Medicaid expansion a hot topic during last week's session
March 20, 2019
People filled the Montana Capitol Saturday to testify during an all-day hearing on two competing bills that would extend Medicaid expansion, some of them arguing to keep the program as is, some arguing for more requirements for enrollees and others arguing against the program completely.
Republican Rep. Ed Buttrey of Great Falls and Democratic Rep. Mary Caferro of Helena are carrying competing Medicaid expansion bills, which were heard back-to-back Saturday. With nearly 100,000 Montanans enrolled on the state-federal partnership program, and its expiration date looming in June, expansion is one of the most contentious issues this session.
Caferro's House Bill 425 would keep the program similar to how it works now, but would eliminate the program's expiration date and add some fees for hospitals and healthcare centers that benefit from the program. Buttrey's House Bill 658 would also make Medicaid expansion a permanent program, but it includes stricter eligibility requirements for recipients.
People wanting to testify filled the Capitol's old Supreme Court chambers and waited to say their piece.
"As you can see," Caferro said, while gesturing to the packed room, "this is an amazing issue we have before us."
At noon, more than 400 people filled the building to participate in a rally of support for Caferro's bill.
Medicaid expansion is government subsidized health insurance for low-income and disabled citizens. An expansion program was first passed into law in 2015, and was carried by Buttrey. The federal government has been matching state contributions to the program at 100 percent, but that rate lowers to 90 percent in the coming year.
Lawmakers are trying to decide how to pay for that 10 percent gap and what the program will look like going forward.
Buttrey said expansion has been successful in the state, and he wants that to continue. But, he said, he also wants to ensure that recipients of the subsidy are "actively participating in the future of our state." His bill would include work requirements and asset testing, meaning enrollees would need to report to the government that they have a job or are looking, and what kind of property they own. Based on these reports, the state could determine some recipients are no longer eligible to stay on the program.
Some lawmakers argue the program is too big and unsustainable. Rep. Mark Noland, R-Bigfork, spoke in opposition of Caferro's bill.
"We do not have enough money to provide all of the services that are asked of us," Noland said.
Others argue that the additional requirements in Buttrey's bill are impractical and unfair.
Kate Clyatt, a seasonal farm worker, testified that she doesn't know many family farm employers who provide benefits like health insurance or pay enough for employees to by their own insurance plans.
Clyatt also said being a seasonal worker may affect her eligibility for expansion if her job doesn't fall within the stipulations of the work requirement mandate.
"I don't want to lose coverage because my work schedule doesn't conform to a 9-to-5 job," Clyatt said.
Gov. Steve Bullock supports Caferro's bill, and has spent much of the session promoting the social and economic benefits of expansion. He is not in favor of work requirements or asset testing. A George Washington University study showed that one-in-three enrollees would lose coverage if work requirements are implemented.
Another argument from opponents of Buttrey's bill addresses its non-severability clause, meaning if one section of the bill is found to be unconstitutional, the entire bill is void.
Al Smith, a representative of the Montana Trial Lawyers Association, said there a number of sections in HB 658 that would likely be challenged if it's passed into law, making it a risky piece of legislation.
"This is just a bad policy piece to have in there," Smith said.
Some Montanans want Medicaid expansion to end altogether. A number of people used the failure of I-185, an initiative that would have taxed tobacco to pay for permanent Medicaid expansion, as proof that voters do not want any form of Medicaid.
"I would think carefully about trying to override the will of the voters," the CEO of the Montana Policy Institute, Brent Mead, said.
The tobacco industry spent more than $17 million campaigning against the initiative.
Rep. Dennis Lenz, R-Billings, is chair of the House Human Services Committee and said members will vote on both bills at the end of this week.
Sen. Tom Richmond, R-Billings, asked the Senate Finance and Claims Committee last week to table his bill, Senate Bill 278, after it received significant backlash. The bill would have allowed an electric utility, like NorthWestern Energy, to buy more shares of Colstrip's coal-fired power plant for $1. It would also allow the utility to tack the environmental cleanup and decommissioning costs onto consumers' electric bills.
