University of Montana Political Science Professor and Mansfield Center Fellow Rob Saldin and Lee Newspapers Capitol Reporter Holly Michels.

And Holly, Gov. Steve Bullock gave his last State of the State address this week, and he rightfully bragged about Montana's economy.

Holly Michels: Yeah, Bullock spent a lot of time in this speech talking about his legacy, including economic programs that he's seen in his time in office, including Main Street Project. Another big piece of his legacy that he talked about is Medicaid expansion, which he implored lawmakers to continue.

He also talked a lot about infrastructure. This year he’s pitching a $290 million package that has $44 million for smaller oil- and coal- and gas-impacted communities, which he thinks is going to help get it across the line this year.

Bullock also talked about public preschool, which is something he's championed since he first took office. In 2017 he got $6 million from lawmakers to start a pilot project that he said has been very successful. There are statistics that show about 93 percent of kids who go through that program come out ready for kindergarten, and he's using that to sort of try to sell a program this year for about $30 million to make a public statewide preschool option.

SM: He definitely wants Medicaid expansion to continue, and not only to continue but to continue without any particular caveats. Here's what Bullock said during his State of the State address last night:

"It doesn't make sense to me that when we have a nationally recognized model that's helping people succeed in today's economy that we'd consider any measures that would take health coverage away from working folks. Measures that would cost more to administer than provide the services in the first place. Or measures that won't pass muster in the courts."

SM: He wants, Holly, Montana’s Medicaid expansion program to continue pretty much as is.

HM: Yeah, that's been a call of the governor for a long time. Republicans have said that they also would like to see the program continue but with some additions such as work requirements, which they're calling "community enhancements." Bullock spent a lot of time talking about successes that the programs had. Talking about $600 million that it's put into the state economy; creating jobs, somewhere between about 6,000 to 7,500 new jobs; and also just the benefits of more people accessing mental health services and things like that. He did make pretty clear, I think, in his speech that he doesn't have an appetite for what Republicans are suggesting at this point.

SM: Well the other thing the governor doesn't have an appetite for are some deep cuts to Social Services, which did happen in the last special session, and something the governor referenced.

“Let's make sure that the consequences of 2017 and the resulting special session will serve as lessons learned, not lessons repeated going forward,” Bullock said.

SM: And those cuts were painful, Holly, and still are.

HM: Yes, they are. Some of what the Legislature is looking at this session is rebuilding. In the speech on Thursday night Bullock insisted on a $300 million rainy day fund, which is cash in the bank for Montana for emergencies that would deal with things like the expensive fire season we saw in 2017, or if the revenue projections are off, which they also were that year. Republicans have said they want a lower amount, around $200 million, because they'd like to use the difference elsewhere in state government.

SM: Senate President Scott Sales gave a very short rebuttal to the governor's address, sounding the usual Republican themes of developing natural resources and less reliance on federal money. And he had this to say about health care coverage.

“The best health care program that anybody can have is a good job so they can buy their own health care.”

SM: And Rob, that's not exactly a ringing endorsement of government-funded health care.

Rob Saldin: No, it certainly isn't, Sally. I mean it really points though, I think, to the Medicaid expansion that Holly was talking about earlier and that everyone has anticipated is going to be the big battle in this legislative session. Bullock talked about it. Sales talked about it. Those responses from the other party after the State of the State – they're always a little tough. It always comes off as a little bit of an afterthought. People kind of scurry over from the House chamber to the Senate chamber after the governor talks, and people kind of have their minds on what they're doing next and are a little eager to just move on to the next thing. So it's always a little bit of a tough situation. And we see it in the State of the Union address too when the opposition party follows the president. It's a struggle to get people to pay attention. You have a much shorter amount of time. You don't have all the pomp and circumstance that the main event has.

SM: His point about if you have a good job you'll have good health care – I think there are a lot of Montanans who think they have good jobs, but don't think they have good health care.

RS: That's absolutely right. And you know, one of the things with Medicaid expansion is that it's designed to help those people who may have jobs but don't have coverage through their employer. And so it seeks to fill that niche in health care coverage.

SM: Holly, the Republican plan unveiled this week, a draft of the plan anyway, for Medicaid expansion does include, as you mentioned, some provisions for work requirements. And that's a point that the governor says isn't necessary, but Republicans say is.

HM: Yeah, so Rep. Ed Buttrey, a Republican from Great Falls who actually carried the bill to expand Medicaid in 2015, is bringing the bill this session too. And he emphasized that the draft reporters got this week is still a very early idea of what might be in the final bill. But it gives us an idea of what he's thinking about. It has those work requirements. Buttrey calls them “community enhancements.” So what Buttrey’s proposal looks like is 80 hours a month of what can be work, volunteering or other activities, like participating in a substance use disorder program. There are some exemptions for people who might be full-time caregivers for children, or someone who's elderly, students or others who can't work. Buttrey emphasized talking to reporters this week that he's not trying to kick a large number of people off the program. But we have seen similar requirements in states like Arkansas, where they saw about 18,000 people lose coverage under similar to what Buttrey’s proposing in his bill. One thing Buttrey’s emphasizing is that his program doesn't come at an additional cost to the state. It raises some revenue by charging fees on some hospital services and also extending a tax on insurance companies.

SM: Well here's how Buttrey described his work provision.

