As a gallery packed full of onlookers watched, the Montana Senate by a 1-vote margin endorsed a bill to continue Medicaid expansion in the state with the addition of work requirements and an expiration date of 2025.
Six Republicans joined with all 20 Democrats to pass the bill 26-24 on second reading. It would not have advanced on a tie. It needs to clear a final vote Tuesday, on a transmittal deadline, to move back to the House. There representatives will consider amendments added by the Senate.
One of the major changes to House Bill 658 on the Senate side was the addition of a 2025 sunset date. The original bill the Legislature passed to expand Medicaid in 2015 came with an expiration date of this summer to give a chance to review the program this session. House Bill 658 is carried by Great Falls Republican Rep. Ed Buttrey.
Monday's vote came after the bill stalled out in the Senate at the end of last week on a tie vote, and later attempts to put it back on the schedule failed. Medicaid expansion's fate has been tied to another piece of legislation dubbed the "Save Colstrip" bill, which eases the way for the state's monopoly utility, NorthWestern Energy, to increase its ownership in the Colstrip power plant and pass the costs onto ratepayers.
A group of five Republicans who are co-sponsors of the expansion bill but voted against it Thursday said then they want to make a point about other balls still in the air — including the Colstrip bill — during the final days of the legislative session.
A heavily amended version of that bill, which returns oversight of any possible deal to the state Public Service Commission, passed second reading in the House on Monday.
Sen. Russ Temple, a Republican from Chester, is the Republican co-sponsor who switched his vote from a "no" on Thursday to a "yes" Monday. Temple said "no comment" when asked why he changed his vote after the Senate adjourned Monday.
Four other Republican co-sponsors, Sen. Duane Ankney of Colstrip, Tom Richmond of Billings, Brian Hoven of Great Falls and Jeff Welborn of Dillon, voted against Medicaid expansion Monday.
Richmond is carrying the Colstrip bill and said Monday he was swayed by arguments made against Medicaid expansion on the floor.
Ankney, who is also a co-sponsor of the Colstrip bill, said he still thinks Medicaid expansion is good but he wanted more opportunity to see natural resource bills, including the Colstrip bill, get more traction.
"My no vote was based on the fact that I still think there was some work we could have got done, some negotiating with some very important job-creating, economy, revenue bills and this to me looks like that just shuts that down," Ankney said. " … I wanted to sit down and negotiate this out and get some of these natural resource bills passed, and it would have been the happiest day of my life if I could have voted a yes on this bill."
Asked if he thought his no vote hurt the chances of the Colstrip bill or others he wants to see pass the finish line, Ankney said it "damn sure don't do it any good."
Ankney said he didn't blame the other Republican members of the so-called Solutions Caucus who voted for the Medicaid expansion bill on the floor, including sponsor Sen. Jason Small, of Busby.
Small carried the bill in the Senate, and said Monday it addressed all the concerns people have raised about Medicaid expansion since it passed, from questions about people skirting eligibility requirements to work provisions. Small also called the six-year sunset “reasonable.”
“This is trying to get people back to work. It’s not meant to be something you can live on the rest of your life,” Small said.
Sen. Fred Thomas, the Senate majority leader, also spoke about the Medicaid expansion bill being tied to other proposals working their way through the Legislature.
"While many people want Medicaid expansion in the state, we also want the jobs and economy bills to pass too and this may be our only opportunity," Thomas said.
Sen. Daniel Salomon, a Republican co-sponsor from Ronan, spoke in support of the bill. He countered some points made by fellow Republicans critiquing the program, including that it adds to the national debt and has resulted in millions of dollars in reimbursements to Montana hospitals.
Salomon said while Republicans talk about the ballooning federal debt, “whatever we do is like a drop of water in the ocean.” He also pointed out how much federal money makes up the overall state budget. In 2019, 46 percent of the state budget was federal funds
“We accept federal money for highways, we accept federal money for education, we accept federal money for fish and game. You name it, we do it," Salomon said.
Sen. Jennifer Fielder, a Republican from Thompson Falls, cited the defeat of a ballot initiative last fall that would have lifted the sunset on Medicaid expansion and increased the tobacco tax to pay the state’s share of the program as a message from Montanans they didn’t want to see expansion continue.
“The voters of Montana said no and here we are, some of us thinking we know better. My vote is with the people of Montana who said no to this last fall and they ask us to vote no on this today,” Fielder said.
The tobacco tax effort was the most expensive ballot initiative in state history, with tobacco companies spending $26 million against it.
Sen. Brian Hoven, a Republican co-sponsor who voted against the bill, said was frustrated with the asset testing in the bill and that it does not capture net worth. He was also frustrated with the provisions in the bill for 501(d) religious organizations, which is how Hutterite groups are organized. Many Hutterite colonies used to fund their own insurance, which reimbursed hospitals at a higher rate than Medicaid, before expansion became available under the Affordable Care Act. A fiscal note estimates about 2,500 Hutterites are covered on Medicaid expansion.
Sen. Jon Sesso, a Butte Democrat and minority leader, said the bill is a good compromise between what Democrats and Republicans wanted. Democrats had their own proposal to continue Medicaid expansion that was voted down in March. After that, Buttrey's bill was amended to ease some of the requirements for reporting hours worked or exemptions to the work requirement.
Other changes made after the Democrats' bill was defeated including lifting language that would have ended expansion in Montana if a court found work requirements invalid. The bill has language that would continue Montana's program until 2025 without work requirements if the U.S. Supreme Court strikes them down.
"I think we have addressed the concerns that were raised by the public, the concerns we have raised with each other, to make this the best product it can be in 2019," Sesso said.