A bill to continue Montana’s Medicaid expansion program, which provides health coverage to 96,000 low-income adults, cleared its first legislative hurdle Tuesday evening, as the House Human Services Committee voted 11-8 to send it to the House floor.
All eight of the panel’s Democrats joined three Republicans to approve House Bill 658, which would remove a June 30 expiration date on the program, but also add a significant new eligibility requirements for participants: 80 hours a month of “community engagement,” which could be a job, volunteer work, caretaking for a relative, or other specified activity.
Democrats, who have steadfastly spoken out against work requirements for Medicaid recipients, reluctantly supported the bill sponsored by Republican Rep. Ed Buttrey, saying the program is too important not to continue.
“I think we recognize that the political context has changed, and there are 96,000 people who are anxious, watching what we’re going to do in this building, and wondering whether they’re going to have health insurance in July,” said Rep. Kim Abbott, D-Helena, shortly before the vote. “And so, I think for us, we’re willing to compromise.”
Buttrey, who sponsored the 2015 bill that began Medicaid expansion three years ago, told MTN News after the vote that he disagreed with predictions that the new requirements would lead to tens of thousands of people losing their coverage.
“We’re pretty famous for our Montana-made solutions, especially in health care,” he said. “And I think we’re going to do it in a way that is going to make sure that we know a large percentage of these folks are working and likely meet the community-engagement requirements already.”
Gov. Steve Bullock, a supporter of Medicaid expansion, has said that nearly 70 percent of those covered by Medicaid expansion are working.
Buttrey also pushed through an extensive set of amendments to his bill Tuesday evening, designed to soften some of the new requirements. His changes expanded who can claim an exemption to the community-engagement requirements, among other things.
Buttrey said the new requirements are aimed at what he believes is a relatively small group of participants who aren’t working or in school or taking care of relatives, and who can continue with the coverage if they get involved with work training or other programs meant to help them improve their health and find a job.
“If people don’t want to contribute at all to their health or their financial success, they will go off the program,” he said. “But for people that want to be part of their own successes in health, the state will be there for them.”
Medicaid expansion, funded largely by the federal government, provides health coverage to adults earning up to 138 percent of the federal poverty level, or about $17,200 a year for a single person. In the first two-and-a-half years of the program, the feds spent almost $1.2 billion in Montana on Medicaid expansion, while the state spent only $58 million.
It’s estimated that the program will spend as much as $1.5 billion over the next two years, with 90 percent covered by the federal government.
Buttrey’s bill now heads to the House floor, where it’s expected to pass, and then to the Senate. While it appears that a coalition of Democrats and moderate Republicans are behind the bill, Buttrey said many steps still remain before it becomes law, including the signature of Bullock, a Democrat.
“I view this (vote) as step one of five,” he said. “So it’s a long road ahead to get it done.”
The House Human Services Committee took a circuitous route toward approving the bill Tuesday night, as Republicans first started voting to amend a Democrat-sponsored alternative before eventually killing it.
House Bill 425, sponsored by Rep. Mary Caferro, D-Helena, would have continued Medicaid expansion past its June 30 deadline, with few changes.
Republicans on the committee, on a party-line vote, started the evening by amending the work requirements into Caferro’s bill.
Rep. Lola Sheldon-Galloway, R-Great Falls, who requested the amendment, said it was aimed at people who are getting essentially free health coverage while they’re not working or doing anything constructive.
“We’re talking about the 34-year-old who is sitting on the couch playing video games, is now depressed, because he’s not getting enough sleep, because they play too long, not eating correctly, not exercising, not socializing, but can yet draw Medicaid,” she said. “We’re requiring (work) from able-bodied people that are taking advantage, I think, of the medical side, when they could be off the couch.”
But the Democratic vice-chair of the panel, Rep. Gordon Pierson of Deer Lodge, said the amendment had ruined the bill and moved to kill it. Several Republicans joined Democrats to table the bill.
Buttrey then rolled out his bill — along with a lengthy list of proposed amendments. After he explained them, conservative Republicans on the committee began objecting, saying the changes essentially created a new bill that hadn’t been publicly vetted.
“Not only do we not have time to process it, but neither does our public, our constituents,” said Rep. Barry Usher, R-Billings. “That is not the bill that we had hearings on.”
Yet when it came time to vote on the amendments, Democrats on the panel supported them — along with the three Republicans who eventually joined to form the majority that approved the bill: Buttrey and Reps. Tom Welch of Dillon and Walt Sales of Manhattan.
Shortly before the final vote, Rep. Forrest Mandeville, R-Columbus, expressed the frustration of conservatives who opposed Medicaid expansion or wanted a closer look at what the program would become, under HB658.
“I can count to 10; I’ve been sitting here just like all of you and I can see where this is going to go,” he said. “But this bill, the way it is now, not knowing what’s in it and how it’s going to impact everyone, I just cannot support this bill as amended.”
