Governor Steve Bullock released his two-year budget proposal during a Monday Morning news conference at the state capitol. Highlights include a spending increase of 5.5% this year and close to 3% next year, as well as $300 million in improvements to the state’s roads, sewers, and other infrastructure, and a $300 million surplus to take care of emergencies.
But the proposal that could produce the most contentious debate concerns Medicaid.
Bullock is pushing once again to expand the state and federal health-care system for the poor. He wants to leverage federal dollars made available under the Affordable Care Act to add 70,000 low-income people to what he’s calling the Healthy Montana Plan, based on the existing Healthy Montana KIDS Plan, which is government-funded, but privately-managed:
"So there would be a private insurer administering the dollars. It wouldn’t grow state government. Thereby also affording us not only the opportunity to cover people, but also institute reforms and cost saving measures as well."
Bullock is proposing reforms to the way Medicaid health care is delivered, and to the payment system as well. Bullock’s Healthy Montana Plan would pay health care providers more than they get from regular Medicaid, but still less than they get from private insurers.
Bullock said, "The opportunities include both utilizing the private sector. We will have a provider network. We can institute reforms through the third party administrator or the other administrator and really provide opportunities to keep close on this population."
Twenty-seven other states have already expanded their Medicaid systems, and a few more are considering that, so Bullock says keeping Montana’s current Medicaid system, and turning down the federal money for another two years, would put the state at a disadvantage.
In 2013, Republicans in the Legislature successfully fought a different attempt to expand Medicaid. The incoming Majority Leader of the Montana House, Keith Regier, wants to see the present system reformed to serve only the truly needy, before expanding it.
"Able bodied people that could be working, we ought to help them get a job," Regier said. "People that have maybe had surgeries or whatever and acquired a dependency on narcotic drugs, those type of things, help them to get off of Medicaid paying those things.”
Currently in Montana, able-bodied people are not eligible for Medicaid, regardless of income. Governor Bullock’s proposal would allow them to get it if they make less about $15,500 a year.
Regier says he isn’t persuaded by the argument that federal Medicaid dollars are passing by Montana and going to other states. He says the less federal government involvement there is in Montana’s health care system, the better:
"You’re looking at federal government that is into debt probably $17 trillion, and the federal government is having a tough time managing the VA and Indian Health Services properly, so we’ve got to be careful what involvement the federal government has in the program."
Regier suggested that Governor Bullock was ignoring the message sent by the voters in the 2014 election, by focusing on issues like Medicaid expansion, instead of crafting proposals to grow the job market and the overall economy.
Bullock says the healthy Montana economy, which boasts an expanding job base and unemployment below the national rate, is what allowed him to propose a spending plan with eight percent growth.