He told the committee he had a new bill drafted that he believes improves on SB 278.
"Past the personal attacks, I think there's some good criticism of the bill," Richmond said.
Diego Rivas, a senior policy associate for NW Energy Coalition, wrote an op-ed in the Great Falls Tribune to express opposition to the first bill.
"Simply put, this bill has NorthWestern customers writing a blank check to the utility that ensures our electric rates will be the highest in the northwest for decades to come," Rivas wrote.
Coal is one of the state's largest revenue generators, but is also proven to have adverse effects on the environment. When burned, coal emits methane gas, carbon dioxide and sulfur dioxide, which contribute to air pollution and can lead to respiratory illnesses, according to the U.S. Energy Information Administration.
As states turn to alternate sources of energy, like wind, solar and nuclear, the demand for Montana coal is decreasing. Lawmakers, like Richmond and Sen. Duane Ankney, R-Colstrip, are trying to save this industry through legislation.
Richmond's new bill, the Montana Energy Security Act of 2019, is similar to SB 278 by offering up more shares of Colstrip's power plant and allowing cleanup and decommissioning costs to be tacked onto ratepayer bills. However, it would give the Public Service Commission more oversight than before, and caps the tacked-on ratepayer costs at $40 million over five years.
Sen. Jon Sesso, D-Butte, said this bill is "absolutely" an improvement. He said he trusts the intention of the bill is to stabilize not only the coal industry, but the price of electricity in general. He said although the new bill is still receiving criticism, it's a step in the right direction.
"It has as much merit to protect Montana consumers as it has demerit in the eyes of some," Sesso said.
The Montana Energy Security Act, numbered Senate Bill 331, now awaits for a committee hearing.
Chronic Wasting Disease
Montana lawmakers are considering ways to prevent the spread of a brain-degrading disease among deer in hopes of protecting wildlife and human health.
Chronic Wasting Disease, also known as "Zombie Deer Disease," is a fatal neurological condition that has been found in pockets of the deer population across the country and in Montana. Some research suggests it could be transferred to humans if they eat contaminated meat.
Rep. Bradley Hamlett, D-Cascade, is carrying House Bill 586, which would allow lawmakers to bypass a two-thirds vote requirement to pass infrastructure funding for state laboratories that test for CWD.
Hamlett told legislators in the Senate Agriculture, Livestock and Irrigation Committee last week that the run-down facilities are slowing prevention efforts.
"It takes too long to get these results back," Hamlett said.
HB 586 already passed the House on a 93-6 vote.
The Montana Stockgrowers Association, the Rocky Mountain Stockgrowers Association, the Montana Farm Bureau and the Montana Milk Producers Association support the bill. No one spoke in opposition.
Chelcie Cargill, representing the farm bureau and the milk producers, said these organizations find "great value" in improving the efficiency of state labs.
"This lab is critically important for ag, but also as a public health issue," Cargill said.
Budget Bill Advances With Some DPHHS Funding Restored
After hearing emotional testimony on the state budget, the House Appropriations Committee restored some funding to the Department of Health and Human Services budget last week and advanced the main budget bill to the full House of Representatives.
The new changes to the DPHHS budget include allocations for 7 full-time employees in the Disability Employment and Transition Division, which helps helps individuals living with disabilities gain skills and find employment. Those services are often called vocational rehabilitation. The committee also added more money from the state's general fund to the Tobacco Medicaid and Health Initiatives Fund, which helps pay for government-subsidized healthcare.
House Bill 2 sets how much money the state will pay into government agencies, like the DPHHS and the Office of Public Instruction. The budgeting process spans most of the session, and House Bill 2 is the only bill the Legislature is constitutionally required to pass.
The appropriations committee passed the bill on a 16-6 vote Monday.
Rep. Eric Moore, R-Miles City, chairs the health and human services subcommittee. He says those who opposed the cuts to vocational rehabilitation for disabled Montanans during public hearings helped spur the motion to add 7 full-time employees back into the budget.
