Montana voters have made it abundantly clear that Initiative 185 was the wrong way to fund the state’s Medicaid expansion program.

But that doesn’t necessarily mean they want to let Medicaid expansion expire. And now it’s up to the Legislature to find a better way to prevent 94,000 Montanans from losing their health care. 

Gov. Steve Bullock and a bipartisan group of state lawmakers worked across party lines three years ago to bring Medicaid expansion to Montana. However, they included a sunset date of July 2019 so they could evaluate the success of the program and determine whether to continue, modify or terminate it.

Last fall, I-185 sought to make the program permanent and partially fund it through an increase in the state’s tax on tobacco products. But as we opined before the elections, the initiative was seriously flawed.

Though I-185 was billed as a way to fund Medicaid expansion, the overwhelming majority of the revenue it generated would have been used for other purposes. The initiative went so far as to limit the percentage of revenue that could be used on Medicaid expansion, leaving questions about whether it would even be able to fund the full cost of the program it sought to make permanent.

We believe those fatal flaws are what ended up sinking the initiative on election day. But we also believe most Montanans would continue to support Medicaid expansion if legislators can find a reasonable way to pay for it.

Medicaid expansion is currently available to Montanans who make less than 138 percent of the poverty level. According to St. Peter’s Health CEO Wade Johnson, the program keeps those people out of the emergency room and gets them into a primary care setting where health issues can be identified and managed before they become serious.

And while there’s no disputing the positive impact it has had on the nearly one in 10 Montanans and roughly 7,000 Helena-area residents enrolled, the benefits of the program extend much further.

According to the Kaiser Family Foundation, a review of 202 studies suggests that Medicaid expansion not only presents an opportunity for gains in coverage and improves access to care, but it also has a positive economic benefit on states and providers where it is available.

The amount of revenue Medicaid expansion brings into Montana far exceeds the amount the state spends on it, as the federal government is responsible for 90 percent of the costs. Much of that revenue ends up with medical providers like St. Peter’s Health and Shodair Children’s Hospital, each of which stands to lose millions of dollars if Medicaid expansion ends.

“We will have to find ways to reduce our costs, likely scaling back programs, services or staff” if the program expires, Johnson said.

Studies have also shown that states that have implemented Medicaid expansion have experienced a decrease in uncompensated care, which helps keep medical costs down for everyone.

In addition, Montana has seen an increase in employment among those eligible for Medicaid expansion, even as other states have seen a decline. This seems to suggest that the program is helping Montanans get back into the workforce and onto a path to self-reliance, which is a good first step toward ending the cycle of poverty.

Montana is one of 37 states looking out for their own by refusing to deny health insurance to citizens with no other options.

Let’s not become the first to take that away from them.

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Helena Independent Record


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