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The Session Week 6: Health department funding and colliding world views

Corin Cates-Carney: This is legislative day 31 of 90 we're a third of the way through. This week, lawmakers are starting to piece together the biggest part of the state budget and world views about LGBTQ rights are colliding over rules for public schools.

Corin Cates-Carney: This is The Session. A look at the policy and politics inside the Montana State House. I'm your host. This week, Corin Cates-Carney with Montana Public Radio.

Mara Silvers: I'm Mara Silvers with Montana Free Press.

Ellis Juhlin: I'm Ellis Juhlin with Montana Public Radio.

Alex Sakariassen: I'm Alex Sakariassen with Montana Free Press.

Corin Cates-Carney: We're going to take a look at the debate in public schools in a moment. But first, let's dive into the state health department budget. Spending on health and human services makes up over 50% of all funds appropriated by the legislature. A lot of those funds, including programs for Medicaid and Medicare, end up being matched by the federal government. Mara, In recent years, we've heard a lot about how Montana's behavioral health system is in a tough place. A lot of people needing care and not enough providers to help. How does the Gianforte administration want to fund that work?

Mara Silvers: So most people probably know that a lot of Montanans use Medicaid for their health insurance. About 316,000 people as of November, actually. And what's critical to understand is that the state of Montana gets to decide how much it's willing to reimburse health care providers who work with those patients with public insurance. When it comes to mental health addiction treatment, nursing homes, providers have said for a long time that the reimbursement rates are just way below where they actually need to be. They can't retain staff, keep their doors open or provide quality services because most of their patients or a large chunk of their patients use Medicaid. So the Gianforte administration and his appointed leadership at the health department pretty much agree with that point that Medicaid reimbursement rates are kind of the root cause for the atrophy we're seeing across this part of the health care industry. So his budget is proposing a lot of new spending in state and federal funds to increase those rates. More than $243 million over the course of the biennium, to be exact.

Corin Cates-Carney: So it's a big pool of money, but not all lawmakers are on the same page with the Governor on how to spend it. What are they saying?

Mara Silvers: You know, interestingly, some lawmakers, Republicans and Democrats, are basically saying that Gianforte budget doesn't go far enough to fix this problem. And one of the reasons why they're saying that goes back to the study that the state commissioned after the last legislature to look into these rates and figure out how Montana's reimbursements stack up compared to the true cost of providing services. That study confirmed that Montana is paying way below benchmark standards. But Gianforte's budget, doesn't propose filling the whole gap. It would go more than half of the way there the first year, but then it would drop down to about a third of the differential in the following year. So, for example, the current day rate that the state is paying for some nursing homes is about $200 a day. The study says that should be closer to $280 a day. And Gianforte's budget would fall somewhere in the middle. Now, not all Republicans seem to be on board with filling the entire rate gap. But there are alternative proposals that are taking shape, and we just have to wait and see how much support they have. Democratic Representative Mary Caferro of Helena sits on the Health Department's Budget Committee and said last week that she'll be introducing a bill to increase those rates to the study's recommended levels.

Rep. Mary Caferro: Montana has a good, strong infrastructure in our state. We have providers that are dedicated, they're state based and they've provided services in some cases for a hundred years. So we need to invest in those providers so that they can build back that infrastructure necessary to take care of Montanans.

Mara Silvers: Final numbers on that proposal aren't in yet, but the Health Department has estimated that it would cost the state general fund an additional $46 million a year to meet the study's recommendations.

Capitol Talk logo with an illustration of the state Capitol next to host Sally Mauk, reporter Holly Michels, and Political Science professor Rob Saldin
Lawmakers target gender-affirming care, scientific theories and 'San Francisco elites'
Bills affecting transgender Montanans draw emotional debate. Scientific theories are targeted for elimination from public education. And Senator Daines battles Twitter and "San Francisco elites."

Corin Cates-Carney: The executive and legislative branches have clashed over similar budget debates in the past. The Governor often likes to see more flexibility in department spending. The legislatures, as the appropriators want to see things outlined in line items before lawmakers leave town. What are some of the other major projects the governor outlines in his proposal for the state Health Department?

