As the dust settles from this year’s midterm elections, a few things are becoming more clear about the 2019 legislative session — Republicans retained their majority but perhaps not the unity that carried them through 2017. And everyone is gearing up for a potentially fiery debate about what to do with Medicaid expansion.
The 2019 regular session will be the last for Montana Gov. Steve Bullock, a Democrat who has tangoed with a Republican-dominated state House and Senate his entire tenure. Sometimes he’s been able to find a dance partner, and others a cold shoulder. While Democrats picked up a few legislative seats in November, they're still in the minority.
Three years ago, Bullock and a group of more moderate Republican lawmakers worked with minority Democrats to pass Medicaid expansion, which now provides health insurance to nearly a 10th of the state’s population but is set to expire next summer unless legislators vote to extend the program.
Gathered in the state Senate president’s office last week, three of the top Republican leaders all nodded and offered a collective “yup” when asked if Medicaid expansion would be the marquee battle of the 90-day session that kicks off Jan. 7.
“It’s going to be the 100-pound gorilla in the room,” said Senate President Scott Sales, a Bozeman Republican who last week won the same leadership position he held in 2017.
When lawmakers passed Medicaid expansion, they built in a sunset date of July 2019. That was meant to give them time to see how the program has worked, how much it cost and to decide whether to continue, alter or end it.
This fall there was also a ballot initiative to permanently expand Medicaid and pay for it through an increase in the state’s tax on tobacco products. Voters shot it down by a 6-point margin. While some Republicans say that’s a mandate to kill the program, others in the GOP and Democrats argue Montanans want to see it continue, but didn’t like the initiative's approach or were swayed by the more than $17 million tobacco companies spent to defeat the measure.
In Sales’ assessment, there are three camps, each with their own take on what to do with the program that covers more than 96,000 adults who earn up to 138 percent of the federal poverty level.
“The Democrats, some of them believe it’s a fundamental human right ... . There’s those of us that are more conservative that are afraid fiscally it’s not sustainable in the long run. ... And then there’s the more moderate members of the Republican caucus that were instrumental in getting it passed last time. I think they've come to the conclusion some serious sideboards need to be put around it to make it more affordable for the taxpayer,” Sales said.
Those sideboards would include some sort of work requirement, a proposal Republicans have already suggested in a letter sent this fall to Bullock. There are also calls for enhanced means and asset testing, as well as a suggestion to require drug testing.
For his part, Bullock put the program into the budget he released this week. He plans to pay for the state’s share of costs with money from the general fund. In 2020, the state is projected to spend $57.4 million, but also save $28.4 million through savings created by the program.
Casey Schreiner, a Democrat from Great Falls who was elected House minority leader, wants to see expansion continue. He argued work requirements, tried by a few states, have not proven to be successful and pointed to Montana’s voluntary program to connect recipients to workforce services.
Though there's no conclusive connection to the voluntary program, Montana has seen a jump in employment among the population eligible for Medicaid expansion, while other states have seen a decline since 2015.
A report this summer also showed just over 81 percent of Medicaid recipients in Montana lived in families where at least one adult was working, and 67 percent were working themselves.
“I have a lot of faith this body is going to do great things and we can hammer something out fairly quickly,” Schreiner said. “Limiting (who can be covered under expansion) just takes away health insurance for Montanans. And I don’t think with I-185 (the ballot initiative) going down, that’s what the people have said. I think the people got scared of some sort of tax increase. It had nothing to do with doing what’s right.”
Great Falls legislator Ed Buttrey, a Republican moving from the Senate to the House this year, carried Medicaid expansion in 2015, in the form of the Montana Health and Economic Livelihood Partnership, or HELP, Act.
Buttrey thinks expansion has been a success and should continue, but would benefit from some changes like work requirements and means and asset testing.
“I literally plan to spend the entire session working on HELP No. 2,” Buttrey said. “I think there is an appetite by most legislators that the program continues. It’s been a great program for the state. I think it’s a bipartisan group that realizes how important it is that we move forward, but it will have to change."
