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Lawmakers hear public testimony on Medicaid expansion bills

March 16, 2019
Residents traveled from all over the state to testify before the House Human Services Committee in Helena, Mont., Saturday, March 16, 2019. The committee held an all-day hearing in the Old Supreme Court chambers at the Capitol on two bills for continuing the state's Medicaid expansion program, with one to one to continue the current program with a voluntary workforce training program and another that would add work requirements for most able-bodied recipients. Committee members did not vote on either bill. (AP Photo/Amy Beth Hanson)

HELENA, Mont. (AP) — Montana lawmakers heard public testimony during an all-day hearing Saturday on two bills with different visions for continuing the state’s Medicaid expansion program that insures nearly one out of every 10 residents, while several Republican lawmakers opposed both bills.

A bill by Democratic Rep. Mary Caferro seeks to make permanent the program much as it has been since it began in 2016, including charging premiums. The health insurance program serves about 96,000 low-income Montana residents and will end in June if lawmakers do not reach an agreement.

Her bill would increase funding for the state’s voluntary workforce training program that officials say has been so successful that other states are considering emulating it.

Individuals, medical providers, health insurance companies, tribes and advocates for veterans and the homeless traveled from all over the state to tell the House Health and Human Services Committee that Montana’s Medicaid expansion program has saved lives and money with early detection of illnesses and management of chronic diseases or helped address mental illnesses or addictions, allowing people to return to work.

Democratic Gov. Steve Bullock supports the existing program, saying businesses all over the state have employees covered under Medicaid expansion while the program cut hospitals’ $400 million in uncompensated care in half. Research by the University of Montana indicates the program supports about 5,000 jobs and $280 million in personal income each year.

“I hope everybody else can see the value in our investment,” Caferro said, noting she and fellow lawmakers also receive taxpayer subsidized health insurance.

Afternoon testimony turned to a bill by Republican Rep. Ed Buttrey that proposes requiring 20 hours of “community engagement activities” each week for most able-bodied adults, expands an asset test and includes an agreement with Hutterite colonies to pay the state’s cost of their members’ coverages.

Full-time students, the disabled, pregnant women and full-time caregivers are among those who would be exempt from the community engagement/work requirements under Buttrey’s bill.

Mary Dalton, the former Medicaid director for the state health department, questioned the need to change the workforce component, which Buttrey developed in 2015.

“We have the most successful voluntary work program in the United States — one that other states are looking to replicate, and yet we are looking at an Arkansas model” with work requirements that are being challenged in court, Dalton said.

Dalton and others expressed concern about a provision in Buttrey’s bill that would kill it if the federal Centers for Medicare and Medicaid Services doesn’t approve the community engagement/work requirements and provisions that call for disenrolling people for failure to pay premiums or meet reporting requirements.

Both bills would include a fee on hospitals’ outpatient revenue in part to help pay the state’s share of the cost and in part to help leverage additional federal funding to increase Medicaid reimbursement rates.

Several Republican lawmakers opposed both bills, arguing state and federal funding for the program is not sustainable and voters last November rejected an initiative to increase tobacco taxes to pay for Medicaid expansion.

Sen. Keith Regier said he recently read letters to the editor in the Daily Inter Lake in Kalispell, one from a college student and another from a seasonal worker who said they benefited from Medicaid expansion. He suggested both could have found additional work to pay for their health insurance.

“Instead the luxury of school going uninterrupted or working just seasonally and having health care coverage is paid for by who, elderly taxpayers living on a fixed income, parents working to raise their family and entrepreneurs who are struggling to build a business and make payroll,” Regier said, urging lawmakers to let the program expire.

Rep. Nancy Ballance said she long opposed Medicaid expansion, but urged fellow Republicans not to let their ideology “stand in the way of what I know is doing the right thing,” because Buttrey’s bill includes work requirements and an expanded asset test.

An analysis of the Republican bill by Milken Institute School of Public Health at George Washington University suggests its provisions could cause more than half of those covered lose their health insurance.

Under the Trump administration, the Centers for Medicare and Medicaid Services is supporting state efforts to create work and community engagement programs as part of Medicaid expansion and on Thursday released a framework for states to use to monitor and evaluate such policies.

The committee did not vote on the bills.

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