22 November 2013

Expanding Medicaid by ballot initiative is not without risk

With the backing of Governor Bullock, progressives are pushing an initiative for the November, 2014 ballot, that would authorize Montana to accept federal funds for expanding Medicaid in Montana. Approximately 70,000 Montanans would be eligible for the program.

But there’s a catch, and it’s a big one. As Mike Dennison reports, securing voter approval is not enough:

However, a ballot measure cannot appropriate money. If the measure gets on the 2014 ballot and passes, the 2015 Montana Legislature still would have to approve the spending for the program expansion.

Kim Abbott, president of the Health Montana Initiative, said if Montanans pass the measure, she’s hopeful the Legislature will respect their wishes and approve the spending.

A majority of Republicans at the 2013 Montana Legislature successfully rejected Medicaid expansion, saying they opposed expansion of “Obamacare” and a program that would end up costing the state too much money.

Unless the voters also send more Medicaid friendly legislators to Helena, there’s no guarantee the legislature will respect the wishes of the voters. That could happen, but the strategy is risky. If the initiative is defeated, no legislature will defy the wishes of the voters, and those 70,000 Montanans who could be helped with expanded Medicaid will be denied that help for a very long time.

Why are the initiative’s backers taking that risk? There are, I think, four reasons:

Passing the initiative applies moral and political pressure to the next legislature. That can’t hurt, but how much it would help is anyone’s guess.

Expanded Medicaid eligible Montanans need help now, not later. Leaving them in the cold until 2017 seems unconscionable.

The backers believe there is strong support for expanding Medicaid in Montana.

The initiative can be used as an organizing tool to boost turnout, especially in the 18–29 cohort that turns out in lower numbers in midterm elections. A boost in turnout improves the fortunes of Democratic candidates. Several sources have told me they expect the turnout to reach or exceed 60 percent of registered voters.

A 60 percent registered voter turnout in the 2014 midterm is possible, but not a given. Registered voter turnout has been below 60 percent in three of the last four midterm elections, and voting eligible turnout has been even lower. Flathead Memo’s historical turnout statistics page has the details. Below, graphs for your quick reference.

PDF for printing.

PDF for printing.

I support expanding Medicaid in Montana. But until I can read the proposed initiative, and get a sense of the resources available to promote the initiative, I’m not deciding whether to support it.