A Medicaid expansion policy with new requirements for some low-income adults enrolled in the program passed its first major vote today on the Montana House floor.
The so-called Medicaid Reform and Integrity Act cleared the initial vote 61-39, despite objections from the Republican majority leadership.
House Bill 658 would continue and significantly change Montana’s Medicaid expansion program, which without reuathorization will expire in about 3 months.
Rep. Ed Buttrey, a Republican from Great Falls, carried the current law that passed in 2015. Since then, Buttrey says the healthcare policy has been a major success.
"We’ve created more jobs. We’ve got folks healthier and got them into those jobs. Those people have bought homes. Those people have bought cars. Those people have paid taxes."
When Montana first expanded Medicaid, the Obama administration didn’t allow states to require enrollees to work in order to receive health coverage. So Montana created an optional workforce development program through the state department of labor.
But President Donald Trump has rolled back the work requirement rule and Republicans here want to include that change in state policy.
House Bill 658 includes 80 hours per month of "community engagement" requirements for certain so-called abled-bodied adults on expanded Medicaid.
For most of the legislative session adding these kinds of requirements was a huge non-starter with Democrats. Minority leadership said they opposed the bill from Rep. Buttrey.
But then Democrats' own bill was killed. It would've kept the expansion going as-is, with additional money going toward the optional workforce program,
House Minority Leader Casey Schreiner says Democrats were left two options: vote for the Republican bill they didn’t like, or watch Medicaid expansion expire.
Over 96,000 people are enrolled in Medicaid expansion in Montana, which means the health care program covers over 9 percent of the state population.
"While this isn’t perfect, and there's things in here — let me tell you — we do not appreciate. But we’re also not willing to take it away from the folks back home. People need healthcare," Schreiner said.
Nineteen Republicans joined 42 Democrats in supporting the bill friday afternoon.
Some Republican opponents say the more than 80 amendments made to House Bill 658 over the last few days has left them unsure what they were voting on.
Rep. Forrest Mandeville is a Republican from Columbus.
"This is a complicated issue and this bill never really had a hearing," he said.
Other Republicans say Montanans already rejected Medicaid expansion during the last election.
House Majority leader Brad Tschida, from Missoula, says lawmakers are ignoring voters on ballot initiative 185. That initiative would have raised tobacco taxes in the state and removed the the expiration date for the current Medicaid expansion program.
"Fifty-three percent of the people in this state said no to Medicaid expansion, and we stand here as superior beings to those folks," Tschida said.
Numerous amendments proposed by Republicans during the bill’s more than two hour debate on the House floor today were rejected.
Along with establishing the new requirements for some Medicaid expansion enrollees, House Bill 658 would also increase premiums for people who stay on the program for more than two years. It also collects money to help pay the state’s costs for the program from new fees on hospitals and a premium tax on workers compensation policies sold by the Montana State Fund.
After the House vote this afternoon, the Governor's Office of Budget and Program planning released an updated fiscal impact analysis for the bill. It says over 8,000 people would fall under the “community engagement requirements” outlined in the policy. The governor’s budget office assumes that half of those people will be disenrolled from health coverage for failing to meet the requirements.
Earlier this week a U.S. District Court judge in Washington D.C. blocked Kentucky from adding work requirements to its Medicaid expansion and stopped Arkansas from continuing its current program.
The ruling does not have any direct impact on the legislation moving forward in Montana. However it could if House Bill 658 becomes law and is challenged in court.