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The initiative to raise tobacco taxes to fund health care appeared to be going down to defeat Wednesday as ballots were still being counted around Montana.

If the majority of voters rejected Initiative 185, they have left more work for the 2019 Legislature. The health care and revenue needs that I-185 supporters aimed to address on Nov. 6 will still demand attention in January and beyond.

I-185 would have raised an estimated $72 million a year in new revenue from higher tobacco taxes and by adding e-cigarettes to the definition of taxable tobacco products.

Medicaid expansion, as approved by the 2015 Montana Legislature, has been highly successful, enrolling 96,000 Montanans who have incomes of less than 138 percent of poverty level. Most Montana Medicaid expansion enrollees have income far below poverty level, even though most are working.

I-185 would have repealed the sunset date of June 2019 for Montana Medicaid expansion. Now it’s up to the 2019 Legislature and Gov. Steve Bullock. The governor supported I-185, but when The Gazette asked state legislative candidates their views, Republicans weren’t keen on it. Some candidates said enrollees should have to work for their coverage. Republicans once again won majorities in both the Montana House and Senate in Tuesday’s election.

State Sen. Eric Moore, R-Miles City, has requested a bill draft to “generally revise Medicaid expansion work requirements.”

It’s healthy for people to pay what they can afford for health care, which is why Montana’s Medicaid expansion program already requires participants to pay the maximum premiums and co-pays permitted by federal law.

A work requirement for Medicaid enrollees isn’t a bad idea, so long as it recognizes that there are individuals who can’t reasonably be expected to work – such as when they are participating in intensive addiction treatment, otherwise sick or injured, caring for young children or frail elderly relatives, in school or job training.

Another important caveat on regulations is that they not cost the state in administration more than they save. Regulations must not be so onerous that law-abiding enrollees drop out because compliance is too difficult. For example, workers can’t easily leave their jobs to go into an Office of Public Assistance to repeatedly verify work hours – especially since the state cut OPA staff and closed offices due to the present biennium’s revenue shortfall.

It’s imperative that Montana not backtrack on health care coverage – particularly while our state and nation are battling epidemics of drug addiction. Medicaid presently covers most of the Montanans in addiction treatment outside of prisons.

If the expansion sunsets, Montana would revert from paying 10 percent of care costs to paying about 30 percent for pregnant women and parents of very young children. The Department of Corrections and county jails would need more money to cover inmate health care. There would be no coverage for most low-income adults needing addiction treatment.

Big Tobacco won big in Montana Tuesday after spending upwards of $17 million on a campaign against I-185.

Montana community hospitals, clinics and health care professionals advocated for I-185. They want their patients to have access to needed high quality care. Since Medicaid expansion began in January 2016, most Montana hospitals have seen decreases in uncompensated care. Most operate on thin or negative margins, so getting paid for patient care is vital to keeping their doors open.

On Tuesday, voters in Idaho, Utah and Nebraska approved initiatives to start Medicaid expansion programs. None of the 32 states that adopted expansion has rescinded it. Why? Because it’s a boon to the states and their people to have health care for low-income adults. Because Medicaid expansion brings more than nine federal dollars into the state for every $1 the state pays for care in this program.

Montana must maintain its Medicaid expansion in a program that best serves the needs of Montanans and makes the most prudent use of public funds.

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— The Billings Gazette


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