HELENA – In the past year, 22-year-old Steffanie Houck of Cardwell has seen multiple doctors for severe abdominal pain, but now she can’t afford any more – and has yet to get a diagnosis of what ails her.
“I never called back to get the referral (to a gastrointestinal) specialist, because we cannot afford it,” she says.
Houck says she’s lost 30 pounds, has trouble walking and can’t work. She lives with her mother, who also has no health insurance.
However, if the state used federal money to expand Medicaid, she would be covered and could see the specialist – and hopefully find a cure that would enable her to get on with her life, she says.
“Somebody my age could actually be able to go out, find a job, get a career and get their life going,” she says. “I want to be independent and not have to rely on others. … I would be able to see the doctors and get on the road to recovery.”
Houck and thousands of Montanans like her would have their health care covered by the government, at little or no personal cost, if Montana decides to expand Medicaid as proposed by Democratic Gov. Steve Bullock.
The bill to enact Bullock’s expansion plan, House Bill 249, is scheduled for its first hearing Friday before the House Human Services Committee.
Most legislative Republicans, however, oppose the expansion, calling it an expensive, unnecessary welfare program that expands “Obamacare” in Montana and will cost the state hundreds of millions of dollars in the future.
GOP leaders have prepared their own smaller expansion plan targeted at disabled adults, parents of poor children and some veterans – and are vowing to block the Bullock plan.
Yet while Medicaid is one of the hottest issues in the 2015 Legislature – and one of the most expensive items in the state budget – it affects only a minority of Montanans and its details remain largely unknown to the public.
Medicaid, passed by Congress in 1965, pays medical bills for the poor and disabled and is supported almost entirely by taxpayer money. The federal government pays about two-thirds of the cost and the state pays the rest.
Some people covered by Medicaid in Montana pay minimal “cost sharing” for their care, such as $4 for a doctor visit or $100 for a hospital stay.
In fiscal year 2014, the Medicaid program in Montana paid hospitals, nursing homes and other health care providers $1.075 billion for the nearly 128,000 people covered by the program, or nearly 13 percent of the state’s population. The state’s share of the bill was $338 million.
Each state decides who its Medicaid program will cover, within federal guidelines.
In Montana, two-thirds of the people covered now are children, in families earning up to 143 percent of the federal poverty level, or $28,700 for a family of three.
Of the adults who are covered, 7,000 are in nursing homes. They can have no more than $8,700 of annual income or resources worth more than $2,000.
Other adults currently covered by Montana’s Medicaid program are disabled or blind, pregnant women, or very poor parents of children already covered. For example, able-bodied parents of kids on Medicaid can be covered only if they earn less than 47 percent of the federal poverty level – $9,400 for a family of three.
Disabled adults can qualify if they earn up to 73 percent of the poverty level and pregnant women can earn up to 157 percent of the poverty level and qualify.
Under the 2010 federal Affordable Care Act – also known as “Obamacare” – the federal government directed states to expand Medicaid to cover everyone earning up to 138 percent of the federal poverty level, or $16,200 for a single person.
It also promised to pay 100 percent of the costs, beginning in 2013, and ramp that share down to 90 percent by 2020.
Then, in 2012, the U.S. Supreme Court struck down the Medicaid-expansion requirement, making it optional for the states. The federal government would still pay its promised share of expansion costs.
So far, 28 states have expanded Medicaid as imagined by the ACA. Montana, of course, is not one of them. The 2013 Montana Legislature, controlled by Republicans, rejected an expansion proposal.
If the 2015 Legislature accepts Bullock’s plan, an estimated 70,000 additional adults in Montana would be covered by Medicaid.
One of them likely would be Lisa Daniels, who came to Helena two weeks ago to testify against the GOP plan, which would not cover her.
Daniels, 50, says she worked her whole life and had health insurance until two years ago, when she quit her job in California and moved to Stevensville to take care of her mother, who has Parkinson’s disease.
She says she eventually dropped her insurance because she could no longer afford it. She now earns less than the federal poverty line, so she is ineligible for any federal assistance to buy private insurance.
“It is very stressful for my whole family that I don’t have health insurance,” says Daniels, who has asthma, but otherwise is in relatively good health. “They would be in real trouble without me.”
Daniels says she doesn’t understand why Montana Republicans oppose expanding Medicaid to help people like her, especially when the federal government is offering to pay for most of the cost.
“I think the purpose of Medicaid is to help people when they need help,” she says. “It’s not a permanent fix. I’ll work again. People go through some times when they need some help. … It’s not welfare; it’s not charity.”
The GOP plan in House Bill 455 does not accept the federal money for a full-scale expansion like the Bullock plan. Instead, it would cover some additional parents of children covered by Medicaid, by increasing their income eligibility threshold from 47 percent to 100 percent of the poverty line.
It also attempts to extend coverage to some military veterans earning up to 100 percent of the poverty line and funds an additional 400 slots for disabled people awaiting Medicaid-funded treatment programs.
The GOP plan would cost the state more money initially while covering an additional 10,000 people, compared to the 70,000 covered by the Bullock plan, at lesser initial state cost. (see related story)
Rep. Nancy Ballance, R-Hamilton and the sponsor of HB455, notes that the Bullock proposal does not finance the 400 slots for disabled people, and says Medicaid is meant to cover the “most vulnerable,” rather than the many “able-bodied” adults getting coverage under Bullock’s plan.
She also says her bill is not an alternative to Bullock’s, but rather a means to cover vulnerable citizens who need care, if Medicaid isn’t expanded like the governor proposes.
“It’s something we need to do, so if (the governor’s) Medicaid expansion doesn’t pass, we don’t leave these people behind one more time,” Ballance says.
Supporters of the Bullock plan say that rationale is pretty thin, because the Legislature could cover those “vulnerable” folks – and then some – by doing the full expansion.
“(The Ballance) bill doesn’t help someone like me,” Daniels told a legislative committee two weeks ago. “I’ve worked hard. I just need some temporary help while I’m in this situation.”
Coming Monday: A look at who gets the money in Medicaid, with and without the expansion.