Last ‘Medicaid Expansion’ proposal in Montana Legislature probably dead

House Minority Leader Chuck Hunter (D-Helena), right, speaks with Montana Legislature Chief Legal Counsel Todd Everts about a vote to refer HB623 to committee, effectively killing it.

House Minority Leader Chuck Hunter (D-Helena), right, speaks with Montana Legislature Chief Legal Counsel Todd Everts about a vote to refer HB623 to committee, effectively killing it.

The last plan before state lawmakers to use federal Medicaid funds to expand health insurance to tens of thousands of uninsured Montanans is mostly likely dead after being referred to a committee hostile to the bill in the legislature’s final days.

HB623 would have used Medicaid Expansion funds provided to states through the Affordable Care Act (ACA) to allow eligible low-income Montanans to buy private health coverage on the insurance exchanges also set up by ACA. The other, more standard, Medicaid Expansion bills have already been tabled by the legislature.

During Friday’s House floor session, House Speaker Mark Blasdel (R-Somers) said he was referring that bill back to the House Health and Human Services Committee. As far as Minority Leader Chuck Hunter (D-Helena) is concerned, that move probably kills the bill.

“That is the Committee that was built for the very purpose of saying no to any kind of expansion of Medicaid and that will no doubt be the fate of this bill as well,” he said.

Hunter appealed Speaker Blasdel’s decision to move the bill to committee—which takes a majority vote. But when the body took that vote, a few Representatives were confused on what their vote meant, like Great Falls Democrat Tom Jacobson.

“I hit my yes button, my green button in support of that motion which in my mind was in support of Chuck,” Jacobson said. “But apparently the way the motion was read, it should have been a no.”

Here’s how speaker Blasdel described the motion on the floor:

“Members of the body, this is a majority vote, a yes vote concurs with the ruling of the chair. A no vote does not.”

That would mean a yes vote agreed with Blasdel’s decision to send the bill to committee. The final tally was an even 50 to 50—with Jacobsen’s accidental vote the only Democratic yes. A tie vote in this circumstance went in Blasdel’s favor—sending the bill to the committee. House Members took a break shortly thereafter and leadership discussed options to reconsider that vote. The break lasted over an hour.

“I think that vote was a failure that didn’t adequately represent the true feelings of the members on the floor,” Hunter said. “When we came back to do a reconsideration the other side had whipped their votes and coerced some folks into changing their votes on those bills.”

A majority vote of 51 would have brought the bill back up to the floor—in theory that’s what the original vote would have been if Representative Jacobsen had voted with the Democrats like he intended. But the reconsideration vote failed 48-52. Speaker Blasdel agrees some minds were changed while leadership discussed reconsideration options.

“There was a lot of misunderstandings about what got put into that bill and what wasn’t,” he said. “There was a lot of discussion among members, obviously I just wanted to take time to look at things with the minority leader and figure out how we were going to proceed.”

Democratic Governor Steve Bullock strongly advocates Medicaid Expansion—and he was quick to condemn the decision.

“These legislators who voted to send our tax dollars out of state are going to have to go home and tell their bosses that they stood in the way of lower health care costs, they stood in the way of good paying jobs and they stood in the way of access to affordable health care for tens of thousands of Montanans who desperately need it,” he said. Great Falls Tribune Capitol Bureau Chief John S. Adams posted the Governor’s full comments.

The Governor did not outright refuse using a veto of the state budget as a bargaining chip to get lawmakers to reconsider some kind of Medicaid Expansion, saying “I think everything’s on the table but we really should be responsible to make sure this gets done, be that this week or the weeks ahead.”

The Legislature is set to wrap up sometime next week.

Expert says we have the best health care in the world – if you have insurance

moroneThough the “health care crisis” in this country seems like a recent issue, in fact, the political debate over the American health care system is decades old. Brown University political science Professor James Morone is a leading authority on that political history. He was in Missoula recently to participate in the Mansfield conference on the future of health care in America. In this feature interview, Morone talks with News Director Sally Mauk about past fights over health care – and what he thinks the future holds.


