Legislative Republicans unveil Medicaid proposal; Bullock says inadequate

HELENA – Legislative Republicans Wednesday unveiled their proposals to expand health coverage for low-income Montanans – but it does not include accepting new federal money that would cover 70,000 additional people. Instead, the GOP wants to limit any expanded Medicaid coverage to the disabled, parents of children in families below the poverty line and some military veterans. Sen. Fred Thomas, R-Stevensville, one of several Republicans working on alternatives to Democratic Gov. Steve Bullock’s Medicaid-expansion plan, said free government health coverage shouldn’t be extended to able-bodied, childless adults. Those citizens can find work and get a federal subsidy to help them pay for private health insurance under the Affordable Care Act (ACA), also known as “Obamacare,” he said. “Let’s keep Medicaid dedicated to taking care of the most vulnerable members of society … and not extend welfare to people who can take care of themselves,” Thomas said. Republicans released a framework of their plan Wednesday, but have yet to draft specific bills that will be introduced at the 2015 Legislature, which convenes Monday. Their plan includes expanding Medicaid eligibility for an additional 15,000 to 18,000 people earning less than 100 percent of the federal poverty level, some Medicaid health-practice reforms that Thomas said would save the state money, and “tort reform,” which means limiting liability for medical practitioners. Expansion of Medicaid, the state-federal program that pays medical bills for the poor, will be a major issue before the Legislature this year. Under the ACA, the state can expand Medicaid coverage to everyone earning up to 138 percent of the federal poverty level, or $16,100 for a single person. The federal government would pay the entire cost in 2016 and 95 percent of the cost in 2017. Bullock has proposed accepting the federal money and expanding Medicaid, but wants to hire a private company to manage claims for the newly eligible people. He noted that the GOP plan would accept some federal money but leave “tens of thousands” of Montanans uncovered. “Rejecting our fair share of federal funding because you don’t like the president is the wrong thing to do for our state’s fiscal health. ..” Bullock said in a statement. Tara Jensen, co-director of the Montana Budget and Policy Center, a left-leaning think tank that supports Medicaid expansion, also said Wednesday the Republican proposal “would cost the state millions of dollars in lost federal funds and will, in fact, require Montana taxpayers to pick up a greater share of the cost.” Under the GOP plan, the state would pay about one-third of the cost of limited expanded eligibility. However, Thomas said Medicaid-system reforms in the Republican plan would save the state enough money to cover those costs. He didn’t have precise figures on what those savings or costs would be. He also said accepting full Medicaid expansion under the ACA would cost the state millions of dollars down the road, as the federal government requires the state to pick up 10 percent of the expansion cost by 2020. Republicans also don’t want to increase the federal debt to pay for what they see as a new welfare program for able-bodied adults, he added. “I think it’s fair to say that the intent of (President Obama and Democrats in Congress) was, in essence, sign people up for a welfare program,” Thomas said. “It has nothing to do with health care. I think there is a direct linkage to the more people who are on public assistance, the more Democrats think they will vote for them.”