Mara Silvers: Yeah, there are a couple of big pots of money that the department is requesting. One is about $30 million for fixes to state run health care facilities. More than half of that would go toward the Montana State Hospital in Warm Springs to get it back up to federal standards since it lost accreditation with the federal government last year. Other requests would go towards technology upgrades. That's another multi-million dollar pot of money. And then there's another $113 million pot for what the department says is developing behavioral health alternatives. That could mean building new facilities in different parts of the state to take pressure off of the state hospital. Lawmakers are trying to get more information about all of those details before the Budget Committee starts taking initial votes on whether to approve or change those requests this week.

Corin Cates-Carney: Moving away from the budget and into more of the policy space in the state House, there's a slate of bills coming up for committee and for votes that all revolve around clashing worldviews about the LGBTQ community. Kids in public schools. Ellis. And Alex, you've been following some of these bills about obscenity, drag shows and how misgendering plays a role in bullying in classrooms. Where should we start?

Ellis Juhlin: Well, Corin, with all these bills, the conversation has really been centered around the safety of kids. That phrase gets thrown around a lot, and lawmakers from both sides of the aisle say that kids safety is their top priority, but they have really different views about what it is that kids need to be kept safe from socially conservative groups. And lawmakers see a society with defined binary gender roles, and we see that reflected in a bill brought by Brandon Ler, a Republican from Savage, that would change laws for public schools so students calling another student by the legal name they don't use or misgendering them would no longer be considered unlawful discrimination. Ler said it's important that kids like his aren't punished unnecessarily.

Rep. Brandon Ler: I expect my children to treat everybody with respect, but it's also disrespectful to my children to force them to lie and not be truthful to themselves about what they believe.

Ellis Juhlin: For the LGBTQ community and allies, it's a different way of viewing gender and sexuality than social conservatives. They want acceptance of their community and their kids and to avoid legislation that singles out trans, nonbinary and two spirit kids in particular. The committee hearing for Ler's bill saw strong opposition from over 30 people, including members of the LGBTQ community, trans kids who've been bullied for their identity, and teachers worried about how this policy could affect their classroom dynamics. Kassia Finn and her son Max, who's transgender, spoke against the bill.

Kassia Finn: Voting yes will be giving the green light to bullying. Beautiful, kind, happy and healthy, trans nonbinary and two spirit kids and their families.

Corin Cates-Carney: There are a few bills here that follow a similar theme, including one that would ban drag shows. Ellis, what's going on there?

Ellis Juhlin: That's right, Corin. Another bill that I've been tracking is from Braxton Mitchell, a Republican from Columbia Falls, that would prohibit minors from attending drag shows and it would prohibit drag performances in libraries or schools that receive state funding.

Rep. Braxton Mitchell: Why exactly did drag shows become children's entertainment and, quote unquote, family friendly? In my humble opinion, there's no such thing as a family friendly drag show.

Ellis Juhlin: I think it's important to note that there are several different amendments that have been proposed on this bill. So depending on how the committee votes, the bill could also include prohibiting drag performances on public property where kids are present or in a location owned by an entity that receives state funding. The Superintendent of Public Instruction, Elsie Arntzen, was one of the bill's proponents. And coming back to that phrase, she said this bill would protect kids. Other proponents echoed that saying drag is inherently sexual and inappropriate for kids. While opponents of the bill argue that this further exacerbates the harmful stereotypes of the LGBTQ community as being predatory towards children. Many of the bill's opponents have also criticized how broad the terminology and definitions are in the bill. Here's SK Rossi with the Human Rights Campaign talking about that.

SK Rossi: It is not limited to sexual oriented businesses because it says or similar commercial enterprise, and it says nightclub, bar, restaurant. I mean, that is an enormous number of businesses in Montana. Its breweries, its distilleries, its restaurants, its bars and its commercial enterprise that serves alcohol and has a drag show.

Corin Cates-Carney: Let's bring in Alex now. You've been following a bill that would ban obscene material from the classroom. What's obscene mean in this case and why is this policy being brought forward?

