Daines: Montana’s Medicaid expansion could end by 2019 without new federal law

HELENA - Montana’s Republican Sen. Steve Daines said in a call with constituents Wednesday night that Medicaid expansion, which now covers about 79,000 around the state, would likely end in 2019 regardless of a U.S. Senate bill expected to terminate the program by 2026.

When Montana chose to join with 31 other states and expand Medicaid coverage to the working poor in 2015, the Legislature included a sunset clause that requires lawmakers in 2019 to reassess the program.

Daines said he spoke Wednesday with state Sen. Ed Buttrey, R-Great Falls, who helped craft the expansion bill, and Buttrey said he didn’t think legislators would vote to keep the program operating.

“The state of Montana is having a very difficult time affording the amount of spending created because we are blowing out the projections. We’re blowing the budget. We’re busting the budget,” Daines said.

Buttrey could not be reached by Lee Newspapers on Wednesday night, but Daines said Buttrey is “very concerned about what’s going here. … He’s pretty convinced we would not renew Medicaid expansion in Montana under these current conditions.”

Daines is referring to the higher-than-expected number of people who signed up for coverage under Medicaid expansion, called the Health and Economic Livelihood Partnership (HELP) Act.

An estimate in 2015 when the HELP Act passed said 45,723 people would sign up in the first year of enrollment, which was the start of 2016, and it would cost $43 million to cover them. But more than 70,000 enrolled by the end of last year and that cost of covering that many people was put at $70 million by the state’s Legislative Fiscal Division this January.

But the state’s Democratic Gov. Steve Bullock, as well as the Department of Public Health and Human Services, have pointed to savings from expansion totaling $10.6 million in state money by the end of 2016, according to a state report from September 2016. Savings came from things like moving people from regular Medicaid, which has a lower federal match, to the expansion program, as well as savings for the state Department of Corrections, which gets more federal funds to pay for prisoner health care under the HELP Act.

Daines held the tele-town hall Wednesday night to get feedback from Montanans on the Better Care Reconciliation Act, the U.S. Senate's iteration of a congressional Republican plan to repeal and replace the Affordable Care Act. The House version of the bill was passed narrowly in May. Montana's Democratic Sen. Jon Tester held a town hall in Great Falls on Saturday and a Facebook town hall this week.

On Tuesday Senate Republicans pushed back a vote on the bill until after their July 4 break because of a lack of support for the bill. Some Republicans from rural states that expanded Medicaid said they could not vote for the bill because it would cut off access to the program for many in their states. Daines has not yet taken a position on the legislation, saying he wanted to hear from constituents. He did not indicate on the call Wednesday night if he supports the bill, but said he expects a vote to happen in July.

Daines told Montana Public Radio earlier this week that he would not vote for the bill if the provision to cut Planned Parenthood funding for a year was removed. If the funding was restored, Daines said, he could not vote for the bill.

Daines defended that position when a caller asked him Wednesday night why he supports getting rid of what the Missoula woman called the “best resource for health care” for some women.

“I am pro-life. I'll stand and fight for those who are most vulnerable in our society. That is the unborn, that is the elderly, that is the disabled,” Daines said. He argued that the Senate bill will take money that had previously gone to Planned Parenthood, which has five clinics in the state, and move it Montana’s 17 community health centers.

Daines’ call, which he said reached 40,000 Montanans, was the day after the release of a report that outlined the predicted severe effects of the Senate bill in Montana. The state would lose $5.3 billion in federal Medicaid funds between fiscal years 2020 and 2026, according to a report by Manatt Health on behalf of the Montana Heath Care Foundation.

More than 216,000 Montanans are covered by Medicaid, 96,846 of whom are children and 19,085 are adults who have disabilities. Under the Affordable Care Act, the state gets an enhanced federal match for money it spends, but the Senate plan lowers the match severely and eliminates it entirely by 2024. The state could not afford to keep the program running without the enhanced match.

Daines said he wants to see Medicaid return to what he called its original mission of providing insurance for the “poorest of the poor,” including children, people with disabilities and pregnant women.

“Here’s the problem. Obamacare expanded Medicaid and it allowed able-bodied adults without children to receive Medicaid at 100 percent covered cost by the federal government. It’s led to a significant spending spree that’s adding to our already $20 trillion debt.”

Those covered under the main Medicaid program could expect to see a decrease in benefits or eligibility under caps in federal funds the Senate bill proposes, the Manatt report said. If Montana wanted to stay under the cap proposed in the Senate bill, it would have to cut spending on Medicaid here by $892 million between fiscal years 2020-2026.

Daines also said he’s concerned about what he called the “collapse” of health care markets and jumps in the costs of insurance premiums. Though Montana has not seen any insurers leave the marketplace here, premiums did jump by 133 percent last year. Companies attributed that to the people who gained coverage having more medical needs than expected.

Daines said he also wants to eliminate tax penalties for people who do not have insurance. Under the Affordable Care Act, he said, in 2014 about 34,000 Montanans paid a penalty because they did not have coverage, and of those 14,000 earned less than $25,000 a year.

“Obamacare was taxing them, penalizing them,” Daines said. “Something had to be done because this Obamacare is just in a death spiral and the individual market is collapsing across this country.”