A reality based independent journal of observation & analysis, serving the Flathead Valley & Montana since 2006. © James Conner.
State Senator Ed Buttrey (R-Great Falls) has introduced SB-405, what’s being called the moderate Republican approach to expanding Medicaid in Montana. I agree that it’s a Republican approach, but it doesn’t seem moderate to me. In fact, I think that Montanans already on Medicaid would be better off if this bill died.
The bill will be heard on Friday, 20 March, at 1500 in Room 317 of the Capitol, by the MT Senate’s public health, welfare, and safety committee.
Republican Senators Taylor Brown, Bruce Tutvedt, and Pat Connell stood with Buttrey while he announced the bill, so the votes to move SB-405 through the Senate may exist. Democrats with whom I’ve spoken believe they can find enough moderate Republican votes to move the measure through the MT House. On that, I have my doubts.
HB-405 accepts federal money for Medicaid and covers Montanans with incomes equal to or less than 138 percent of the official poverty level. That’s good.
But it slaps on every Medicaid recipient an insurance co-pay “premium” (that quacks like a tax) of two percent of their annual income, to be paid monthly. Those who fail to pay can get booted from the program. Two percent may not sound like a lot, and it certainly doesn’t look like a lot to legislators with Republican incomes, but it’s still a small dent in a budget, a monthly inconvenience, and if paid automatically, exposes debit cards and bank accounts to hacks. The fee won’t raise much money, especially after accounting for administrative overhead, so it really only has one purpose: teaching the ne’er-do-wells on Medicaid to take personal responsibility.
HB-405 also puts a ceiling on how much Medicaid recipients can own (Section 18): a light automobile, a house worth $250,000 or less, and $50,000 in cash or the equivalent thereof. If the house is assessed at $250,000.01, there are fees to pay:
(2)The fee is $100 a month plus an additional $4 a month for each $1,000 in assets above the amounts established in subsection (1)(b). (3) The department shall coordinate with the department of public health and human services to obtain the information necessary to administer this section. (4) Fees collected pursuant to this section must be deposited in the general fund. (5) The fee remains until paid and may be collected through assessments against future income tax returns or through a civil action initiated by the state.
Section 18 could play havoc with someone at 50 percent of the poverty level who owns a house assessed at more than $250,000. If the house is assessed for a dollar more (and now there will be an incentive to do just that) than the magic number, someone with an income of $500 a month will experience the equivalent of a 20 percent reduction in income. That doesn’t make sense unless one of the objectives is to get the poor out of their homes and into tarpaper shacks.
Buttrey’s bill also contains sections on “malpractice reform,” the perennial quest of some physicians not to be held accountable for their mistakes, and sets up various committees.
Montana doesn’t need this bill. It doesn’t need Rep. Nancy Ballance’s Scrooge-like Medicaid bill. And it doesn’t need Gov. Bullock’s bill, which lies stone cold dead in the MT House. Bullock’s bill is better than the other bills, but it too falls a country mile short of expanding Medicaid as intended under the Affordable Care Act. Montana needs a clean Medicaid expansion bill. And after that bill become law, our legislature should unanimously pass a resolution urging Congress to create an everyone covered for everyone federal single-payer health care system financed by progressive taxation.