House endorses compromise Medicaid expansion bill

LISA BAUMANN

Associated Press

HELENA - After a hard-fought battle to get the last-standing bill to expand the Medicaid program to the floor, the Montana House of Representatives gave it an initial green lightThursday.

The House voted 54-46 to endorse the amended measure on a second reading with support from 13 Republicans and all 41 Democrats after it was sent to the floor Wednesday.

Thursday, Rep. Roy Hollandsworth, R-Brady, voted to pass the bill, as did Rep. G. Bruce Meyers, R-Box Elder, who voted Wednesday against bringing it from committee to the floor of the House.

Republican Reps. Stephanie Hess of Havre and Mike Lang of Malta voted against the measures both Wednesday and Thursday.

Republican Rep. Rob Cook of Conrad brought the bill to the floor for sponsor Sen. Ed Buttrey, R-Great Falls.

"I think this is the right thing to do and the right time to do it," Cook said.

Buttrey introduced what he called a compromise plan, The Montana Health and Economic Livelihood Partnership Act, after a measure pushed by the governor was defeated in March. It would accept federal funds to expand Medicaid eligibility to people with incomes at or below 138 percent of the federal poverty level - about $16,200 per year for an individual in 2015_but coverage would come with strings attached.

Enrollees would be required to pay premiums each month as well as co-payments for certain services. They also would be asked to participate in a workplace-assessment survey designed to help them get better-paying jobs. The focus would be on existing job needs and new health care jobs created through Medicaid expansion.

Fees also would be charged to people found to have hidden assets in order to qualify for coverage. An oversight committee would collect data on the efficiency and quality of the health care delivered and to make improvement recommendations to the Legislature. The bill would sunset in four years, allowing the Legislature to renew it if it's working, Buttrey has said.

Cook offered the only successful amendment to Buttrey's plan. The amendment appropriates about $2.1 million to state departments, the bulk of which will go to the state Department of Labor and Industry for helping people who enroll find better jobs.

Four unsuccessful amendments were offered by conservative Republicans, including one that would have severely limited who would be eligible for coverage. That would have ensured the bill's demise, according to Cook, who said the federal government would not approve the condition.

Rep. Forrest Mandeville said he opposed the bill in part because the four-year sunset "kicks the can down the road" for future lawmakers to revisit.

"I'm not against helping poor people, which is why I supported Rep. (Nancy) Ballance's bill," the Republican from Columbus said, referring to a bill that would have expanded Medicaid to about 10,000 people. "I believe it (Senate Bill 405) has good intentions. But good intentions do not make a good bill."

Ballance, whose bill was rejected in March, called Senate Bill 405 "the governor's bill with a handful of Republicans' support" and said it would reduce people's incentive to work.

While Bullock's bill was closer to straight Medicaid expansion, Buttrey's proposal would need a federal waiver in order to implement the expansion because of the additional stipulations. A handful of states have received similar waivers.

Buttrey also estimates that because people would have to pay premiums, fewer would sign up than under the governor's plan. He has said approximately 45,000 Montanans of about 70,000 who would become eligible would enroll in Medicaid under his bill.

Rep. Frank Garner said while he didn't support the full Medicaid-expansion proposal, he supports this bill.

"The act of doing nothing is not going to solve the problem for people who find themselves in the range that this covers," the Republican from Kalispell said. "Today I choose to do something."

If Senate Bill 405 passes third reading, it will go back to the Senate for approval of the added amendment. Democratic Gov. Steve Bullock has said he would sign the measure if it crosses his desk.