Governor candidates speak on Medicaid expansion renewal
Montana Free Press asked Republican, Democratic and Libertarian candidates if they would support reauthorizing the low-income health care program, which has in the past been the subject of vigorous debates in the Capitol. Here’s what they said.
Illustration by Stephanie Farmer/MTFP. Office of the Governor photo by Eliza Wiley Credit: Eliza Wiley/MTFP
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Montana’s Medicaid expansion program, a public health insurance option for low-income adults, is scheduled to sunset in June 2025. The coverage is heavily funded by the federal government but is administered by the state health department. If Montana lawmakers and the governor don’t pass legislation next year to reauthorize the program, last renewed in 2019 on a single-vote margin, Montana’s health care landscape would change dramatically. Upwards of 85,000 eligible adults could stand to lose coverage, according to the state’s latest enrollment figures.
The June primary ballots will have five Republican, Libertarian and Democratic candidates for governor. Those candidates, including incumbent Gov. Greg Gianforte, a Republican, and prominent Democratic challenger Ryan Busse, have wide-ranging views on how to run the state’s Medicaid program and whether they would support reauthorization. As part of our 2024 Election Guide project, Montana Free Press asked candidates for governor where they stand on expanded Medicaid renewal via a written questionnaire. Here’s how they responded. (These answers were lightly edited for grammar but are otherwise presented verbatim.)
WHAT WE ASKED:
Montana is one of the states that expanded Medicaid access under the federal Affordable Care Act, bringing health coverage to previously uninsured populations. As governor, would you sign a bill reauthorizing Montana’s expanded Medicaid program in its current form in 2025?
GREG GIANFORTE
Incumbent governor, Republican
“The safety net of Medicaid should be there for those who truly need it, but it will collapse if all are allowed to climb on it.
During the pandemic, the federal government didn’t allow states to verify eligibility for Medicaid, and Medicaid enrollment spiked. Last year, the federal government required states to begin verifying eligibility again. Since then, we’ve ensured only those who are eligible can participate, and enrollment is back down to pre-pandemic levels.
Medicaid should be a temporary program for most people to help them get back on their feet. We should encourage work and reduce government dependency by requiring able-bodied adults with no dependents, excluding seniors and single parents, to work to receive benefits.”
Gianforte’s response doesn’t give a clear ‘yes’ or ‘no’ to our question about reauthorizing Medicaid expansion in 2025. Throughout the campaign, the governor and his running mate, Lt. Gov. Kristin Juras, have endorsed the importance of the safety-net health care program but cautioned against letting it get too big or becoming a resource for people who are not truly in need.
The Montana Legislature and other states have previously tried to attach work requirements to Medicaid for able-bodied adult enrollees, but those efforts have been rejected by federal health authorities under the Biden administration.
RYAN BUSSE
Former firearms sales executive, Democrat
“Yes. Folding more Montanans into Medicaid coverage was a bipartisan solution that has only improved the lives and livelihood[s] of countless people. It has provided certainty and stability in our communities — for kids, seniors and Indigenous people. And it has saved all of us money in the long term. When asked about the 133,000 Montanans who lost Medicaid coverage under Gianforte’s watch, including 36,000 children, he responded that his plan for stripping health care was ‘working as intended.’ That kind of approach is dangerous, cruel, costly and immoral.”
Busse has a clear ‘yes’ to the question of reauthorizing Medicaid Expansion in 2025. While Medicaid expansion doesn’t specifically cover children, it did expand eligibility for families and can help parents access services for their own health care needs. Medicaid expansion is a widely used resource for tribal members in Montana who want health care options beyond what is offered by Indian Health Services, the federally-funded system that often sees long wait times and limited services.
Busse’s reference to Gianforte’s handling of the 2023 post-pandemic Medicaid eligibility reviews stems from a comment the governor’s office made to KTVH in early April. In that statement, Gianforte’s staff said the administration had appropriately conducted reviews to make sure Medicaid coverage isn’t extended for people who no longer meet the program’s eligibility requirements.
TANNER SMITH
State Representative, Republican
“I would have to see what bill comes out of the 2025 legislature. We need to provide some assistance for the healthcare of children and those folks in need of temporary coverage. I also believe people who can work need to work and provide for themselves, including their health insurance. There needs to be sideboards and curbs on Medicaid or it will become financially unsustainable like every governmental assistance program. Those of us in the private sector don’t work 7 days a week so everyone can have freebies.”
Smith doesn’t take a clear stance on whether he would support the reauthorization of Medicaid expansion as it currently exists. Medicaid programs that cover children and other groups of people don’t need explicit reauthorization action by the Legislature next year, meaning they’ll likely remain intact, even if the Legislature chooses to scuttle the expanded coverage for eligible adults.
A 2024 report from the Montana Healthcare Foundation, a nonprofit that has historically supported Medicaid expansion, found that 77% of adults covered by Medicaid in Montana worked full-time or were attending school. An additional 19% said they were disabled, had an impairment to work or were a caretaker for someone else. Only 3% of adult Medicaid enrollees said they were not working and did not have an impairment that prevented them from doing so.
KAISER LEIB
Tech entrepreneur, Libertarian
“Medicaid expansion requires more government spending, which requires taxes, and we should reduce taxes. All government spending on healthcare distorts the market for healthcare. But cutting Medicaid in a vacuum does nothing to restore market efficiencies to healthcare, and I wouldn’t waste a veto on such a bill, if it came across my desk.”
Leib seems to suggest he would allow a reauthorization of Medicaid expansion to become law (which can happen either with the governor’s signature or if the governor chooses not to sign or veto a bill that has been passed by the Legislature).
To Leib’s point about the program requiring more government spending: The same Montana Healthcare Foundation report from 2024 found that the state’s total Medicaid budget was $2.4 billion, but that the federal government reimburses Montana for about 80% of that spending annually, across all programs and populations.
Since Montana first authorized expanded Medicaid in 2015, the overall program has consistently made up about 13% of the state’s General Fund spending, costing between $280 million and $320 million annually.
JIM HUNT
Helena attorney, Democrat
“Absolutely. As governor, I would sign a bill reauthorizing Montana’s expanded Medicaid program in its current form. Studies are clear — early childhood intervention is critical to protect Montana’s most valuable natural resource. Good medical care is critical to successful early childhood intervention and development. For adults, good medical care means more productive workers and a healthier population. Instead of proper healthcare, the GOP wants Montanans to get our primary care in hospital emergency rooms. Emergency room care costs more and provides less. This results in higher medical costs for all Montanans and poorer health for many Montanans.”
Hunt gave a clear ‘yes’ about supporting the reauthorization of Medicaid Expansion in 2025. Like other candidates, he seems to suggest children are covered by Medicaid expansion, rather than other distinct programs like Healthy Montana Kids or traditional Medicaid.
Regarding how Medicaid expansion increases preventative care and decreases reliance on hospital emergency departments, recent data supports Hunt’s claim. The Montana Healthcare Foundation report found that Medicaid enrollees decreased the use of emergency health care services the longer they were covered by the public program. Among other services, the report said that Montanans used their Medicaid enrollment to seek cholesterol screenings, cancer and diabetes screening, exams for sexually transmitted infections, and mental health and substance use disorder treatments.
Medicaid Expansion was one of six issue questions Montana Free Press put to candidates for governor as part of our 2024 Election Guide project. See the others by visiting montanafreepress.org.
