Gov. Bullock did the right thing vetoing Medicaid bill

2013-06-03T09:14:00Z Gov. Bullock did the right thing vetoing Medicaid billGuest column by FRANKE WILMER
June 03, 2013 9:14 am  • 

In four terms in the Montana legislature few decisions have been as difficult as whether to uphold the governor’s veto on House Bill 12. It increases funding to businesses providing services to Medicaid patients and it passed with bipartisan support. Funding for increases to these providers was cut in 2010. Struggling with the devastating effects of the recession, many programs took hits then – including university budgets with students paying higher tuition; the Big Sky RX program was capped, leaving many seniors without assistance for expensive prescriptions; child protection services and tribal college programs were also cut back, or increases rescinded.

So why did the governor veto HB 12 and why am I upholding that veto? HB12 is the only bill that backfills any of the funding lost in 2010. We didn’t pass a bill to backfill university tuition, tribal college assistance, child protection services, senior prescriptions and so on. All are worthy.

Every spending bill goes through tremendous scrutiny both for its policy content and budget impact. It must pass House appropriations and Senate finance committees, and both chambers. Then the governor gets a final look – and it was his judgment that paying for all the bills passed put us too close to budgetary structural imbalance, where we literally take in less than we spend by $21 million – nearly a third of it in HB 12.

Second, House Bill 2, the budget bill, already increased funding for direct care workers, Medicaid providers and people with development disabilities – $65 million, including a 2 percent increase in provider reimbursement each year of the biennium. It’s overdue. It’s a little less than state employees received (although some will get no raise at all), and they do some of the most challenging work for some of the lowest wages in the state. HB2 increases provider reimbursement rates for the first time in four years.

Third, nothing in HB12 guarantees that the money will be used to increase employee wages, increase employee benefits, hire more employees or provide more services. I understand why providers want the backfilled money they thought was coming their way and I know that many get by only because of the generosity of local donors in their own communities. They do work that matters. Some might use the funding to improve employee wages and benefits, but those are permanent commitments and this is one-time-only funding. The governor might have offered an amendatory veto to HB12 or any of the over 200 bills that came to his desk when it was too late to amend them and send them back to the legislature for approval. But the Republican leadership didn’t give him that opportunity because they held up too many bills until the last days of the session, foreclosing on the governor the option of offering amendments.

When HB12 came to him, he was looking at a structural imbalance in the budget, a bill that backfilled cuts for only one program over all the others that took hits during the recession, and beneficiaries who were already included in the budget increases in HB2. He might have thought, “I’d be a lot more popular if I didn’t veto this bill.” But he did the tough thing.

We work with two figures in balancing the budget. One is the actual money in the bank now minus the actual money going out in expenditures now. That’s what the governor determined was at risk. The other is money we expect to have in the bank at the end of two years. That’s a higher figure and some legislators argue for spending the higher figure – but two years is a long time. Try budgeting your expected income for your expected expenses for two years. I know the governor didn’t do the easy thing, and supporting his decision was not easy either. But I will respect his reasons for vetoing HB12.

Rep. Franke Wilmer, D-Bozeman, represents House District 63 in the Montana Legislature.

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(5) Comments

  1. LBaxter
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    LBaxter - June 05, 2013 3:05 pm
    It all boils down to trying to keep a non profit facility open and staffed on rates that are way below the break even point let alone to provide maintenance for facilites. Staffing in NE Montana is extremely tough and when you cannot provide wages that people can support themselves on they look elsewhere. When you consider the extremely difficult nature of the work nursing home staff do that just compound the problem. Cost shifting the additional $40.00 a day and up to private pay residents is not an option. The Medicaid program should at the very least pay cost per day. We are not able to earn any income from savings due to interest rates below 1% and are now using savings to run operations due to the Medicaid deficit. It wont take long to have to close our facility due to the State not allowing for basic needs of its constituents.
  2. HomeHealthNurse
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    HomeHealthNurse - June 04, 2013 6:18 pm
    Rep. Franke Wilmer, D-Bozeman, represents House District 63 in the Montana Legislature, I am disappointed in your response to the HB12 veto. The provider cuts in 2011 did not work. It devastated many providers financially. This is not just about money, but about finding the right people to work with our elderly, disabled children and adults and mentally ill population. It is becoming more difficult to retain dedicated and trained employees with low wages. Living in rural Montana, it’s very costly for Direct Care Workers to travel from home to home and this is not reimbursed by the State of Montana. It is up to workers to keep their cars running, fueled and insured. You are correct in stating it is not guaranteed for providers to give direct workers an increase in wages, however, the owners of Nightingale Nursing and Caregiving and Consumer Direct are guaranteeing all funding will go towards our direct care worker’s wages. Home care agencies are not receiving applications or resumes. Without better wages and reimbursements from the State of Montana, home care agencies such as ours, will have to start turning more clients away from services. This will cause many people to go without home care services, costing the State of Montana more money. Why? Some will end up in the State Hospital, by not receiving care from a nurse or a care giver to assist in managing their mental health, Dr. appointments and personal care. Others will not be safe at home without a personal assistant to help prepare a balanced meal, assist with mobility or remind to take medicine. Many hospitalizations will occur without managing their blood sugars, medication errors or having an unexpected fall. Franke, you might think you know about budgets and what is right for the State of Montana, however, I know about basic homecare services for our elderly, disabled and mental health population. They have the right to stay at home and without capable employees they will not be able to continue to do so.

    Teresa Ellis, LPN
    Program Manager
    Nightingale Nursing & Caregiving
    2201 Harrison Ave , Suite 2
    Butte, MT 59701
    Phone: (406) 782-5024
    Fax: (406) 782-5760

  3. ChiefCharloParent
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    ChiefCharloParent - June 04, 2013 10:59 am
    This is a joke right? You stated that these workers are underpaid and do the toughest work. You state that the minimal increase is long overdue. Yet, you vote against what amounts to 6 million in statewide funding when there is a 300 million surplus that the Governor is holding onto for his pet projects. This bill effects the care provided to our elderly, and children across Montana. Even the Republicans understand how important this bill is when they provided overwhealming bipartisan support for HB12..
  4. Sherm
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    Sherm - June 03, 2013 4:25 pm
    Here in the Bakken, we are still working under rates that were set in July of 2008. Our starting wage for full-time direct care workers is $8.80 an hour. Compare this to the $11 an hour paid to state workers at MDC doing identical work. All we heard all session from the governor was how underpaid state workers were and that they needed at least a 5% increase each year. Well they nearly got that. But 2% for providers is just fine for the governor and Wilmer. At $8.80 an hour the single mothers with two children who work for us are below the poverty line. And this while trying to survive in the Bakken. We have plenty of openings Rep. Wilmer. Why don't you move over here and work for us? You may even be in line for a 2% increase!
  5. claudius
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    claudius - June 03, 2013 12:05 pm
    Once again, Ms Wilmer presents the thoughtful, objective reasoning we count on from her in the Legislature.

    I think Gov Bullock thought long and hard on that veto, along with the others he felt compelled to issue. Perhaps next session some of the partisan game-playing will be reduced so the balancing process between the Legislative and the Executive branches can work as it should.
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