Stakeholders discuss Medicaid Expansion at annual Healthcare Forum

Stakeholders across the healthcare industry gathered in Helena today to discuss big changes coming in the next year.

Medicaid Expansion dominated the conversation at this healthcare forum conference.

That expansion is an option states have to comply with provisions in the Federal Affordable Care Act.

It still would have to be approved by a Republican-dominated legislature.

The Montana Healthcare Forum is an annual event. It’s organized and sponsored by stakeholders ranging from insurance companies to hospitals, nonprofits and universities.

Montana AARP Advocacy Director Claudia Clifford was on the organizing committee. She said there was a feeling of particular importance this year.

“First of all, it’s right before a legislative session,” she said, “that always makes things feel more urgent but this is a big deal that we’re gonna address probably providing healthcare for half of our uninsured population.”

Or, at least that’s what’s on the table for state legislators—Medicaid Expansion. If the state provides $5 million in what’s being called administrative costs, the federal government will provide the rest of the money to cover about 80 thousand new Montanans under Medicaid.

Economist Sarah Wilhelm works as Research Director for the nonprofit Montana Budget and Policy Center. She says recent research from the University of Montana shows expansion to be a good deal for the state.

“The numbers are really striking because what we see is that medicaid expansion could actually pay for itself,” she said.

Wilhelm says a large influx of federal dollars could create new jobs and higher incomes. This would lead to increased tax revenues that would offset the money paid by the state over a nine year time frame.

“It’s a historic moment,” said Helena Democratic Senator Mary Caferro. “It’s an opportunity to finally do something about the uninsured issue.”

She says the information presented at the healthcare forum solidifies her support for expanding Medicaid. She says she believes lawmakers will put their differences aside and approve it.

“Because Legislators recognize that the majority of montanans are not extreme and the majority of Montanans want real solutions to this issue,” Caferro said.

Democrats like Caferro, however, are not in control of the Legislature.

“Federal Dollars isn’t just free money that falls out of a tree, those dollars are coming from us,” said Helena Republican Representative Liz Bangerter.

She presented at the healthcare forum with Democratic Senator Caferro. Bangerter says lawmakers need to think about the stability of those federal funds before expansion.

“I just don’t think we can guarantee that those payments will be at that level for the next nine years no matter whose in the executive office or in congress,” she said, adding she’s not so sure Republican lawmakers will go for it. “If you were to just go up and say Federal Medicaid expansion the caucus would kill it.”

But a uniquely Montana solution, crafted along with the stakeholders at the healthcare forum, she says that may be considered.

The state budget outlined by outgoing Governor Brian Schweitzer calls for passing the expansion.

Legislature reaches unprecedented stalemate on revenue estimate

A committee of state lawmakers found themselves in an unprecedented stalemate earlier this week.

The legislature’s Revenue and Transportation Interim Committee failed to pass an official revenue estimate in their last scheduled meeting before the legislative session begins in January. It’s the first time the committee has not passed a revenue estimate since the current process was put into place a couple decades ago.

The estimate failed on a party line vote as democrats are trying to get some change into the process.

The Montana Legislature’s revenue estimate is a big deal. Legislative services chief legal counsel Todd Everts says it’s the starting point lawmakers use to set their budget. Because by law, budget expenditures cannot exceed the revenue estimate. So you have to have a revenue estimate “and under law it’s the revenue and transportation interim committee that’s required to introduce that resolution,” Everts said.

And normally the Revenue and Transportation committee passes the resolution on their last meeting before the session. They are required to do so before the first business day in December.

This time it failed on a six to six party line vote. Democrats wanted to take the revenue estimate resolution and put it into a bill—specifically the general budget bill known as House Bill two.

The Governor’s office has thrown their support behind the idea.

“What we’re proposing to do is no different than what every family in Montana does with their checkbook. Make sure your expenses and your revenues are all kept in one place,” said the Governor’s Budget Director, Dan Villa. It’s also a strategy.

“It would require that all 150 Legislators for the first time in four sessions actually have the opportunity to vote not only on what the expenses look like but what the revenues look like,” Villa said.

During the last few sessions, both Democratic and Republican Speakers of the House have sort of held the revenue estimate hostage from the Senate. This happens by the Speaker keeping the revenue estimate in the House Taxation committee and it never gets debated by the full House or Senate. Lawmakers on both sides during the interim have been working on a way to address this situation. The idea of moving the revenue estimate into the larger budget bill was the Democrat’s way of going about this. But Legislative legal counsel Todd Everts says it would be in conflict of the state constitution.

“The Constitution requires that the general appropriation bill shall only contain appropriations,” Everts said.

The Governor’s office disagrees. But Senate Minority Leader, Butte Democrat Jon Sesso says they will accept the recommendations of legislative staff.

“OK, we don’t want to push for an alternative our own attorneys are advising us against, so we set that down,” Sesso said.

But the Democrats still didn’t approve the resolution. Sesso says the Revenue and Transportation committee should wait until the Rules committee meets on December 3rd to consider some rule changes and then convene a last minute impromptu meeting to pass the revenue estimate.

Sesso says he’s worried by passing the revenue estimate first the rules to change how it would be implemented would not have been passed by the rules committee “and as a result it would have been business as ususal and I thought that we had bipartisan support that business as usual was not acceptable anymore,” he said.

Sesso and Senate President, Billings Republican Jeff Essmann  both sit on the Revenue and Transporation Committee.

