Gov. Steve Bullock signed a bill Thursday to continue Montana's Medicaid expansion program for another six years, as long as federal funding continues.
He was joined at the signing ceremony by bill sponsor Republican Rep. Ed Buttrey and Democratic Rep. Mary Caferro, who sponsored a separate bill that did not pass.
The bill continues the program, which began in 2016, and provides health insurance to about 95,000 low-income adults. It would have ended on June 30 if lawmakers had not reached an agreement. He also held ceremonial signings for other bills to lower health insurance and prescription drug costs.
"These bills continue the progress our state has made in recent years to provide quality and affordable health care to Montanans, and they will further our efforts to increase access, reduce costs, and improve the quality of care," Bullock said. "By finding common ground and taking much-needed action now, we continue to be an example for other states to follow."
Bullock, however, vetoed a bill that sought to help insurance companies negotiate better contracts with pharmacy benefit managers — the middle man between drug manufacturers and pharmacies.
The vetoed bill would have required any rebates offered by drug manufacturers go directly to the health insurers to be used to reduce premiums for policies sold through the Affordable Care Act marketplace. The office of state Auditor and Insurance Commissioner Matt Rosendale wrote the bill, saying it would have saved about 70,000 Montanans up to $8 million in the first year.
The bill would increase administrative costs and result in higher drug costs, Bullock wrote in his veto letter.
"Bullock's veto is a gift to the pharmaceutical and insurance industries and a slap in the face to consumers," Rosendale said in a statement.
Bullock has signed several bills dealing with pharmacy benefit managers, including bills that would not allow PBM's to charge pharmacies unexpected fees or prevent pharmacies from operating mail order businesses. Another bill mirrors a federal law that says PBM's can't prevent pharmacies from telling patients the cash price of their drug is less than their insurance co-payment.
The governor earlier signed a bill, similar to one initially proposed by Rosendale's office in 2017, to set up a high-cost reinsurance program for policies sold on the exchange. It will use premium taxes and federal money that would have been used for premium tax credits to pay medical claims that cost more than $40,000 and less than $1 million. It's estimated the reinsurance pool will offset any insurance premium increases by 10% to 20%.
Buttrey's Medicaid expansion bill requires able-bodied recipients to participate in 80 hours of work or community engagement per month, strengthens an asset test, allows the health department to verify an applicant's income with the Department of Revenue and increases premiums for people who stay on the program for more than two years. It also adds a tax on hospitals to leverage more federal money and increase reimbursement rates for Medicaid claims.
It also includes $2.5 million to help recipients with job training.
It's estimated the Medicaid expansion program could bring about $720 million in federal funding into the state in each of the next two fiscal years.
Supporters said the program created jobs, saved lives, helped keep rural hospitals open and reduced uncompensated care for hospitals, which reduces cost-shifting to insured residents.
Bullock also signed bills Thursday to:
- Allow Montana reservations to adopt the Community Health Aide Program, which allows dental health aides, behavioral health aides, and community health aides to work with licensed providers to increase access to health care on reservations;
- Create a grant program to support local mobile crisis mental health teams that could help ease the use of law enforcement and hospital staff in the case of a mental health crisis;
- Appropriate $500,000 for suicide prevention for veterans and Native American youth.