As the Montana Legislature starts its 90-day session, during which the debate over if and how to continue Medicaid expansion in the state is expected to take center stage, the governor is focusing on a new line of support for the program — its benefit to businesses.
Since lawmakers voted in 2015 to expand Medicaid coverage to nearly 100,000 of the working poor, Gov. Steve Bullock, a Democrat, has touted plenty of facts and figures, from number of Montanans who gained health insurance and accessed critical medical procedures and preventative care, to reports showing the program has a positive effect on the state’s economy and preserved the financial stability of rural hospitals.
Now the governor is emphasizing the number of businesses in the state that have employees enrolled in the program. More than 18,000 Montana businesses employ people covered under expansion, with about 16 percent of private sector employees enrolled, according to numbers from the Montana Department of Revenue and Department of Labor and Industry released Tuesday.
“I think that it’s time we finally fully recognized the value of Medicaid expansion is as much for Montana business as it is for the Montanans receiving health care,” Bullock said in a press conference. “Far too often, though, when we talk about Medicaid expansion, there are those who want to frame the gains to our state as benefiting just our doctors, hospitals and health care community. … There are those including some in this building who try to frame Medicaid as a giveaway to Montanans.”
Statewide, 57 percent of private businesses have had at least one employee enrolled in expansion, which extends Medicaid coverage to people earning up to 138 percent of the federal poverty level, or $15,418 a year for an individual or $26,347 for a family of three.
According to data from the federal U.S. Department of Health and Human Services, only 37 percent of Montana businesses offer health care to their employees.
In the accommodations and the food service sectors, traditionally lower-paying jobs, about 90 percent of employers have workers who are covered under expansion. Numbers are also high for retail businesses, including gas stations, where about 67 percent of businesses have an employee covered by expansion.
According to the report, private employers in Montana would be subject to tax penalties between $11.1 million and $16.7 million without expansion coverage.
Under federal law, employers with 50 or more full-time employees have to offer health insurance to employees or pay a penalty. However, if employees are covered by Medicaid, their employers don't have to pay the penalty.
“We hear about the cost of this program to Montana,” Bullock said. "If employers had privately insured all those workers … the cost to those businesses would have been somewhere between $353 million and $940 million borne by those businesses in 2017.”
Republicans in the past have argued against the program, saying because expansion covers more than double the number of people originally expected, it costs far more than the 2015 bill anticipated.
Montana’s expansion program came with a voluntary workforce program meant to help people covered on expansion improve their employment situation and wage. The program is called HELP-Link and funding for it is part of the governor’s budget proposal.
A report in 2018 from the Bureau of Economic Research at the University of Montana for the Montana Healthcare Foundation found that labor force participation among Montanans eligible for Medicaid expansion coverage rose 8.5 percent since expansion. While the report did not directly link the increase to the voluntary HELP-Link program, it did point out the figure dropped 2.5 percent nationally.
Republicans have made clear that for Medicaid expansion to pass, there must be some sort of work requirement and assets and means testing added to the program. Bullock on Tuesday said those measures will take coverage away from people. An estimated 7 in 10 people covered on expansion are already working.
“I’m not going to be supporting measures that take health care coverage from folks who can’t meet a work or hour quota, that wouldn’t pass muster in court or that actually cost more to administer than it would be to provide the … health care coverage in the first place,” Bullock said.
State Rep. Ed Buttrey, a longtime Republican state senator from Great Falls who carried the expansion bill in 2015, said Tuesday he doesn't see a bill passing without some sort of work requirement, which he calls a community benefit.
Bullock's "going to have to live with the community benefit requirement if he wants the program to continue,” Buttrey said. “I’ve been transparent with him. I want to work with everyone to make sure they’re realizing requirements are not meant to be punitive, they can be tracked. … Everyone has skin in the game … and the community benefit is the way they do it, keeping in mind there are a lot of exceptions in the community benefit for people that have chronic illness. There are a lot of ways to meet that requirement other than work."
A bill to continue the program has not been introduced yet. Buttrey said Tuesday he has drafted one outside the legislative bill drafting process and the text of of the bill will be available in coming weeks.
“I think we can have a bipartisan solution, but that means not only showing the data that it’s working. We have to show why we want to make the changes we want to make and also implement reforms the federal government now allows that folks in my caucus have been seeking,” Buttrey said. “We don’t want to be punitive. We don’t want to implement requirements that are difficult to track or too expensive to run, and that’ll be an argument in the process,” Buttrey said.
What will become clear in the coming days is if the argument works on lawmakers and Montana businesses.
“I think the Bullock administration is making a very good argument about how businesses are benefiting from the program,” said Bridger Mahlum, government relations director for the Montana Chamber of Commerce.
Mahlum said the chamber, which supported expansion in 2015, wants to see “sideboards to prevent the program from becoming too much of an entitlement in which it benefits those who don’t need it most. We want to make sure those who are enrolling in the Medicaid program are the ones that truly need it most and not those that are taking advantage of the system.
“We’ll be there and be involved and provide a voice for the business side,” Mahlum said.