Medicare expansion, plus reform!

Republicans are looking a bit schizophrenic lately when it comes to a potential Medicaid expansion in Montana.

They firmly rejected Democratic Gov. Steve Bullock’s preferred bill that would add as many as 70,000 people to the Medicaid program, with the federal government covering the expansion cost entirely over the next three years. A Democratic “blast motion” to get the bill out of committee got only 49 of the necessary 60 votes.

Then House Republicans took all provisions out of their own alternative Medicaid bill and passed it on to the Senate. That move seems to be aimed at keeping some legislative vehicle alive in the process to see if some agreement can be reached in the final weeks of the session.

It’s not pretty, and we never like seeing legislators vote for bills that are nothing but empty shells. There’s too much room for mischief that way.

The good news though is that many GOP lawmakers want to see firmer provisions requiring reforms in the Medicaid system before signing onto an expansion, and we can go along with that.

“Reforms” would be measures designed to contain or reduce health-care costs. As we understand it, supporters of expansion say that cost containment would happen as a natural result when health-care coverage is extended to 70,000 people who currently don’t have it.

Supporters argue that currently, when those uninsured folks need medical treatment, the costs are shifted to people who can afford health care, thus increasing the health-care costs for everybody.

The bill favored by Gov. Bullock was almost entirely silent on mandated reforms to provide further assurances there will be some containment of currently spiraling health-care costs, and that may have been its major flaw.

The usually conservative-leaning Montana Chamber of Commerce has just recently weighed in with support of expansion, provided there are reforms, and that may sway some Republican lawmakers.

But to be sure, there will be a contingent in the GOP caucus that are rejecting expansion because of firm expectations that federal funding will eventually dry up, leaving Montana taxpayers on the hook for a much larger and more expensive Medicaid program.

We are sympathetic to that argument, too. It’s hard to justify bleeding the federal beast just because it is out of its mind, and has no idea that it is living on borrowed money.

Ultimately, the success or failure of this program long-term will be a measure of how much the high hopes of its proponents are based in reality. If health-care costs are truly contained as a result of Medicare expansion, it may well be the best of course of action.

Editorials represent the majority opinion of the Daily Inter Lake’s editorial board.