A reality based independent journal of observation & analysis, serving the Flathead Valley & Montana since 2006. © James Conner.
There are must read posts on Sen. Ed Buttrey’s Medicaid expansion bill, SB-405, at Montana Cowgirl and 4and20blackbirds today. At 4and20, William Skink discusses the impact of the bill on the poorest of the poor. Cowgirl discusses the overzealous attempts of Republicans to keep the bill from being blasted from the MT House’s health and human services. At one point, 40 Republicans tried to adjourn the House, evidently Sine Die, to avoid the blast. Cowgirl has the vote tally on that student senate maneuver.
Buttrey’s bill, formally known as the HELP act, is less a Medicaid expansion bill than a hospital relief act that also makes pursuing malpractice lawsuits more difficult.
In his opening remarks to the House’s HHS committee, Buttrey said that each year, Montana’s hospitals provide $400 million in uncompensated care. At present, he asserted, that care is provided free to those who would be covered by SB-405, but under SB-405 those people would pay the highest allowable “premiums” (de facto income taxes) and copays. “It’s about people paying for their health care instead of getting it for free.”
“This act is all about personal responsibility.” By this he means that the poor, who teabaggers believe probably are in their predicament because of moral failings, will understand the true cost of health care, and thus be more responsible, if they feel the pain of a reduced income and the maximum allowed copay.
The so-called “premiums,” incidentally, will be collected by the third party administrator — a private insurance company — that will run the program and collect the “premiums.” As the graph below displays, the “premiums,” which were not part of HB-249, pay for most of the TPA’s cost. So the TPA become a sweetheart deal for a private health insurer, financed by taking money from the Medicaid pool. Some might call it a payoff.
It’s also, he said, at least twice, about reducing the unholy and ever present trinity of “fraud, waste, and abuse,” the three straw men that all politicians learn to campaign against without shame.
Finally, Buttrey told the committee, his bill provides malpractice “reform.” Translation: SB-405 makes it harder for patients hurt by physicians and hospitals to sue for damages. That in turn reduces the incentive to provide better care and make fewer mistakes, so the lives that may be saved by extending Medicaid may well be offset by the deaths that could result from weakening the deterrence to mistakes that malpractice lawsuits provide.
If Democrats and the so-called moderate Republicans can hold together today and not make mistakes on the House floor, they may succeed in passing SB-405 on its second reading. If that happens, the hospitals will rejoice behind closed doors while progressives who should know better may cheer like high school students at a football game. And the poor? They'll become poorer.