2 April 2013

Who will pay for treating the Expanded Medicaid eligible
in Montana — Uncle Sam or Montana’s hospitals?

Here’s what happens if the legislature refuses to accept Medicaid expansion in Montana:

1. As many as 70,000 Montanans with incomes in the 100–138 percent of the Federal Poverty Level band are left in the cold; or to be more precise, left in the emergency room.


2. Montana forgoes almost $6 billion in federal dollars. Expanded Medicaid is 100 percent federally funded for the first three years, 90 percent federally funded thereafter.


3. Montana’s hospitals, which cannot turn away patients with life threatening ailments (heart attacks, automobile accidents, for example) are stuck with the bill for treating the Expanded Medicaid eligible. And hospital bills for the ill who are not protected by an insurance plan with locked-in fees will rise as hospitals attempt to recover costs.

Only one group benefits from rejecting Expanded Medicaid — the right wing ideologues who oppose government funded health care on principle; and in many cases, not just government funded health care but also any kind of health insurance. They seek the satisfaction of having their ideology prevail, and seem unmoved by the harm caused by denying their fellow human beings access to affordable health care.

Approximately half of the legislators in each house of the Montana Legislature, Republicans all, belong to the anti-expansion caucus. Approximately a dozen GOP house members who sometimes join Democrats to defeat nutball measures such as HB-303, Rep. Krayton Kerns’ (R-Laurel) “sheriff’s bill,” hold the balance of power in that chamber. Slightly less than half that number of similarly moderate (moderate in a relative, not absolute, sense) Republicans hold the balance of power in the senate.

These swing vote GOP pragmatists have two options for expanding Medicaid:

1. A straightforward implementation of Expanded Medicaid. SB-393. the Senate version of HB-458 (tabled in committee), carried by Sen. Christine Kaufmann (D-Helena), does this.


2. Using the dollars for Expanded Medicaid to purchase on the Obamacare insurance exchanges private insurance policies for Expanded Medicaid eligible Montanans. This is possible, but not done easily. It’s an option that appeals to Republicans because it’s consistent with the (moderate) Republican belief that everyone should exercise “personal responsibility” by purchasing private health insurance.

I suspect brinksmanship and other games will hold expanding Medicaid in Montana hostage until late in the session. And it’s possible the impasse won’t be resolved even then, leaving the matter to be concluded in a special session this summer.

It’s to no one’s credit that this issue remains unresolved. Meanwhile, the legislature is busy fooling with raw milk, roadkill, arrows with lighted nocks, tying the right to vote to property ownership, and proposals for letting undertakers dispose of Dad’s remains by dissolving them in pressurized hot lye.