Alex Sakariassen: Yeah, Corin, Republican Bob Phalen of Lindsay has a bill that would apply criminal penalties to educators who give students access to material that the state classifies as obscene. That means descriptions of and quoting state law here, perverted ultimate sex acts, things that are deemed patently offensive, representations of normal sex acts, etc. The bill is primarily supported by voices from within the parental rights movement, really mirroring a lot of what we've been seeing talked about nationally. And much of this criticism has really focused on books that are centered very specifically on transgender characters and themes.

Corin Cates-Carney: And what are you hearing teachers say about how these kind of policies would get incorporated into classrooms?

Alex Sakariassen: First, educators have repeatedly quoted the Montana Constitution, specifically Article ten and its guarantee of helping every student reach their full potential. I hear the phrase local control a lot in hearings. Teachers and administrators really feel that these sorts of conversations rightly belong among local leaders and among local communities. Not as a representative for the teachers union put it, legislative overreach. I'll also point out that they're not excited about the prospect of criminal charges under Phalen's obscenity Bill. That could have a really chilling effect on teachers and school librarians as they're making decisions about what materials they have in their classrooms or school libraries. Second, there's a very real fear among teachers that policies like these will make it more more difficult for them to provide a supportive and reaffirming environment for students and protect them from bullying and harassment. The line of thinking is that kids will feel more emboldened to misgender their trans, non-binary and two spirit peers, and if that happens, may be more inclined to make hurtful remarks about other students as well. And teachers feel the legislatures proposals are really going to tie their hands when it comes to responding to those incidents in real time and preventing them from becoming physically violent. I should add that before it passed out of committee, House Bill 361 was amended to allow districts to intervene if a student's behavior rises to the level of bullying. We're really going to have to see whether that's enough to address teachers concerns as this debate continues.

Corin Cates-Carney: One of the themes coming up in these hearings is conservative supporters of these policies have fundamental opposition to allowing transgender, nonbinary and gender diverse people to express themselves in schools. Members of the LGBTQ community, especially trans people, have said they're trying to live their lives and they're not the ones starting the culture wars. How are Republicans who control these committees reacting to those arguments?

Alex Sakariassen: Yeah, I'm not sure we're really seeing anyone on these committees reexamining their worldview here. In fact, with the misgendering bill, Representative Jed Hinkle, a Republican from Belgrade, really pushed back on the LGBTQ advocates position with this notion that kids raised in a household or in a faith that sees gender as only binary shouldn't be forced to violate what he called their own sense of reality. Ler really echoed that in his closing statements when he made a First Amendment argument on behalf of his children and others like them. But on the obscenity front, the local control argument actually won over some moderate conservatives on the House floor. It still passed to the Senate, but several Republicans voted against it because on principle, they don't like to see state government taking a heavy hand in public education. And they really see this as that heavy hand.

Corin Cates-Carney: If these bills do advance out of committees and get passed in the chambers, they'll end up on Governor Greg Gianforte's desk. What's the Governor's position on these bills?

Ellis Juhlin: So the Governor hasn't specifically commented on these bills or this social issue, although it's worth noting that he hasn't been directly asked about it either. He did touch on some conservative social issues like anti-abortion sentiments, parental rights and school choice in his State of the State a few weeks ago. But he hasn't taken a public stance on these bills in particular.

Corin Cates-Carney: Thanks, Ellis. And also thanks to Mara and Alex for jumping on the show this week.

Ellis Juhlin: Thanks, Corin.

Alex Sakariassen: Yeah, thanks, Corin.

Ellis Juhlin: Thanks.

Corin Cates-Carney: Before we go, lawmakers are cracking open the budgets for agencies all across the state government this week. And we're a month away from the transmittal break when general bills must pass out of their original chamber and into the other. That means the pace of policy is really going to start picking up.

This has been The Session, a preview of the policy and politics inside the Montana State House. The Session is produced by Montana Free Press, Montana Public Radio and Yellowstone Public Radio. Join us next week for a new episode and subscribe wherever you get your podcasts.

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