Despite the looming fight over Medicaid expansion, when lawmakers descended on Helena last week for training and to elect leadership, Republicans in speeches to their caucuses were more focused on getting a member of their party back into the governor’s office in 2020 than upcoming policy battles.
Democrats for their part stressed a need to preserve Medicaid expansion and other health care initiatives. Health care was a winning issue for the Democrat at the top of the ticket in November's midterm, U.S. Sen. Jon Tester. A poll of voters by The Associated Press also found it was the top concern for people at the ballot box.
"I'm going to concentrate on a couple of issues, the Medicaid expansion and continue to do all we can to keep health care costs down and improve access to health care for as many Montanans as possible," said Senate Minority Leader Jon Sesso of Butte, who was re-elected to his leadership post from 2017. "… I'm going to work with Republicans in the Senate to forge an expansion bill that makes sense for everybody."
But Sales, as well as Sen. Fred Thomas, a Stevensville Republican and No. 2 in Senate Republican leadership, both told their caucus the focus should be on coming through the session strong so the party is in a position to elect a Republican governor in 2020.
Rep. Brad Tschida, a Republican from Missoula and No. 2 in House Republican leadership, told his caucus a Republican governor “should be at the top of our list as far as our goals and objectives.” It would be achievable, Tschida said, only with a harmonious GOP.
Still, there were hints of cracks in the foundations of unity Republicans rebuilt after infighting that hamstrung the party in 2015.
Greg Hertz, a Republican from Polson who was elected Speaker of the House last week, ran for the position on a call of a united front. But his challenger, Hamilton Republican Nancy Ballance, told the House GOP caucus they’d be a “caucus in name only” if they didn’t quash already-brewing disagreements.
One of those disputes is already being publicly deliberated. It's over the rules of the House, and how many votes it would take to revive a bill that's lingering in committee, or "blast" it onto the House floor for debate.
Buttrey, the longtime state senator who is moving to the House this year, proposed during an August Legislative Council meeting to reduce the number of votes it takes to blast a bill from a three-fifths majority of 67 to just a simple majority of 51. The Senate only requires a simple majority.
Buttrey argues moving to the simple majority means Republicans wouldn’t need help from Democrats to blast bills. The rule's present form, he argued back in August, allows “a minority of members to control the destiny” of some legislation.
Hertz, the incoming House speaker, said he would oppose the rule change.
“The rules that we have in place, they look like they are adequate and they’ve done the job for decades here in the Montana House,” Hertz said.
Outgoing House speaker Austin Knudsen, who helped heal over GOP wounds in 2017, was more blunt about the proposed change and what it could do for any hopes of Republicans cohesion.
“(You’ll) tear off a hell of a big scab and make a heck of a war. It’s going to be fun to watch. I’m glad I’m not going to be here. A lot of these rule changes are poison. I think they’re going to create a heck of a set of fireworks that I’m glad I’m not going to be around for," Knudsen said last week.
Still, Hertz said after he won the speaker position that his calls to work together in his nomination speech were more of a refresher for Republicans and not indicative of any underlying splits.
“I think it is a reminder. It’s no secret we’ve had our differences in 2015,” Hertz said. “We worked better in 2017 and we were very united during the special session. My goal is to carry that unity forward into the 2019 session.”
One of the places Republicans do appear to be on the same page is opposition to the governor's tax proposals. To help boost revenues, Bullock has pitched about $100 million in new taxes, some from ideas that were defeated in the 2017 regular and special session. That includes a tobacco tax increase, as well as hikes on alcohol, lodging and rental car taxes.
While the governor said he's an "eternal optimist" and believes he'll find a Legislature willing to work with him, there wasn't much enthusiasm among Republicans last week.
“I think there are a lot of Republicans, whether they’ve signed tax pledges or not, are absolutely not going to have an appetite for any type of tax increase,” Buttrey said.