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The Session Week 11: Healthcare funding, childcare initiatives and vaccine bills

We’re on day 55 of the 90-day session. This week we’re talking about health care funding, childcare initiatives and vaccine bills.

This is The Session, a look at the policy and politics inside the Montana statehouse.

Mara Silvers We're on day 55 of the 90 day session. This week we're talking about health care funding, childcare initiatives and vaccine bills.

This is The Session, a look at the policy and politics inside the Montana statehouse. I'm Mara Silvers with Montana Free Press.

Shaylee Ragar I'm Shaylee Ragar with Montana Public Radio.

Keely Larson And I'm Keely Larson with Kaiser Health News.

Mara Silvers Lawmakers have spent the last week digging into budget negotiations as House Bill 2, the state's primary budget bill, continues to take shape. Some of the highest profile debates have been about health care access and how much the state pays Medicaid providers. Shaylee, you and I and other reporters spent a lot of time in those committee hearings last week.

Shaylee Ragar Yeah, Mara. We saw a lot of marathon meetings in the House Appropriations Committee last week. One of the first things that was on their list was a budget proposal to extend Medicaid coverage for women after they give birth. Mara, why do you think that was one of the most controversial proposals?

Mara Silvers Yeah, that was an interesting one to watch because there was Republican disagreement about it this session. Governor Greg Gianforte, his administration wanted the Legislature to fund this expansion, which is about $2 million and would affect between 1,000 and 2,000 new moms over the course of the next two years. But that budget line was rejected by Republicans on the Health Department subcommittee a few weeks ago. So Democrats brought it up again when the health budget came before House appropriations last week, and they ended up having enough Republican support in that committee to advance it.

Shaylee Ragar So break this down for us. What exactly would it do?

Mara Silvers Right. For background. Montana used to let anybody who qualified for Medicaid expansion keep their health care for a full year before their eligibility was reevaluated. But Republicans ended that after the last legislative session. So now pregnant people in Montana with Medicaid expansion have health insurance for 60 days after they give birth. And according to leading medical organizations in Montana and across the country, that short time frame for health care coverage really does not set women up for the best medical outcomes.

Research shows that about a third of pregnancy related deaths happened in the first year after someone gives birth, and that continued health care coverage is really important for helping people with chronic health issues, substance use disorders, depression and a lot of other complications. So health care providers pushed really hard for that funding to be included in House Bill 2. And the committee's vote makes it more likely that that will happen.

After a study found the state underpays Montana Medicaid providers by tens of millions of dollars, lawmakers have advanced a proposal to fully fund the gap.

Shaylee Ragar Right. Because of course, nothing is settled with the budget until it's passed and delivered to the governor's desk, so lawmakers can still amend it.

One of the other issues that is still being hashed out is how much the state will increase Medicaid reimbursement rates for health care providers. Where's that debate sitting now?

Mara Silvers Sure, yeah. This is still a big tug-of-war between Republicans and Democrats and health care providers. So to recap, a study that was conducted over the last couple of years found that Montana underpaid its Medicaid providers by quite a bit. So we're talking about nursing homes, group homes, personal care services for people with disabilities, mental health providers. Those are some of the big groups that are front and center in this conversation. So those providers say that low rates are the reason why their services have been closing down and why there's long wait lists for other programs. So the governor's budget proposed filling in more than a third of the gap between current rates and the study's benchmark. But Republicans on the Health Budget Subcommittee decided to go even further than that after a lot of pressure from providers. So the rate changes they passed along party lines a few weeks ago would fill in roughly 80% to 95% of the differential between current and benchmark rates.

But providers, Democrats and even some other Republicans still maintain that that increase doesn't go far enough to keep pace with inflation and account for the true cost of services. So providers have kept showing up to these hearings before House Appropriations, urging lawmakers to fund rates at the benchmark level and not a penny less. Jacquie Helt was one of those people. She's an advocate with the labor union SEIU, which represents nursing home care workers in Montana.

Jacquie Helt "Partially funding the provider rate steady is like throwing a drowning person a defective life preserver. They might not drown right away., but they most likely will drowned."

Mara Silvers Helt was testifying in favor of another bill, House Bill 649, sponsored by Democrat Representative Mary Caferro from Helena. And that would fund rates at 100% of the study's benchmarks. The committee has not yet voted on that bill.

Shaylee Ragar Mara, where do you think the majority of Republicans on the House Appropriations Committee stand on boosting rates even more?

Mara Silvers It's hard to say because they're under a lot of pressure right now, but they are holding firm so far on increasing rates more than the governor's budget, but not as much as providers want. Trying to find kind of this middle ground. Republican Representative Bob Keenan from Bigfork defended that position in a hearing on Thursday.

Bob Keenan "I understand, you know, 'mommy, I wanted a horse, I didn't want a kitten.' Well, we're doing the best we can, and these numbers are historic, they're unprecedented. And I think we're getting there."

Friday is the official halfway point of Montana’s 68th legislative session. Lawmakers have pulled several marathon floor sessions this week to pass bills through the House or the Senate before a procedural deadline.

Mara Silvers Shaylee, you've been tracking bills to fix Montana's child care shortage that have also been going through committee hearing after committee hearing. And this is another top issue for a lot of Montanans struggling with affordability right now. What are lawmakers debating and which proposals are alive at this point in the session?

Shaylee Ragar Definitely, Mara. And we saw the House Appropriations Committee also take up a child care proposal before them last week, and the committee voted down a $9 million pot of funding for the Best Beginnings scholarship, which helps low income families pay for child care. But that proposal isn't dead in the water yet. Representative Alice Buckley, a Democrat from Bozeman, is also carrying a bill to expand eligibility for the scholarship and to try to stabilize the rate at which providers receive funding from the program. That also has a $9 million price tag. So while the line item in the budget was voted down by Republicans, Representative Buckley has quite a few Republican co-sponsors. She says the bill addresses a few different components.

