I 185 won't fund Medicare or traditional Medicaid

Montana voters are being asked to make a major policy decision this year that will have long-term effects on the state budget and the tax burden of all Montanans.  I’m referring to I 185, the ballot initiative that would make permanent an expensive entitlement program called Medicaid Expansion.

As voters prepare to make this serious choice about the direction of state spending, it’s important to understand exactly which programs, and people, are affected.

One major program not impacted by I 185 is Medicare, which covers healthcare costs for the elderly as well as some younger people with disabilities.  Medicare is meant to ensure that those who cannot work or have retired after decades of paying into the Medicare system receive the proper care they need.

  A second major program not impacted by I 185 is traditional Medicaid, which has been the healthcare safety net for the most vulnerable Americans like low-income pregnant women, single parents and the disabled.  Medicaid has always been a lifeline for those who could not afford health insurance on their own.

The program that is affected by I 185 is Medicaid Expansion.  Under the Affordable Care Act (Obamacare), states were authorized to offer Medicaid benefits to a much larger population.  In 2015, the Montana legislature enacted the HELP Act, which authorized Medicaid Expansion in the state for a four-year trial basis.  

Nearly 100,000 Montanans have participated in Medicaid Expansion.  Of those new enrollees, more than 75 percent are working-age adults and more than half do not have children.

To recap, I 185 does not affect the health programs for Montanans over age 65 or for the recipients of traditional Medicaid.  It only affects the relatively new entitlement program, Medicaid Expansion.

And this is the choice Montanans will need to make in November: should we continue to pay for Medicaid Expansion? How, and under what circumstances?

The legislature passed this program on a trial basis with the intention of assessing whether it was effective and if it could be afforded.

However, I 185 completely cuts the legislature out of the process, bypassing them and avoiding the examination of Medicaid expansion originally planned.  Instead, I 185 asks the voters to create a permanent statutory appropriation– one that might even be unconstitutional, according to the Legislative Services Department.  

I 185 leaves the Department of Public Health in charge of the program.  Bureaucrats will get to decide how much money they need to fund Medicaid Expansion and spend whatever amount they say is necessary.  The measure doesn’t contain any requirements for legislative oversight, cost controls, accountability or transparency. That’s a scary thought, especially in light of healthcare costs spiraling out of control.

It’s also important to note that though I 185 raises nearly $75 million from taxes on tobacco products, only a fraction of this new revenue is dedicated to paying for Medicaid Expansion.  I 185 allocates no more than $26 million per year, about 40% of the projected cost of Medicaid Expansion, meaning that all Montana taxpayers will be responsible for covering a $34 million unfunded mandate.

It is irresponsible to take away planned legislative oversight of a massive, expensive program and permanently put taxpayers on the hook for a massive permanent appropriation.  

We already know that there are problems that need to be fixed in Medicaid Expansion. It’s proven to be nearly twice as expensive as originally estimated. It included a workforce-training program to help enrollees find higher-paying jobs to get them off government assistance, but less than a quarter of enrollees have signed up.  

I 185 does absolutely nothing to address these problems; in fact, it makes them worse by bypassing planned legislative oversight.  

The bottom line is I 185 would lock into place an immensely expensive program before we have a chance to fix it.

Please join me and vote no on I 185.

Sen. Bob Keenan, R-Bigfork, represents Seante District 5 and served as vice chair on the Senate Health and Human Services Committee in the 2017 Session.