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Rep. Ed Buttrey in committee

Great Falls Rep. Ed Buttrey, a Republican, explains amendments to his bill to extend Medicaid expansion in Montana. 

The Montana House on Friday indicated it will pass a Medicaid expansion bill that adds work requirements to the program, just days after a federal judge struck down similar requirements in other states.

House Bill 658 cleared second reading in the House 61-39 and passed the House Appropriations committee Friday. It must clear a final House vote by Monday to meet a transmittal deadline.

The program that extends Medicaid coverage to more than 96,000 Montanans will sunset this summer unless lawmakers choose to continue it. Medicaid expansion covers those earning up to 138 percent of the federal poverty level, or $17,236 for an individual and $29,435 for a family of three.

Republican Rep. Ed Buttrey, of Great Falls, is carrying the legislation, which was heavily amended Tuesday. After nearly two hours of debate on the House floor Friday, 19 Republicans joined with all Democrats in the House to vote for the bill.

The changes to the bill Tuesday dramatically reduced the reporting requirements for those subject to work requirements, to the point where a new state estimate issued Friday put the number of people who could lose coverage under the provisions at just 4,081. An earlier estimate based on the previous version of the bill put that number at 59,000 who could lose coverage.

The note says the Department of Public Health and Human Services would be able to determine if people meet or are exempt from many of the community engagement requirements using existing administrative data instead of having people report to the department.

Work requirements in Arkansas have caused about 18,000 people to lose coverage. In some cases that was because people who worked enough hours faced obstacles reporting that work.

A federal judge invalidated Arkansas and Kentucky's work requirements Thursday, saying the U.S. Department of Health and Human Services did not properly consider how many people could lose coverage under the provision.

Another of Buttrey's amendments Tuesday night removed a clause in the bill that would have ended Montana's program if a court invalidated work requirements. It was replaced with a provision that would sunset Montana's program in 2025 if the U.S. Supreme Court strikes down work requirements. 

"Regardless of how you feel about the work requirements, I hope you'll see the benefits of these significant reforms of the bill," Buttrey said Friday on the House floor.

Republicans made nearly a dozen efforts to amend Buttrey's bill on the House floor Friday. That included everything from trying to get rid of a fee on the Montana State Fund to pay for the program to capping the number of people enrolled at 7 percent of the state population. It's around 9 percent now. Other amendments would have added a sunset in 2023, increased the work hours required from 80 to up to a possible 120 a month, and more.

All of those efforts were defeated. Most of the floor debate was filled by legislators who opposed the bill.

Joining several other Republicans, Rep. Brad Tschida of Missoula cited the number of people in his district who voted against the failed Initiative 185 last November that would have continued expansion with an increase to the tobacco tax to pay for the state's share of the program.

"People of Montana, I hear your voice. You know how I'll be voting. I'll be voting against this bill," Tschida said.

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Republican Rep. Nancy Ballance, from Hamilton, countered Tschida by saying she thinks voters defeated that initiative because of constitutional concerns. It was also the most expensive ballot initiate in state history, with tobacco companies spending $26 million against it. 

"As a conservative Republican, I find it necessary to stand up and speak, Ballance said. "We heard some very impassioned things from people on this bill that I believe were very honest and heartfelt … but we also heard some things that were extremely disingenuous."

Others opposed to the bill said they were concerned about the overhaul it had earlier in the week, saying they weren't sure exactly what the bill would do after it was changed so much.

Lawmakers also accused Buttrey of drafting the bill in secrecy and cutting a backroom deal to get support, something Buttrey denied on the House floor.

Rep. Mary Caferro, a Democrat from Helena who carried her party's bill that would have continued expansion without the work requirements, said the compromise came from working between Democrats and Republicans to find a solution. Caferro's bill was tabled in committee Tuesday.

"No deals were cut. This was a negotiated package. We were working together on behalf of our constituents," Caferro said.

Rep. Eric Moore, a Republican from Miles City, said he was able to support the bill in part because the funding for the state's share of Medicaid expansion would move from a statutory appropriation to part of the biannual budgeting process, giving lawmakers additional oversight.

"Theoretically we have a two-year sunset every two years," Moore said of whether the bill passes. "The program is not funded unless the Legislature chooses to do so."

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