YIN AND YANG - Expanded Medicaid

Thursday, March 14, 2019
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By Jennifer Mericki

Former Campaign Coordinator

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By Brad Molnar


By Brad Molnar

Dueling plans to extend Expanded Medicaid in Montana shall soon be fully unveiled. The competing versions are from Rep. Buttrey (R) Great Falls and Rep. Mary Caffero (D) Helena. Caffero rebuffs work requirements and Buttrey pretends to mandate work requirements to receive Expanded Medicaid coverage.

Four years ago Buttrey and Caffero were co-sponsors for Medicaid Expansion. Buttrey testified 30,000 to 50,000 would sign up and the number would drop to 20,000 participants through co-pay and work training requirements. Enrolled numbers now hover at 98,000. Democrats estimate that if recipients have to report work searches monthly 25 percent would drop out of the program. Rep. Buttrey now defines “work” as community involvement, volunteerism, etc. for eighty hours a month and advocates self reporting work searches to keep enrollees enrolled.

Recipients of Medicare Expansion can earn no more than $34,000 for a family of four. On top of the $34k of reported income many will qualify for an additional $31,000 in “benefits.” To accept overtime, or get advanced training, may cost the family more in benefits than the promotion or training can generate. Escaping welfare is difficult. In 1995 many states, including Montana, changed their laws to “able bodied cannot receive welfare” and the rolls dropped by 50 percent. Amendments since then have pushed the numbers back up.

The main arguments to maintain Medicaid Expansion are that it keeps rural hospitals profitable, moves the permanently disabled to SSI Social Security more efficiently and at less costs to the states, 100 cases of breast cancer were discovered, more veterans and Native Americans received coverage, and job training is included in the program. These are all good things. But Social Security SSI shortcomings should be reformed at the federal level not thru optional state programs. The same goes for veteran and Native American programs. If these programs are not functioning at an acceptable level they should be revised or eliminated. But don’t make them into a state or federal program that will turn 96,000 people, and their children, into multi-generational welfare dependents. Montana has many job training programs. We do not need Expanded Medicaid to add another. Welfare dependency is a horrendous way to fund hospitals or build a political base. With almost a billion new dollars a year for funding Medicaid Expansion we could certainly fund wellness programs in a more effective way.

As Lt. Detective Columbo used to say, “Just one more thing sir,” in 1999 Montana was 49th in the nation for income and had a population of 900,000, of which 9000 were on Medicaid. Mr. Buttrey, we now have one million

people in Montana, are number 40th in the nation for income, have almost zero unemployment, and have 250,000 on Medicaid. Why do you now want to incentivize even more welfare dependency?”

Fun fact: Currently 25

percent of Montana resident’s are on Medicaid and other welfare benefits. By any measure one-in- four Montana’s is on welfare and the other three are working two jobs to provide those benefits.

Brad Molnar spent 8 years in the Montana Legislature serving on the Health, Human Services, and Aging Committee.


By Jennifer Mericki

Medicaid expansion is not a handout. It’s a unique Montana solution for affordable, accessible healthcare. The Medicaid expansion program provides access to health care for adults living on incomes below 138 percent of the federal poverty line, including Veterans. However, it doesn’t include pregnant women, emergency room care, family planning, immunizations or generic drugs, to name a few. Low-income people pay monthly premiums as well as co-payments for certain services, which averages up to 5% of their quarterly income. People participate in the work force as enrollees participate in assessment surveys to help get better-paying job.

More than 8 in 10 Medicaid expansion enrollees live in working families. 7 in 10 are themselves already working but can’t afford private insurance or their employer doesn’t offer it. And those that aren’t working, 1 in 3 are ill, elderly or disabled. This blows the lid off the current proposals for work requirements. Those that can work do and those that can’t, won’t be able to, in turn subjecting our most vulnerable members of society to no healthcare. That is not what any respectable, civil society would do.

Medicaid expansion

increases the capacity of mental health care programs and makes them more effective in providing treatment and other necessary services. Early access to healthcare services can have a dramatic impact on achieving longterm recovery, reducing stigma, discrimination, isolation, and address mental health related issues in our criminal justice system.

The impact with Medicaid expansion represents a significant economic driver to our state. Providing healthcare coverage results in substantial federal matching with federal funds flowing into the state. When individuals gain health coverage, they can access preventative care and other health services they need, experience improved health outcomes, and can better afford basic necessities. Individuals get care earlier which keeps them healthier, on the job and brings down healthcare costs for all of us.

Montana has experienced savings and economic power in local communities with this program. It helps our rural hospitals and clinics keep their doors open and even expand services. This offers our rural residents a choice and convenience in their healthcare decisions. Its benefits are irrefutable and proves it’s a lifeline to our rural hospitals that so many people in this state rely on.

Medicaid expansion has a significant economic impact on our state. Health care is our largest source of private sector income and its second largest source of jobs. Hospitals, Nursing homes, and other healthcare providers rely on Medicaid expansion as critical revenue. It also positively impacts the reduction of uncompensated care. Healthcare facilities reduce write-offs from unpaid bills that would normally get passed along to us in the form of increased pricing and rates.

Medicaid expansion now insures more than 96,000 people, generates more than $500 million a year in healthcare spending, has provided $902 million in healthcare services and saved about $40 million in benefits. Overall, the savings and revenue tied to Medicaid expansion outpace the expected cost to the state. Montana needs Medicaid expansion permanently.

Jennifer Mericki was a Montana Campaign Coordinator in the 2016 Bernie Sanders Presidential Campaign

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