After legislation that could spell the end for Medicaid expansion in states like Montana cleared the U.S. House on a close vote, some are calling on Montana’s senators to defeat a Republican plan to repeal and replace the Affordable Care Act.
The Montana Budget and Policy Center, a nonprofit that researches budget, tax and economic issues, said Thursday the revised version of the American Health Care Act would effectively end Medicaid expansion in Montana, which has extended coverage to more than 70,000 people.
“The bill passed by the US House of Representatives is even worse for Montanans and our state than the bill presented earlier this year,” said co-director Heather O’Loughlin. “AHCA represents a dramatic and unprecedented cut to Medicaid and is not a solution that will work for Montana.”
In the 2015 legislative session, Montana voted to expand Medicaid as a part of the Affordable Care Act, making coverage available to those who earn up to 138 percent of the federal poverty level.
When the HELP Act was passed, it came with a 2019 sunset date, which was put in place so the state could assess the viability of the program under stepped-down federal reimbursement rates. What Republicans in Washington are proposing drops reimbursement further than previously called for at the start of 2020.
A report from the Congressional Budget Office issued for the first version of the Republican repeal-and-replace plan estimated some states will end their Medicaid expansion program because of that. While it’s not clear what will happen in Montana, numbers from the Department of Health and Human Services applied to CBO estimates show it would take the state an extra $251 million a year to keep coverage as it is now.
Gov. Steve Bullock, a Democrat, released a statement Thursday criticizing the bill.
“This is another half-baked proposal to kick the legs right out from under those with pre-existing conditions, seniors, cancer patients and the 76,000 Montanans that now have health care under Medicaid expansion,” he said. “We need thoughtful and affordable solutions that expand coverage and protect patients, not ones that only benefit millionaires and members of Congress.”
The bill now moves to the Senate, where Montana Sens. Jon Tester, a Democrat, and Steve Daines, a Republican will vote on it.
Tester called this iteration of the Republican plan worse than the last.
“The House is forcing seniors to pay more, jeopardizing health care for Montana women and failing to address the rising costs that are draining pocketbooks.”
He called on lawmakers to “get off their political soapboxes so we can work on real solutions.”
Daines released an audio statement saying “It’s time now for the U.S. Senate to take action and make health care affordable for all Montanans,” though he did not clarify how he would vote. The Senate will likely not take up the bill until June, when it will be heavily debated and possibly amended.
The Montana Budget and Policy Center also said the Republican plan would increase premiums and out-of-pocket costs and alter the greater Medicaid program, which covers 240,000 Montanans, by moving $3 billion in costs to the state over the next decade.
The center said the bill would let states create a high-risk pool for those with pre-existing conditions, and those pools would have premiums so high they would be unaffordable.
States would also be permitted to waive a requirement under the existing Affordable Care Act, also known as Obamacare, to provide what’s known as essential health benefits. Those benefits include things like maternity care and mental health care. That change means it’s likely women will be charged more for insurance, according to the center.
“This proposal takes a bad bill and makes it worse,” said Sarah Howell, executive director of Montana Women Vote. “We cannot go back to the days where individuals were being denied coverage or forced into high risk pools that were outrageously expensive and covered very little.”
Montana did not have a congressman vote on the bill because the state’s sole seat in the U.S. House is empty after Ryan Zinke resigned to become Secretary of the Interior.
But candidates to fill his position in a May 25 special election weighed in Thursday.
“No Montanan would vote for this bill,” said Rob Quist, a Democrat from Creston. He also said Congress should not rush “through something as disastrous as this bill, which will raise health care costs for working Montanans.”
In a statement from a spokesman, Republican Greg Gianforte, a Bozeman tech entrepreneur, said he wanted more information before he would say if he supported the bill.
“Greg needs to know all the facts because it’s important to know exactly what’s in the bill before he votes on it,” spokesman Shane Scanlon said.
The Congressional Budget Office, which produces nonpartisan analysis of legislation, has not yet produced a review of the bill, though it did for the previous version.
In a debate last Saturday, Quist said he supported the Affordable Care Act and that it needs to be preserved and fixed, not tossed out.
“Before we get any new health care plans we need to fix the one we have.”
Gianforte said his barometer would be if a plan preserves rural access and coverage for pre-existing conditions while reducing premiums.
“Does any repeal-and-replace proposal reduce premiums for average Montanans and does it preserve rural access? If it does, I’ll vote for it.”
Libertarian Mark Wicks, an Inverness rancher, said the Affordable Care Act is not affordable and he wants to see the government get out of health care.