Health gets political

The 69th Legislature is kicking off week 15. Today, we're talking about health policy. This is 'The Session', a look at the policy and politics inside the Montana statehouse.

MTPR's Shaylee Ragar is joined by Mara Silvers from Montana Free Press.

Shaylee Ragar: Mara, we are slowly nearing the end here.

Mara Silvers: Yeah, there's some light at the end of the tunnel.

Shaylee Ragar: We're getting there. It's just a speck in the distance. So we are gonna get into some health policy, Mara, and there is so much to talk about on that front. However, I think we should also update listeners on some judiciary bills 'cause they've been hearing lots about them this session and we have some updates.

Mara Silvers: There are so many and I don't know where they all have landed.

Shaylee Ragar: Those bills are definitely having mixed success. That special interim committee that met solely to talk about changing up regulations for the judiciary produced 28 bills to look at changing regulations for the judiciary.

There are Republican lawmakers that say the judiciary is biased against Conservative policies. They wanna have more oversight over the judicial branch, but a lot of the bills that they proposed from that interim committee have not been successful. Kind of the headlining policy that has gotten the most attention and is even supported by Governor Greg Gianforte is a proposal to make judicial elections partisan. We have seen five attempts in five different bills to make judicial elections partisan and all are dead at this point, they have not been revived, and it looks like that policy is not gonna get done.

Senate Majority Leader Tom McGillvray told us in a press conference last week that he's not happy with the results of where they're at.

“It's discouraging, frankly, that we didn't get more done.” 

Mara Silvers: It shows just the difference between expectation versus reality at the beginning of the session and what lawmakers think they might be able to get done versus how the cookie crumbles when we're this close to the end. And of course, we should say nothing is dead until sine die–things could change, but with that many attempts, it does seem like that's a pretty definitive response from the body as a whole.

Shaylee Ragar: Yeah, goes to show it is hard to pass a bill in the legislature and it is designed to be that way and there is not total agreement among Republicans on policy. They hold big majorities in both chambers and they have not agreed on this policy.

Another place that we are seeing some disagreement and some…

Mara Silvers: …Unexpected evolution of policy…

Shaylee Ragar: Yes, exactly, is on the health front. Mara, you follow these topics closely. There's a lot going on. Let's start with a proposal to separate the Department of Public Health and Human Services into two departments. This would be a huge shakeup. Mara, talk to us about this.

Mara Silvers: When I first heard that this bill was being drafted, I thought that it was a messaging bill. Like, I thought that it was going to be a bill about how government is too big and the Department of Public Health and Human Services as the state's largest agency is just unwieldy.

But I didn't think that it would actually get very far. And to my surprise, it has passed with a broad bipartisan coalition of support. So the votes that we've seen on this have been honestly shocking to me, because it's not every day that you see a proposal to shake up the status quo and state government this dramatically have broad support across both parties.

Shaylee Ragar: Right. So let's talk about what this bill would do in practice.

Mara Silvers: So House Bill 851 would, like you said, divide DPHHS into two separate state agencies. One of these buckets, which I think I'll say is the driving purpose behind the bill would be tasked with overseeing institutional care settings and some other types of community care.

Basically the Montana State Hospital in Warm Springs, the Montana Mental Health Nursing Care Center in Lewistown, the Chemical Dependency Center in Butte, veterans homes, all of those settings would go under one department, as would the community programs that intersect with those inpatient facilities. That's one bucket, that would be one new department.

The other health department would handle basically everything else that the Department of Public Health and Human Services currently touches. That includes the administration of state Medicaid programs, contracts with service providers who run community programs, foster care, child welfare, early childhood supports.

The list goes on and on and on because this is such a massive agency.

Shaylee Ragar: It does strike me though that all of those things do fall under the umbrella of health. It makes sense that all of those things are housed in a department. Why do this? What's the goal?

Mara Silvers: In a nutshell, as I've said, DPHHS is the state's single largest agency, and it's no secret that many of the state’s state-run facilities, especially the state hospital, have been over budget and underperforming for years. Lawmakers wanna pull back the curtain and basically have more clarity about what's going on at those facilities.

So the bill sponsor is Representative John Fitzpatrick. He's a Republican lawmaker from Anaconda. He talked about this on the House floor last week.

“The problems at DPHHS are not new. They reach back 30 years. It suffers from continual top management turnover. In the last two years, there have been four superintendents at Warm Springs.”

The bill passed that vote by a huge margin, 82 to 15, and now that bill is moving on to the Senate.

Shaylee Ragar: Governor Greg Gianforte was asked at a press conference last week if he would comment on this bill, what his thoughts were. He said he would not comment on specific legislation. That's kind of a canned answer we get from him sometimes.

“But I will tell you more generally, we are opposed to bigger government.”

The way the state manages its public institutions has been under scrutiny for years, and that's again, a topic of discussion this session. Mara, remind us, what are people concerned about and how are lawmakers proposing addressing those issues?

Mara Silvers: I'd say there are generally a few strategies that are showing up in the bills that I'm watching about state institutions and how to help people with serious mental illnesses.