Alice  Buckley "It's a really complicated issue, and I think it's been frustrating in some ways because you start pulling on one part of it and then realize, oh my goodness, we're dealing with a broken system."

Shaylee Ragar Buckley has another bill that has advanced to the state Senate to clarify that home daycares are residential use of property, meaning they shouldn't be regulated as businesses.

And then there are Republican bills that would say the state does not have to license home daycares caring for fewer than six children. And another to increase the ratio of kids per provider a daycare can accept.

And then a Democrat just introduced a bill to create a $1,600 tax credit for child care providers.

Montana's A.G. threatens to sue Walgreens over the abortion pill. The 2024 ballot could include a slew of proposed constitutional changes. Gov. Gianforte celebrates a major legislative win. And some Republican lawmakers propose a definition of sex.

Mara Silvers Of course, child care didn't just become an issue this session. This is something that we've been hearing about for years now. But there does seem to be quite a bit more momentum this time around compared to last sessions. What do you make of that?

Shaylee Ragar Yeah, I mean, we knew before the pandemic hit that Montana was facing a lack of available and affordable childcare.

According to state data, the number of available childcare slots for infants and toddlers is decreasing. We also know the majority of families struggled to afford care and that those working in the child care industry are often making poverty wages. So Montana was in crisis mode last session dealing with the fallout of the pandemic.

And the pandemic absolutely exacerbated the childcare problem. But there are so many moving pieces and so much in flux. There wasn't a lot of policy proposed or drafted to help deal with the childcare issue. I should note that there was quite a bit of federal pandemic relief money that was allocated towards boosting childcare, but again, not a lot of policy.

Representative Buckley says she thinks it goes deeper than just the chaos of the pandemic. That childcare has long been seen as a private issue to be addressed in the home, most often by women and not necessarily by policymakers.

Alice  Buckley "Because of this, this work has been relegated mostly to the work of of women. I think it hasn't been valued and it's not seen as a quote unquote, economic issue."

Shaylee Ragar But the issues surrounding childcare persist. And Buckley says this session feels different. Like with Medicaid provider rates, after lawmakers had to push these issues on the back burner in 2021, there's now more momentum and more recognition that this is a workforce issue, not just to be figured out by families.

Mara Silvers I'm going to turn to Keely now because you've also been doing a lot of reporting about an issue that was pretty deeply rooted in the 2021 session, which is vaccination and vaccine related bills.

Listeners might remember that Montana passed House Bill 702 in the prior session, which was a broad prohibition on mandatory vaccinations in workplaces and most other parts of society. How has vaccine legislation advanced so far this session, Keely?

Keely Larson Yeah, totally. One way that vaccine legislation has popped up this session deals with exemptions or reasons that people have for not wanting to get the vaccine. Montana already has religious and medical exemptions, but Senate Bill 450, sponsored by Republican Senator Daniel Emrich from northwestern Great Falls, would add a conscience exemption. In defense of this bill, Emrich said it would give parents more options to decide whether or not to vaccinate their kids, including for personal or moral reasons. And all of these exemptions would apply to the type of vaccines that you'd get before entering school, like the measles, mumps and rubella shots or the MMR shots.

In one of the hearings for the bill, Dr. Lauren Wilson, the president of the Montana chapter of the American Academy of Pediatrics, said that this would be the first time a state introduced a conscience exemption for childhood vaccines since Texas did in 2003.

Lauren Wilson "States with personal exemptions have some of the lowest rates of vaccinations. Why does that matter? We should take the example of measles, which can be spread very rapidly. To prevent an outbreak of measles in school, around 95% of children need to be immunized."

Keely Larson Those broad level concerns like immunity to measles or polio or other old diseases that have all been eradicated after successful vaccine campaigns are some of the big concerns of people like Dr. Wilson and other opponents to Senate Bill 450.

This year, lawmakers have introduced proposals to expand vaccine exemptions in schools and change criteria in the workplace and the legal system.

And there are other bills related to vaccines, too. There was one from Republican Representative Jennifer Carlson who sponsored House Bill 702 last session that would require schools to let parents know about these exemptions or about the potential ways that they can opt out of vaccines.

Jennifer Carlson "Vaccine exemptions have been available for 30 to 40 years. We still have a 95% to 97% vaccination rate. But parents have a right to know that they are legally allowed."

Keely Larson Another would make it so adverse vaccine reactions are covered under worker's compensation, and a different one would make it so vaccine status can't be used as grounds for decision making in guardianship or custody cases.

Mara Silvers So at this point in the session, most of these bills have probably had to pass out of the original chamber in which they were introduced. So what's the status of all of these pieces of legislation?

Keely Larson Yes. So all of these bills are awaiting their next hearing in committee, part two. And that means that the public will have another opportunity to testify for or against the bills in the future.

Mara Silvers Yeah, it sounds like there's a lot to pay attention to for the future of those bills.

Before we go, a quick update on some of the things we've talked about in previous weeks. A package of bills totaling $1 billion in tax cuts, rebates and spending was signed into law by Governor Greg Gianforte last week.

Other policy bills dealing with abortion restrictions and banning gender affirming health care for transgender minors are starting to be scheduled for hearings in their second chambers.

And we're also starting to see bills proposing constitutional amendments be introduced as well.

We'll keep you posted on all of that and more in the coming weeks. This has been The Session, a look at the policy and politics inside the Montana statehouse.

Shaylee and Keely, thank you so much for your time.

Shaylee Ragar See you next week.

Keely Larson Thanks, Mara.

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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