Popular Daily Beast blogger says yes to background checks, no to assault weapons ban

Megan_McArdle_portraitMegan McArdle describes herself as a “squishy Libertarian”. She’s also a popular blogger for Newsweek and the Daily Beast, and former senior editor at the Atlantic Monthly. McArdle is in Missoula to participate in this week’s Mansfield conference on the future of health care in America. In this feature interview, McArdle talks with News Director Sally Mauk about health care, gun control – and the latest kitchen gadgets. McArdle just did a feature story on the International Housewares show…

Why Governor Bullock says it took so long to introduce Medicaid Expansion bill

Governor Steve Bullock (D-MT), left, and Representative Chuck Hunter (D-Missoula) sit for an interview in the Governor's office Wednesday

Governor Steve Bullock (D-MT), left, and Representative Chuck Hunter (D-Missoula) sit for an interview in the Governor’s office Wednesday

Looking to move forward on one of the biggest, and most controversial, issues before the Montana Legislature this session, Governor Steve Bullock introduced his bill for Medicaid Expansion this week. The expansion is rolled into a larger health proposal Bullock calls Access Health Montana (HB590)

The Governor’s office says his bill will expand Medicaid to 70-thousand needy Montanans and create five-thousand jobs in the next year. The Federal Government will cover 100-percent of the expansion costs, but the state would face about $5 million in administrative costs related to the expansion and other requirements of the Affordable Care Act over the next two years, according to a report by the Montana Department of Health and Human Services.

The bill’s introduction comes nearly two-thirds of the way through the session. Bullock says that has given “the public the opportunity to start paying attention to this whereas many things get buried at the start of the session.”

Representative Chuck Hunter (D-Helena) is carrying Bullock’s Access Health Montana Bill. He says the extra time has allowed for discussions behind the scenes on the bill, “but I think it’s allowed us a chance to be thoughtful about what’s in the bill and to really make sure out of the many approaches to transforming the system that the approach was right.”

But the late introduction is giving Republican lawmakers pause.

Representative Mark Blasdel (R-Somers)

Representative Mark Blasdel (R-Somers)

“We’ve been waiting for quite some time to see the Governor’s bill, and finally it’s introduced,” said House Speaker Rep. Mark Blasdel (R-Somers) Blasdel has assigned the bill to the House Human Services Committee where a hearing will be held on March 25th.

“This is a billion dollar decision for Montana,” said Republican Senator Jason Priest (R-Red Lodge), “We’re gonna make it in 15 days? It’s irresponsible.”

Priest is sponsoring a bill which would push back any implementation of Medicaid Expansion. As Mike Dennison of Lee Newspapers reports, the bill would create a bi-partisan committee to study Medicaid Expansion over the next two-year  legislative interim period.

Priest says the first reason for legislators to study their options is there is no hard deadline for the expansion. “It’s not like looking at this option in more depth prevents us from taking advantage of any expansion opportunity.”

Priest does not support Bullock’s bill as written. He advocates other reform systems for the uninsured, such as the idea of providing premium support for low-income Montanans to buy health insurance on the open-market.

Senator Jason Priest (R-Red Lodge)

Senator Jason Priest (R-Red Lodge)

“If we can reform the existing Medicaid system and the expanded population then I’m willing to consider voting to implement a reformed system under Obamacare,” Priest said.

Representative Hunter calls Priest’s bill to create a study committee on Medicaid Expansion a delay tactic. He says the Legislature also created a study committee after voting in 2011 not to create a state-run healthcare exchange under the Affordable Care Act.

“That study bill really resulted in no meaningful study and no progress on the issue. That’s how I see this proposal as well,” Hunter said.

“If we don’t do this now,” Bullock said, “if we study it for two years or four years or six years. Those are Montana tax dollars that will be going to cover insurance for individuals in Arizona, North Dakota, Nevada and other states.”

Senator Priest argues Montana already receives more money than it puts in from the federal government, “so Montana dollars aren’t going somewhere else, we’re already receiving everybody else’s dollars.”

Affordable Care Act opponent says the act is not affordable

GraboyesThe mandate provision of the Patient Protection and Affordable Care Act or “Obamacare” goes into full effect next year, requiring uninsured individuals to purchase health insurance or pay a penalty. Businesses with 50 or more employees must also provide health insurance for their workers, or be penalized. The National Federation of Independent Business opposed the Act and remains one of its harshest critics. Their senior health care adviser, Robert Graboyes (“Gray-boys”), will be in Montana next week, to talk with business owners about the Act’s impact. In this feature interview, News Director Sally Mauk talks with Graboyes about his objections to Obamacare – and his predictions…

BOTH SIDES: LR 122, prohibiting the government from mandating the purchase of health insurance

We’re looking into the last of three legislative referenda appearing on the November ballot. These are measures referred to the voters by the state legislature.