So, the first big bucket of bills is an effort to expand bed capacity for people with mental illness who overlap with the criminal justice system. So the Gianforte administration is asking for funding to turn an existing unit of the state hospital into something that can serve this forensic population, which is sometimes a group of people called ‘Guilty, But Mentally Ill’ patients, or GBMI.

There's also another major bill that came kind of late in the session that would use existing behavioral health dollars to build a whole new forensic facility in the eastern part of the state. That would add at least 70 beds, maybe more. Another strategy is to ease some of the backlog of people who are stuck in limbo between county jails and the state hospital.

One of those bills would give county attorneys and jail staff more authority to evaluate and treat patients locally without having to transport them back and forth to the state hospital.

Third, lawmakers are looking at ways to do community commitments for people who are potentially a risk to themselves or others, but who are not part of the criminal justice system.

That strategy would pull in more local treatment providers who theoretically would be able to stabilize patients in the community instead of having to send them to Warm Springs and some mental health advocates are leaning on the department to put more funding towards those types of community settings, which could help ease some pressure on state institutions down the road.

Shaylee Ragar: Sounds like a lot of asks for local partners and local providers. What are officials saying about the feasibility of these proposals?

Mara Silvers: Yeah, I mean, this is one of the interesting political dynamics that we see shake out here. So some of these proposals that the Gianforte administration put forward were bills to limit when the state hospital has to admit someone.

But those proposals did not fly with county prosecutors, jail staff, local hospitals, disability rights groups. So eventually those other groups started drafting bills to strengthen local mental health and criminal justice services so that they can better handle the patients that the state says it can't care for.

And interestingly, the state hasn't been opposing those bills. And I think that it's because they know that it's a trade off. They have to have everything advance, not just the bills that they originally proposed. So we'll see what the governor ends up signing, but I think at this point DPHHS officials are approaching these bills as mutually connected. They all need to pass in order to fix a pretty widespread problem.

Shaylee Ragar: Mara, a lot of these bills will cost more money and DPHHS already accounts for a huge chunk of the state budget and the money the state receives from the federal government. We know that some of the federal funds are in limbo right now.

The Trump administration has been clear and wants to make big cuts. What does this mean for Montana?

Mara Silvers: The money is not a guarantee. I think Montana is in this position of having a budget surplus, but with so much federal uncertainty on the horizon, lawmakers are not feeling super confident in that surplus right now.

We have heard staff from the state health department talk about this exact issue during a hearing before Senate Finance and Claims last week. The department director Charlie Brereton was asked pretty point blank, how is the state health department feeling about federal cuts or preparing for the possibility of future cuts?

And he said they're not really in an emergency situation yet.

“Really what we're doing is trying to find opportunities to mitigate those funding cuts wherever possible.” 

Shaylee Ragar: So the legislature has to finish its business by Day 90. That's the first week of May. If the feds happen to hand down cuts after adjournment, which seems like it could be very likely, then what happens?

Mara Silvers: There's more than a little chance that lawmakers are gonna come back for a special session, which we haven't had since 2017 in this state. It's not likely that all of Montana's federal funding would just dry up overnight. It's not just like a spigot that would be turned off.

But it could be the fact that we see major changes to some programs that have been a durable part of the state budget for a long time, and lawmakers are gonna have to figure out what to do about that. So reporters talked to Senate President Matt Regier about this last week, and he didn't shy away from that scenario.

“It could be very negative, it could be very positive of come back and as a state react to what the feds are doing in a special session that could, that could very well benefit the people in Montana.”

Shaylee Ragar: Right. So they're kind of on board with the temporary pain for long-term gain mantra that we've been hearing.

Mara Silvers: Totally. I think he made that pretty explicit.

Shaylee Ragar: Well, definitely lots for us to still be watching. We're gonna leave it there for now. Before we leave, Mara, do you have a favorite moment from last week you can share?

Mara Silvers: Yeah, so one of the fun things that happened last week was the legislature's annual blowout party that lawmakers throw it's called attache. I've never gone and I think that there are kind of like some cultural rules around like ‘what happens at attache stays at attache’ but there are always leaks. Like one of the funny things that appears to happen at attache every year is just lawmakers roasting each other and teasing each other mercilessly.

And there's a slide show that gets put together where lawmakers are, you know, the butt of the joke in different ways. And it's so funny to see like, little tidbits of that come out or hear rumors about it afterwards. So this is my, this is my call for submissions. If you have an especially funny joke from attache, please let me know because they are funny for reporters to hear too.

Shaylee Ragar: Yes. I kind of like the air of mystery.

Mara Silvers: Shaylee, what a fun thing happened for you last week?

Shaylee Ragar: I will say my favorite moment was that Montana PBS's Breanna McCabe had a story come out about legislative families.

“And altogether it's the most-related pairs serving in any legislature nationwide.”

And the interviews are so great. They're so funny.

“I started looking around at all the different families that are represented here, there's a lot.” 

So you gotta check it out on Montana PBS.

Well, thanks so much for joining, Mara. This has been The Session, a look at the policy and politics inside the Montana State House.

Mara Silvers: Thank you.