Essmann calls this irresponsible. He says the committee was talking about rule changes to how the revenue estimate is put to use. But he says passing those rules is the job of the rules committee. The revenue committee, he says, is supposed to pass the estimate.

“To attempt to use their effort to block the fulfillment of a statutory duty in an effort to force a rule change I think was counter productive,” Essmann said.

Especially when there is general consensus on the amount of the revenue estimate which is rare. He’s not so sure there will be an impromptu meeting on December 3rd.

“I expect the rules committee to meet to discuss the proposed rule changes and make a decision,” he said.

“And then you will all meet as Revenue and Transportation right afterward?” I asked.

“No, that meeting has not been called,” Essmann replied.

“Do you expect it to be called?” I asked.

“Not at this point.”

“So then what happens if there is not a meeting held on its last statutorily possible date to pass that revenue estimate?”

“I’ll be discussing that with the Speaker of the House,” Essmann said.

If the estimate is not passed as required by law, Legislative legal Counsel Todd Everts isn’t sure what is going to happen.

“I’m not sure what the remedy would be,” he said.

Governor Schweitzer presents final budget

Governor Brian Schweitzer hands $2 calculators to Lee Newspaper reporters Chuck Johnson and Mike Dennison following Schweitzer’s last budget presentation on Thursday

Governor Brian Schweitzer has released the final state budget of his tenure.  He says the budget provides a roadmap for the 2013 legislature and Governor-Elect Steve Bullock as they discuss Montana’s finances in the coming months.

Schweitzer’s recommendations are in no way binding to either Bullock or the Legislature, but the Schweitzer budget will likely be used as the starting point. The popular, two-term Governor used the presentation of the final budget to tout what he sees as the successes of his Administration. Schweitzer also put forth a list of priorities he hopes the state keeps pushing forward when he leaves office.

Governor Schweitzer begins his last budget press conference after just returning from a week and a half-long trip to the Caribbean.

“I’m back from having my toes in the sand and a beer in my hand,” Schweitzer said.

In just a few weeks he’ll be handing over the reigns of Montana’s government to fellow Democrat Steve Bullock.

“Our last, most important duty is to pass a budget along to the next administration,” he said. A budget that continues the Schweitzer legacy of large, record-setting surpluses, which the Governor points out with characteristic tongue-in-cheek humility.

“Our cash in the bank today is actually $469,758,700 dollars and 47 cents…so we’re about ten times more than they’d had in history, let’s move along,” he said.

Schweitzer’s last budget focuses on the three biggest pieces of that budget, which he labels as education, medication and incarceration. Those three combine to make almost 88 percent of the budget.

“And it really matters to the people of Montana that we get these things right,” he said.

For education, which makes up half of a budget, he wants to invest $67 million into K-12 education. Schweitzer wants to freeze college tuition for the next two years by injecting $34 million dollars in the Montana University System. He says decisions like that in the past have led to recent reports showing Montana increasing its rate of those with a college degree at the fastest rate in the nation.

For the medication component Schweitzer seemed to reverse an earlier position on the state paying for the Medicaid expansion included in the Affordable Care Act. In the past, Schweitzer has expressed reservations about how much this could cost in the long term. But now, he says the state should spend $5 million dollars to get additional funding from the federal government to pay for Medicaid expansion.

“To get 80 thousand Montanans covered with health care, 80 thousand,” he said.

And for incarceration, Schweitzer wants to add $30 million dollars to the department of corrections. Schweitzer says most of the people in prison have drug or alcohol problems, he wants to increase funding for rehabilitation programs.

“To get people ready to go back into society,” he said.

Outside of those big three, Schweitzer touted his plan to fix the state’s ailing employee pension systems. The current funding model has those systems over $3 billion dollars in debt over the next 30 years. Schweitzer’s plan asks for higher contributions from both state employees and their employers as well as adding money from natural resource development.

He wants to boost state employee pay 5 percent each of the two years. Schweitzer advocates an $88 million dollar bonding bill for construction projects for the Montana Historical Society and at state Colleges and universities. He says this bill could create over 21 hundred jobs.

“We’re proposing this bonding bill to the next legislature and shame on them if they don’t pass it,” he said.

But the next legislature will be controlled by Republicans and they will be coming with their own priorities for the budget, including the nearly $470 million dollar surplus.

A spokesman for Governor-Elect Steve Bullock says they have just received Schweitzer’s budget and will be reviewing it before making their modifications.




2013 Montana Legislature chooses leadership

The lawmakers are back in town.

Members of the 2013 Legislature arrived in the capitol this week.

Capitol Reporter Dan Boyce tells us the parties have chosen their leadership in the Senate and House of Representatives.

And here’s the Associated Press story on the same topic by Matt Gouras:

HELENA, Mont. (AP) — Montana legislators are picking new leaders in advance of the 2013 Legislature.

Republicans still control both chambers following last week’s elections.

In the Senate, Republicans ousted Senate President Jim Peterson of Buffalo and rejected current Speaker Pro Tempore Bruce Tutvedt’s bid for majority leader.

The GOP instead chose Sen. Jeff Essmann of Billings as their nominee for Senate president, Art Wittich of Bozeman as majority leader and Debbie Barrett of Dillon as speaker pro tempore.

Senate Democrats picked Jon Sesso as their new minority leader.

Republicans chose Mark Blasdel of Somers to fill a vacant House speaker’s post. Gordon Vance of Billings will be the new majority leader and Austin Knudsen of Culbertson was picked as speaker pro tempore.

House Democrats elected Chuck Hunter of Helena minority leader.