Medicaid expansion battle shifts to Legislature

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A sun set illuminates the sky over the Montana Capitol in Helena on Tuesday, Jan. 17. (Sam Wilson/Daily Inter Lake)

Although an initiative aimed at funding Medicaid expansion in Montana was rejected by voters in the general election, proponents have vowed to continue the quest to find funding to preserve the health-care program that assists low-income residents.

Initiative 185 would have put a $2 tax on tobacco products to generate enough annual revenue to fund a large portion of the cost for expanding Medicaid coverage. The measure failed by a slim 6 percent margin.

“The work of Healthy Montana Coalition is not over — the lives of nearly 100,000 Montanans are at stake,” Chris Laslovich, I-185 campaign manager for Healthy Montana, said in an online statement. “For health advocates, rural hospitals, nurses, and doctors across the state, we will keep working to protect the health care that one in 10 Montanans need.”

In 2015, the bipartisan Health and Economic Livelihood Partnership (HELP) Act passed, securing a four-year financial backbone for the expansion of Medicaid in Montana, which nearly 100,000 residents statewide now rely on for coverage.

The plan, approved under the federal Affordable Care Act, is now fast-approaching its June 2019 expiration date, putting the future healthcare needs of nearly 10 percent of the state’s population into a place of uncertainty.

In Flathead County alone, nearly 9,000 residents are currently enrolled in the program, or about 10 percent of the county’s population.

The initiative, backed primarily by Healthy Montana, was vehemently opposed by tobacco giants. When dust from the election had settled, I-185 had tallied nearly $20 million in opposition funding, turning it into the most costly ballot measure in Montana’s history.

Now, the question of whether or not to continue Medicaid expansion has fallen into the laps of state legislators.

Beginning in January, lawmakers will have three months to try and settle on a program. If the act expires, Montana will become the first state in the nation to allow its Medicaid expansion, created under the fold of the Affordable Care Act, to lapse.

Gov. Steve Bullock recently proposed a bold, two-year $10.3 billion state budget, a portion of which would go to covering the cost of Medicaid expansion. As part of the proposal, Bullock suggested raising an estimated $50 million a year through tax increases on various goods including liquor, rental cars and hotel rooms.

However, some Republican legislative leaders were quick to express their distaste. Sen. Majority Leader Fred Thomas said if the survival of Medicaid was contingent upon increased taxes, then “it’s not gonna happen.”

There have been no other public proposals for backing Medicaid expansion past June.

“We now turn our attention to the Legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” Laslovich said.

Bullock also recently released an ‘interactive dashboard’ on the Montana Department of Health and Human Services website breaking down Medicaid expansion by the numbers.

The findings are substantial, relaying that 85,077 adults have received preventive services since the beginning of the program and nearly 40,000 patients have received inpatient and outpatient mental-health and substance-use services, among other discoveries.

“With this new tool, Montanans can see firsthand that Medicaid is also providing the care that prevents costly complications down the road,” Bullock said in a press release. “In every county in our state, it’s making a real difference in improving the health of thousands of Montanans.”

In addition to outlining how residents have benefited from Medicaid, the dashboard also represents what is at risk not just for patients, but for the economy, should the act expire in June.

“The sunset of the HELP Act would have significant impact on the lives of many Montanans, the health-care economy and community hospitals,” said Kalispell Regional Healthcare’s Chief Strategic Officer Jason Spring. “KRH is no different. We will continue to monitor and model various scenarios to determine the impact to patients, programs and services as we learn more.”

Spring did not detail exact ramifications for Kalispell Regional Healthcare should the HELP Act expire, but said the data is “compelling” that a sunset would be a “big hit on the economy of Montana and in turn, the health-care resources in Flathead County.”

One report prepared by the University of Montana in 2018, shows new Medicaid expansion spending would support a large amount of economic activity — approximately 5,000 jobs and $270 million in personal income each year between 2018 and 2020.

The report estimates that by the end of its first five years, Medicaid expansion would create about $1.2 billion in personal income and that the plan has a “substantial effect on Montana’s economy.”

The findings of the UM report align with another study conducted in 2017 titled “Repealing the Medicaid Expansion: Implications for Montana.”

A portion of the study, funded by the Montana Healthcare Foundation, was dedicated to looking at uncompensated care in hospitals. According to the study, after just one year, hospitals saw a “dramatic decline in both bad debt and charity care since expansion took effect.”

The study, conducted shortly after Congress announced it was considering ways to repeal and replace the Affordable Care Act, suggests Montana has a lot at stake if the plan expires, including more than 10,000 jobs, the state’s ability to diagnose and treat substance-use disorders, large sums of federal funding and millions of dollars in additional state savings.

Reporter Kianna Gardner may be reached at 758-4439 or

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