The full first clause of LR 122 says, “an act prohibiting the state or federal government from mandating the purchase of health insurance coverage or imposing penalties for decisions related to the purchase of health insurance coverage.”


I don’t know if this rings any bells, but it should. It’s probably the most controversial element of the Patient Protection and Affordable Care Act, otherwise known as “Obamacare.”

This referendum has run into a little bit of a hitch though.

“It really has no impact whatsoever,” said Helena Democratic State Senator Christine Kaufmann.

LR 122 was drafted before the US Supreme Court issued its ruling on the Affordable Care Act. That June ruling declared the US Constitution does allow the federal government to mandate the purchase of health insurance coverage. And a law passed by the voters of Montana cannot overrule that.

So in some ways, LR-122 would effectively be a statement from the people.

Republican Speaker of the Montana House of Representatives Mike Milburn says it’s an important one to make. He says the Federal Government mandating to states is becoming more common.

“States should have certain rights and when we see those being encroached upon, we need to push back,” Milburn said.

Democratic State Senator Christine Kaufmann does support the Affordable Care Act, so she wouldn’t want to make that statement. But she says this kind of gesture is pointless anyway.

“It’s an exercise in futility,” she said. “Why should we spend all this emotional energy saying ‘get out of the way federal government, we can handle this ourselves’ when we’ve never been able to handle healthcare ourselves and it’s going to be a meaningless solution.”

LR 122 would be unconstitutional the moment it passes. But, a lawsuit would need to be filed against this new Montana Law and the law would need to be declared unconstitutional by a judge. That ruling could then be appealed, so on and so forth. These things take time.

Meanwhile, if Mitt Romney wins the Presidential election, he has vowed to do everything he can to repeal ObamaCare. Say Romney wins and gains enough Republican support in the House and Senate, repeal is possible. If that repeal happens before LR 122 is declared unconstitutional, then it would no longer be unconstitutional.

MILBURN: “So, it’s still very applicable and we’re hoping it will pass just to send that message,” Milburn said.

Another indication that the fight over health care reform is far from over.

This story uses excerpts from my Montana PBS special on the ballot measures, “From the People: Montana’s 2012 Ballot Measures”

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Bullock, Hill attend Montana Healthcare Forum

Montana’s candidates for governor each held a forum with professionals in the state’s healthcare industry this week.

Democrat Steve Bullock and Republican Rick Hill each needed to respond to pretty specific questions from the Montana Healthcare Forum.

The Montana Healthcare Forum has been going on for years. Groups like the AARP and the Montana Chamber of Commerce and insurance companies like Blue Cross, Blue Shield of Montana come together with medical professionals and state lawmakers to talk about problems in state healthcare and potential solutions.

Bullock and Hill each spent an hour separately fielding questions on what they would do to improve healthcare from the Governor’s seat.

The questions ranged from Medicaid expansion to budgeting to community based healthcare. Bullock was more receptive of changes coming under the federal health care law.Hill would rather see Republicans in Washington D.C. overturn it. But, Hill says he would work within the law if that does not happen.

The candidates differed in how they want to address rising healthcare costs. Bullock says it’s through more effective preventive care—getting people to see a primary care physician more often.

“Most of the costs end up dealing with chronic issues and end of life issues,” Bullock said. “Let’s address is through prevention, through screening and through regular screening beforehand so it never gets to be chronic.”

A different position from former Congressman Hill. He says it’s more important to treat chronic conditions before they reach the acute stage.

“Well, preventive care sort of has a mixed bag in terms of what it’s actually accomplished and that’s why I think most people today are focusing rather on chronic disease management and chronic condition management as opposed to preventative medicine,” Hill said.

As for what each man would do first to address health concerns once in office, Bullock says it’s bringing the stakeholders from the Healthcare Forum together again to plot the best course.

Hill says the Department of Health and Human Services would be the first place he would look to cut costs.