"The committee felt that there was merit in that public testimony," Moore said.
Rep. Mary Caferro, D-Helena, says she appreciates an amendment that doesn't cut services, but that this is a tough decision because it will mean that other divisions in DPHHS will still lose positions.
"When one group shows up and really rallies for their piece of the pie, then it's at the expense of someone else's," Caferro said.
The committee also approved a motion from Moore to remove funding for the the Big Sky waiver, which is a program that allows some Medicaid recipients to get in-home care rather than moving to a nursing home. He said the state needs to reserve funding for its Child Health Insurance Program, and couldn't afford both without having to dip into the state's general fund.
"Quite simply, members of the committee, that was just money that we did not have," Moore said.
Rep. Marilyn Ryan, D-Missoula, opposed the amendment and said the state is not doing enough to address inflationary prices of social services, especially with an aging population. She said the state needs to make more money.
"We will continue to make these ugly choices of who wins and who loses when we do not increase revenue," Ryan said.
In total, 92 amendments were requested for the appropriations bill. A motion to add funding for a preschool program failed. Rep. Llew Jones said money could not be diverted to a pre-K program until a bill that outlines the details of one passes out of committee.
Rep. Rae Peppers, a Democrat from Lame Deer, asked for funding for her bill, Hanna's Act, which attempts to streamline investigations of Montana's missing and murdered indigenous women. Peppers said she was worried the bill would not pass through the Senate if money was not set aside for it. That amendment also failed.
Infrastructure Bonding Bill Advances
A panel of lawmakers has advanced a Republican-backed bill that trims borrowed funding for public works projects to $80 million, half of what Democratic Gov. Steve Bullock proposed.
Rep. Mike Hopkins, R-Missoula, is sponsoring House Bill 652, which the House Appropriations Committee passed 17-5. He said Bullock's suggested $160 million in borrowed funds just wasn't feasible.
"We account for all the projects that the governor does, other than the museum. But we do it, I think, in a far more realistic way," Hopkins said. "The other one (bill) is completely not so, and has proved to not be so session after session after session, or, the entirety of the time the governor has been in office."
The bill removes a $32 million request to build the Montana Heritage Center Museum. It also only allocates $14 million for local communities to fund specific infrastructure needs, instead of Bullock's $44 million.
HB 652 does include $25 million for Romney Hall renovations at Montana State University, but asks the university to privately raise the extra $7 million needed to finish the project.
Last Fall, Senate President Scott Sales, R-Bozeman, said projects like Romney Hall and the Montana Heritage Center Museum were roadblocks to passing an infrastructure package, which failed to pass the 2017 session by two votes. But Hopkins said it's time to bring more classrooms into MSU.
"To be fair, it's a big price tag compared to other things in the bill," Hopkins said. "But the state makes an investment into higher education. I'd want my constituents' tax dollars to go into core classes. With this, we get 1 million hours in math and reading classes per year. That's our investment."
Bullock didn't say if he would support the bill, but said he's glad the Legislature is working to fund projects with borrowed money, which has caused infrastructure bills to fail in past sessions. Bullock also said Montanans suffer when critical projects don't get funded.
"I'm pleased from the perspective that bonding is on the table. This isn't about ideology, it's about a two-thirds vote," Bullock said. "So, I'm glad that the Republicans are coming up with a bill that could break that logjam."
Darryl James, Executive Director of the Montana Infrastructure Coalition, testified in support of HB 652 during the House Appropriations Committee hearing Wednesday. However, James warned the committee to not assume the bill is a comprehensive infrastructure package. He said there is a $2 billion deficit for Montana's critical infrastructure needs.
"That's basic road, bridge, water and sewer projects across the state," James said. "This bill is just a small piece in the overall puzzle."
Shaylee Ragar and Tim Pierce are reporters with the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, the Montana Broadcasters Association and the Greater Montana Foundation. Shaylee can be reached at [email protected]