Senate leader: no avoiding rough politics ahead of Medicaid debate
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MISSOULA — Montana’s Medicaid expansion program will sunset in 2025, barring its renewal before the Montana Legislature, and its passage is by no means secured ahead of what could be a busy session.
State Sen. Steve Fitzpatrick, the Republican majority leader in his chamber, said that Medicaid will likely get caught up among other politicized topics that will coalesce next year.
“It’s going to be hot and controversial,” he said. “And this is going to be a hot and controversial session. This is going to be a rough session.”
Fitzpatrick spoke as part of a session at Free Press Fest, organized by Montana Free Press, Friday at the University of Montana. The panel on “Where Montana Medicaid Goes from Here” included Fitzpatrick, Benefis Health System CEO John Goodnow, state Rep. SJ Howell, D-Missoula, and Cindy Stergar, CEO of the Montana Primary Care Association. The moderator was MTFP reporter Mara Silvers.
Montana legislators first passed Medicaid expansion in 2015 and renewed the program in 2019 by a slim margin after tough debates. Goodnow said that hospitals, which have come to rely heavily on the revenue from Medicaid expansion, were “very concerned” that renewal would fail in 2019.
With more than 100,000 enrollees in Montana at its peak, Medicaid expansion covers people of age 19 to 64 who are low-income earners. Managed by the Montana Department of Public Health and Human Services, Medicaid expansion receives a 90% funding match from the federal government.
In the absence of Medicaid expansion, most recipients would become uninsured. This reflects an environment prior to the initial 2015 expansion that would drive up overall costs, according to Goodnow. He said health care providers consistently saw uninsured adults who waited to get care until their symptoms became severe.
“So what they usually will end up doing is waiting way longer than they should to seek out care,” he said. “And then they go to the most expensive part of the health care system, which are emergency rooms.”
Fitzpatrick said the Medicaid renewal might pass by a slim margin in the Senate, but he pointed to the convergence of multiple issues leading into the 2025 session that underpin his prediction of difficult negotiations. In addition to Medicaid, legislators are also likely to address property tax laws, housing and child care. With multiple headlining policies in the works, bargaining in Helena ramps up.
And although seemingly unrelated to Medicaid expansion, the outcome of the fall ballot measure CI-126 could change the calculation among legislators, Fitzpatrick said. The constitutional initiative, which would eliminate party primaries and send the top four candidates to the general election, will be before voters this November.
If candidates face general election challengers from the same party as a result of CI-126, Fitzpatrick said, then legislators will think twice about voting on controversial bills at the risk of alienating parts of their base.
“It’s like throwing a stick of plutonium in the building,” he said. “That thing is radioactive.”
Howell, the Missoula representative, didn’t disagree that debate could be fierce in the coming session. But they said that with Medicaid expansion being part of Montana’s health care system for a decade, it’s tough to unwind services that are intertwined with that program.
“So much of that work and investments that are being promoted really rely on people having health coverage and being able to access that care, and most of that comes down to Medicaid,” Howell said.
Howell pointed to Gov. Greg Gianforte’s HEART Initiative, which is aimed at a range of areas, such as health care in criminal justice and behavioral health. The state requested and received Medicaid waivers to support some services as part of the initiative.
While the makeup of the Montana Legislature is not yet determined, Medicaid expansion appears to be headed for another tough fight.
“But the nuances of how this will play out, I think we’re all eager to see how that will unfold,” Howell said.
Reporter Matt Hudson, of the Montana Free Press, grew up in Great Falls and is a graduate of the University of Montana School of Journalism.
