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Medicaid hearing

Max Naethe of Kalispell, who testified Friday in favor of a bill to expand Medicaid coverage in Montana, listens with his 10-year-old daughter, Aliceia, to other testimony for Senate Bill 405 at the Capitol. Naethe said he needs a heart transplant and doesn’t earn enough money to get a subsidized policy, but that he’d be covered by expanded Medicaid. In the foreground is the sponsor of the bill, Sen. Ed Buttrey, R-Great Falls.

HELENA – The legislative battle over extending Medicaid coverage to thousands of low-income Montanans took a decisive, dramatic turn Friday, as the state House rejected a trio of alternative measures offered by conservative Republicans.

If the bills stay dead, only one Medicaid expansion option remains before the 2015 Legislature – a compromise proposal introduced this week by Sen. Ed Buttrey, R-Great Falls.

Buttrey’s Senate Bill 405, which had its first hearing before a Senate committee Friday afternoon, would accept as much as $700 million in federal funds the next two years to offer government-funded coverage to Montanans earning up to 138 percent of the federal poverty level, or $16,200 for a single person.

Conservative Republicans who oppose accepting the federal money, because it expands “Obamacare” in Montana, had proposed three other bills that offered slimmed-down versions of government-funded health care or health coverage for the working poor and the disabled.

But, by razor-thin margins, a coalition of House Democrats and moderate Republicans voted Friday to kill those bills.

“It’s just not a fiscally efficient way of looking at it,” House Minority Leader Chuck Hunter, D-Helena, said in opposing the measures.

Hunter noted that the conservatives’ centerpiece proposal – House Bill 455, by Rep. Nancy Ballance, R-Hamilton – spends at least $35 million in state funds every two years to cover about 10,000 people, and that the state must fund 35 percent of the total cost.

Under Buttrey’s SB405, the state saves money the next two years and eventually pays no more than a 10 percent match, and as many as 70,000 people will be covered, he said.

Yet a leader of the conservative bloc in the House warned opponents that the Buttrey bill or one like it may not reach the House floor, and that if Democrats killed the alternatives, they might be killing any chance at expanding Medicaid to anyone.

“We can compare (our bill) to some other, potential, hypothetical bill,” said Rep. Art Wittich, R-Bozeman. “But that potential, hypothetical bill is not before us. It may never be before us. (Our bill) may be the best bill you have the opportunity to vote on. … What I’m hearing is that you will accept nothing short of everything.”

Moments later, the House voted 51-49 to reject HB455, which would have expanded Medicaid to cover about 10,000 low-income parents, veterans and disabled people.

The House also voted 52-48 to reject a bill from Wittich that created government-funded catastrophic insurance for about 800 people, and 50-50 to kill another Wittich bill to encourage more people to sign up for subsidized private health insurance under the Affordable Care Act.

Nine House Republicans and all 41 House Democrats voted against all three measures; one other Republicans joined in against HB455 and two others voted against the catastrophic care bill.

As the Democrat-Republican coalition was killing the health care measures in the House, scores of people lined up to testify in favor of Buttrey’s SB405 in another room at the Capitol Friday afternoon.

One of them, 54-year-old Max Naethe of Kalispell, said he needed a heart transplant but couldn’t get on the list, because he had no health insurance. He said he earned about $13,000 a year delivering pizza, so he didn’t make enough money to get subsidized health insurance on the state Internet marketplace.

“I never imagined this would happen to me,” he told the Senate Public Health Committee. “My only way to survive is a heart transplant. They don’t give those away, especially to people who aren’t insured. …

“Medicaid would give me a sense of security, a fighting chance of getting the transplant and staying alive.”

Hospital executives, physicians, medical students, nurses, tribal officials, business lobbies and county governments testified for SB405, saying it would provide badly needed coverage to thousands of poor Montanans, give an economic boost to the state, and help struggling rural hospitals.

Tara Veazey, health care policy director for Gov. Steve Bullock, said the governor has some objections to portions of the bill, but that he stands in support of it.

“Montanans elected him and they elected you to work across the aisle to find solutions,” she said. “This is too important to be about partisan politics, or about whose bill arrives on whose desk.”

A handful of opponents argued that accepting the federal money is helping plunge the federal government further into debt.

“Is it really patriotic to be taking money from a financially unstable organization that is basically bankrupt?” asked Tom Tuck of Gallatin County. “It’s free money; why not just take it. Well, is it right?"

The Senate committee took no immediate action on Buttrey’s bill.

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