A reality based independent journal of observation & analysis, serving the Flathead Valley & Montana since 2006. © James Conner.
King v. Burwell was argued before the U.S. Supreme Court this morning. A transcript of the session is now available. The case has implications for Montana because if SCOTUS rules for King, subsidies on health insurance policies purchased through the federal exchange will be voided and millions won’t be able to afford their health insurance policies. A decision is expected in June.
Montana’s legislature will adjourn long before June, however, so decisions on expanding Medicaid must be made without knowing the verdict in King. If SCOTUS upholds the ACA, what Montana’s legislature does about Medicaid will stand. But if SCOTUS rules against federal exchange subsidies, decisions in Montana’s legislature could be negated. That’s because instead of expanding Medicaid as intended by the ACA, Gov. Bullock and Democratic legislators, to secure the votes of enough Republican legislators to expand Medicaid, probably must agree to Medicaid expansion that relies on private institutions and health insurance.
Gov. Bullock’s proposal, HB-249, carried by Rep. Pat Noonan (D-Ramsay), will be heard by the MT House’s human services committee on Friday, 6 March, beginning at 1500 mountain time in Room 303 of the Montana Capitol.
The Republican proposal, Rep. Nancy Ballance’s cramped HB-455, heard in the human services committee on 18 February, two days later received a do pass recommendation on a 10–7 vote. The second reading has not yet been scheduled. Ballance, as is becoming her habit, wrote a rebuttal to the official fiscal note on her bill.
I’m not optimistic that any Medicaid expansion bill worth supporting can emerge from this legislature. Taking Medicaid expansion to the people as a citizens initiative probably will be necessary — and I’m not optimistic that the people who failed to collect enough signatures for Medicaid expansion in 2014 learned enough from their failure to mount a successful signature gathering campaign for 2016.
None of the opposition to expanding Medicaid is driven by practical considerations or a decent concern for the health and welfare of less fortunate Montanans. All of the opposition is ideological, driven by a conviction of religious intensity that government — that We the People — must have no place in health care; that all health care decisions must be left to the infallible, invisible hand of the market. In this ice-hearted libertarian-Randian-social darwinism theology, the hungry must feed themselves, the sick must heal themselves, and no hand of help must be offered lest personal responsibility be weakened. It’s tough you know what masquerading as tough love.