Senator Jon Tester

Sen Jon Tester

Senator Jon Tester stopped by the studios of Montana Public Radio today. In this feature interview with reporter Edward O’Brien, Tester weighs in on campaign finance, President Obama’s newly announced initiative to extend tax cuts for the middle class – and availability of resources should Montana’s young fire season really take off

Tom Roberts Commentary: “Supreme Court Upholds the Affordable Care Act”

It would be hard to overstate the importance of the Supreme Court ruling yesterday, supporting the constitutionality of the Affordable Care Act. Commonly known as Obamacare by its detractors, this complex piece of legislation aims to do nothing less than transform the provision of health care in our country. The somewhat surprising ruling written by Chief Justice John Roberts assures his place in the history books of our country. Instead of supporting the ability of Congress to mandate the purchase of health insurance, Justice Roberts did affirm the ability to impose a tax on people who chose not to purchase health insurance. With this component of the Affordable Care Act in place, essentially the entire law is left intact.
The only piece left in question will be the potential expansion of Medicaid services. States will now have the option of deciding whether or not to take additional Federal money in order to expand Medicaid coverage. Rather than all or nothing, states can decide to receive the same level of Medicaid support as they are currently. Or a state can chose to expand that level of federal support in order to provide health care coverage for all citizens with incomes below 133% of the federal poverty level. We can only hope that what our own state legislators decide is based on real needs and not on partisan politics.
While the political process has dominated recent news, it’s important to remember that the real issues here are not political. We have a health care system which is badly in need of improvement. Too many people are either uninsured or underinsured; mostly because they can’t afford health insurance, not because they don’t want it. Our personal, business, state and national budgets are unsustainable unless and until we make major changes in how we finance and receive health care.
Many people believe that the Affordable Care Act did not go far enough. For them, what we really need is a single payer system similar to Medicare, for everyone. At the other end of the spectrum, some people apparently feel that medical care is optional and should be dependent on one’s ability to pay. Now, fortunately for all of us, the Affordable Care Act means that we can approach problems in our health system from somewhere in the middle. Most people will pay at least something in order to receive health insurance. For those who really can’t afford it, we have the option of expanding Medicaid. As a society we certainly have the resources to make sure that no one is denied medical care because of cost. It’s past time to make this happen.
But access by itself is not enough. At the same time we need to control spending and improve quality. We know this is possible by looking at how health care is supplied in different parts of our country. Spending for treatment of the very same illness may vary as much as 3 or 4 times from one locale to another. The compelling part of this is that the quality of medical care and the outcomes are no better and sometimes are worse in the high spending areas. Spending more does not mean better care. This doesn’t mean that we can simply cut payments to areas with high spending. What it does mean is that we can and should find ways to make high spending areas more efficient. At the same time we need to improve the quality of medical care in all areas.
As those of us working in the medical system know, a single payer program like Medicare does not guarantee good outcomes or efficient medical care. Likewise, having individuals pay for their own medical care does not necessarily lower costs and improve quality. These are complex issues that need careful answers. As much as we would like it, there is not a simple solution, and sound bites won’t help. No single federal law by itself will solve all of these problems. Fortunately we have made a start with the Affordable Care Act. We will begin to address complex issues like supporting primary care based Medical Homes and learning which treatments actually work best. Many people believe we have to migrate away from our current fee for service payment system. This Act supports the creation of health organizations that are accountable for the costs and outcomes of the medical care they provide. Hospital systems need to focus on improving population health, not the bottom line. The best outcomes can often be achieved by using the least expensive approach, not the most expensive. We need to turn our insurance industry into one that pays for needed medical care, not one that makes money by avoiding high risk consumers.
It’s an exciting time. With the constitutional issue now decided, we have opportunities to move forward. We can only hope that our leaders are ready to move ahead with new approaches and that we will not continue to be stuck in partisan politics.

Campaign Beat June 22 – Chuck, Sally and Mike talk debates and campaign promises…

Chuck Johnson, Sally Mauk, Mike Dennison

On this edition of “Campaign Beat”, our weekly political analysis program, News Director Sally Mauk talks with Lee newspaper reporters Chuck Johnson and Mike Dennison about the first debate in the U.S. Senate race, a “cancelled” debate, two new TV ads, a gubernatorial campaign promise, and two important U.S. Supreme court decisions that could impact Montana races…