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Brenda Stafford works part-time in a Shelby casino for minimum wage and says she’d like to work more hours, but rheumatoid arthritis and a neck injury she suffered in a car accident three years ago make it too painful to work longer.

She can’t work enough hours to get health insurance through her employer, so she has no insurance — and says she can’t afford the $40,000 surgery or prescription drugs that would ease her pain.

Stafford, 43, is one of the 70,000 Montana adults who could get health coverage through Medicaid if the Legislature votes to expand the state-federal program.

She says that coverage would enable her to get the surgery and the drugs she needs but can’t afford now.

“The way I look at it, I’m probably able to do five more years of hard work now,” Stafford says. “If you give me a little bit of help, I’m going to give you another 20 years of work.”

Last week, Republicans on two legislative committees used their majorities to kill Democrat-sponsored bills to expand the program starting in 2014.

Gov. Steve Bullock and fellow Democrats vow to keep searching for a way to pass the expansion, although it could be difficult, as long as Republican majorities at the Legislature oppose it.

Republicans say expanding Medicaid will blow up the state budget, as the state pays a larger share of the program in future years, overload an already “broken” Medicaid program with more people than it can handle, and hand out “free” health care to thousands of adults who should be buying private health insurance instead.

Democrats argue the multibillion-dollar influx of federal Medicaid money from expansion not only will provide coverage for 70,000 adults who can’t afford it otherwise, but also give a huge boost to the economy, creating jobs and a healthier workforce.

So, which is it? Is Medicaid really “broken,” or is its expansion a humanitarian savior and a jobs program, rolled into one? What does Medicaid really look like and cost in Montana, and how would it change under expansion?

Medicaid, created by Congress in the mid-1960s, is a federal program, but each state gets to design parameters of the program, within federal guidelines.

Montana’s Medicaid program is among the stingier ones in the country. To qualify, you generally have to be disabled, elderly and poor – unless you’re a pregnant woman or mother with children, and then you just have to be poor.

Medicaid covers about 100,000 people in Montana, or one-tenth of our population. About 60,000 of those people are children in families whose income is no more than 133 percent of the federal poverty level – about $26,000 for a family of three.

The parents in that family generally are not covered by Medicaid, unless they have virtually no resources and very little income. Only 13,000 adults who are not disabled are on Medicaid in Montana; the remaining 27,000 are blind, disabled or elderly, some of whom are in nursing homes.

If Medicare is expanded, everyone earning up to 138 percent of the federal poverty level — $15,400 for a single adult, $27,000 for a family of three — would be eligible for Medicaid.

This change basically brings poor adults into the Medicaid fold – about 70,000 people aged 19-64. A University of Montana study indicates that 44,000 of these people have jobs, usually part-time and at low wages.

Starting in 2014, they could apply to be covered by Medicaid, which then would pay their medical bills when they visit a physician, hospital or other medical provider.

Medicaid offer virtually free coverage for those on the program. They can be charged a co-payment, but no more than $5 for a doctor visit or prescription and $100 for a hospital stay.

Stafford, who lives in the small, north-central Montana town of Kevin, says she’s heard the view that adults who want Medicaid coverage just want something for free, instead of paying for it.

“I don’t think it’s anything having to do with a free ride,” she says. “I don’t want to be stuck at home, in pain. I want to be out there, as part of a group, at my work.”

Stafford says if Medicaid coverage paid for her neck surgery and arthritis drugs, she’d be able to work more hours, earn more money, and become eligible to get health insurance through her employer — and get off Medicaid.

“(The expansion) is going to help people who are already out there working,” she says. “We’ve already got Medicaid for the people who aren’t working.”

Of course, Medicaid coverage for Stafford or anyone else who might be on the program is not free — it’s funded by taxpayers.

The program cost $977 million in Montana for fiscal 2011, and is projected to cost $1 billion this year and $1.07 billion next year – before any expansion. State taxpayers cover about one-third of that cost, or some $350 million a year.

If Montana expands Medicaid, the federal government will pay virtually the entire cost from 2014-2016, and then gradually reduce its share to 90 percent by 2020 and the years thereafter.

It’s estimated that over the next eight years, the expansion will pour $5.7 million to $6.4 billion of federal money into Montana, to pay medical costs for the 70,000 new people on the rolls.

Yet state taxpayers also would pony up anywhere from $360 million to $400 million over those same eight years. The state’s 90 percent share, starting in 2020, is estimated at about $100 million a year.

On a per-person basis, Medicaid in Montana clocks in now at about $9,600 per person per year — but that includes the high-cost elderly and disabled clients it covers.

The cost of the new enrollees is estimated by the state at $7,800 a year — certainly less than a private insurance policy for the average adult, if deductible, out-of-pocket costs are included.

Many of the enrollees under Medicaid expansion are expected to be younger adults, who would cost less, but some are bound to be people who are older and sicker, because they’ve may have put off expensive, unaffordable health procedures for years.

Stafford says she realizes that taxpayers would be footing the bill for her surgery, if Medicaid expansion passes. But it doesn’t seem right, she says, that she and other Montanans should be denied basic health care just because they can’t afford it.

“It shouldn’t have to be that, just because you have money, you have the right to feel better,” she says. “I think (the expansion) would be great for the 70,000 Montanans out there who deserve health care. There are probably people out there who deserve it a lot more than me.”


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