"We certainly don't want to put a hour requirement that's  punitive," Buttrey said. "I don't want to — I'm not trying to do something that's going to cause the enrollment numbers to drastically change. You know, we've really all along been about a principle of skin in the game. If you're benefiting from the program, you need to help the program succeed."

SM: But Rob, as Holly pointed out, this has been tried in other states and not always worked well.

RS: Yeah, exactly. I mean in a way this is just Montana's version of a much older debate within American social policy: trying to make a distinction between who is worthy and who is not worthy. And in the Montana context, at least, there are two reasons right now that you're hearing for trying to rein-in Medicaid in one way or another.

The first is that there are more people in the program than initially anticipated, which means it costs more. Now, the federal government picks up 90 percent of the tab for Medicaid expansion. But still, more people in the program means a higher bill for the state.

The other reason some people want to alter the program is to root out what they see as abuses. The argument here is that the Medicaid expansion was supposed to be for people who really need it, but it's being taken advantage of by some people who either don't really need it or who are making no effort to lead productive lives. So, in other words it's one of these efforts to distinguish between those who are worthy of this assistance and those who aren't. This has been an issue in other states concerning Medicaid expansion. It's also, as I mentioned at the beginning, just one of these currents that runs through American social policy. And we see it come up time and time again.

SM: Well, there's a long way to go on this issue yet, and it’s probably not something that’s going to be decided early in the session.

Holly, this session has a number of bills aimed at addressing the crisis of missing and murdered indigenous women. And one of the bills is called Hanna's Act. It's named after a woman, Hanna Harris, who was murdered on the Northern Cheyenne Reservation. One of several missing and murdered indigenous women in the last few years in Montana.

HM: Hanna's Act specifically, that bill would create a missing persons specialist within the Department of Justice that would help on cases like Harris's. Hanna's mother, Melinda Harris Limberhand, spoke about the bill, saying that when her daughter went missing she struggled to have people take a report about her being missing, to help start searches for her. And the hope is that this position would help facilitate so that those reports are taken and missing persons are investigated more quickly. Especially on reservations where you have jurisdictional issues with tribal law enforcement and the federal government also involved.

And those bills are a part of a package that came out of the State-Tribal Relations Interim Committee, and they also were developed with input from the Department of Justice. And we've seen those bills already come out of that committee, which means they've had some support from both parties, which would indicate they might have bipartisan support going forward.

SM: Paula Castro Stops is the mother of a 14-year-old girl, Henny Scott, whose body was found just a few weeks ago outside of Lame Deer. And she says it took three weeks for a search party to be formed to look for her daughter.

“If these, these limitations are put in place, I believe my daughter would have been found alive,” she said.

SM: Such emotional testimony, of course, on this issue.

HM: Yeah, we heard from a lot of people who were related to those who have gone missing or been murdered saying that they struggled to get law enforcement to take that missing person’s report, and there's a separate bill in this package to deal with that. A lot of people said that they were told that their daughters were just out partying or using drugs and alcohol and that they’d come home eventually; and they felt very frustrated, as we heard there, that they weren't taken seriously. So, hopefully this will help address that issue and some of those stereotypes.

SM: As you say, it has bipartisan support, so there could definitely be something done in this session.

Rob, Gov. Bullock made some unwanted national headlines this week when it was learned that a former close aide of his, Kevin O'Brien, had been fired from two high-profile jobs for sexual harassment. One when O'Brien was with the Democratic Governors Association while Bullock was chair, and most recently when O'Brien was a senior adviser to New York City Mayor Bill de Blasio.

RS: Right, well there are some aspects of this that we just don't know all those all the details of. Sexual harassment is broad term. It's not publicly known what specifically happened, but obviously it was enough to get him fired from two separate jobs.

You know, just a little context here, I mean basically what happened here: Bill de Blasio, mayor of New York, came out, was very critical of Bullock in the press that, 'Gosh, if we would have known about what happened with O'Brien at the DGA, we never would've hired him in the first place.' Well, a little bit of that seems hypocritical to me. De Blasio seems to be blaming Bullock and the DGA for covering up what really happened at the DGA. But the reason this whole thing made headlines in the first place is because it came out that de Blasio kind of let O'Brien go, under the auspices that he was leaving for his own personal reasons, not because of sexual harassment. So, in any event we don't know everything that happened. And this is the kind of thing that, you know, you wonder if it did happen several years ago, maybe it wouldn't be making headlines. But in the era of Me Too, society looks at sexual harassment in a different way. It takes it much more seriously than it did even just several years ago.

You know, I think in terms of fallout for Bullock, I don't really anticipate much here in Montana. But it's not good for someone who's running for president, which we have reason to think that Bullock is going to do. De Blasio is a very important figure in the National Democratic Party and he's not someone you want to alienate, so that's not great. But I think, you know big picture, none of these people come out looking great on this. Both de Blasio and Bullock and the DGA all look like they made some effort to kind of not have this stuff come out publicly. And of course, O'Brien himself fired from two positions for what we have to assume was some pretty serious misconduct.

SM: Society may take sexual harassment more seriously, but the question is whether Gov. Bullock and Mayor de Blasio took it seriously enough.

You've been listening to Capitol Talk, our weekly legislative analysis program. I'm Sally Mauk and I've been speaking with University of Montana political science professor and Mansfield Center fellow Rob Saldin and Lee Newspapers capitol reporter Holly Michels. Join us again next week.