Or: How I Learned to Stop Worrying and Love the Medicaid Expansion
Liz recently wrote about the squabbling inside the dem party about how best to expand Medicaid:
“Failure is often more instructive than success.”
While he has a point, I think that folks need to remember the battle over the Healthy Kids Initiative in 2008-2009.
Here’s the quick down and dirty: in 2008, Healthy Montana Initiative, a 501(c)(4) nonprofit ran a ballot initiative campaign to expand access to health care via CHIP and Medicaid for kids in low income families. The campaign was hugely successful and won at the state polls with 70% of voters supporting it. Kids… gotta love ’em, even it they comes from poor families.
Now the problem with initiatives in Montana is that while they can set up new programs and revenue streams, they can’t appropriate funds. So the initiative had to go the the 2009 Montana Legislature for an appropriation. That Legislature had a deadlocked 50-50 House, and Republicans controlled the Senate 27-23.
The appropriation for the initiative was rolled into HB2, the main funding instrument for the state. So, through a very rancorous session, with the House supporting the Initiative funding, and the Senate trying to gut it at every step of the way, the bill eventually passed with the appropriation intact and the CHIP and Medicaid expansion for poor kids was funded.
A newsletter from the MHRN characterized the legislative battle thusly:
“What was not foreseen was a partisan debacle where many Republicans put anti-government ideology ahead of the health of Montana communities and the clear will of the voters who elected them.
In a stunning disregard for the democratic initiative process, Republicans threatened funding for the Plan at every turn. A majority of Republicans in both the House and the Senate stated publicly and repeatedly that voters did not know what they were voting for and/or the Plan was a step towards ‘socialism.’ They threatened to withhold funding for the program.”
So we see that even when a solid majority of Montana voters give the Legislature a mandate to do something, that mandate goes by the wayside when politickin’ and legislatin’ season arrives. That Legislature was only mildly republican, with the words “tea party republican” yet to be coined during the aftermath of the Obama election, and the Baucus-care debacle.
James Conner up at Flathead Memo had an astute comment about the “political weakness” of Montana Democrats :
“Initiative 155, the “Healthy Montana Kids Plan Act,” was approved by almost 70 percent of Montana’s voters last fall, a fact to which I’ve pointed previously. That victory, however, was not, as some I-155 supporters and Democrats suppose, a sign of strength. Instead, it was a confirmation of political weakness.
I-155’s supporters took the issue to the ballot because they could not muster the votes to move the measure through the 2007 session of the legislature. It was the same strategy employed in 2006, when, after an attempt to increase Montana’s minimum wage failed in the 2005 legislative session, supporters of the long overdue increase in Montana’s minimum wage took the matters directly to the voters. As would occur two years later with I-155, the measure was approved overwhelmingly, receiving 72.7 percent of the vote.
So, given the voters’ support for I-151 & I-155, how can those electoral victories be considered confirmations of weakness?
It’s simple. Democrats failed to gain control of the legislature, which is where health care and minimum wage legislation should be considered and approved. In 2006, Democrats lost the house by a single vote and won the senate by a single vote. In 2008, the result was even worse. The house was split 50-50, which meant a Democratic speaker — but Republicans gained control of the senate by four votes. And this happened despite legislative districts that were legally gerrymandered to pack as many Republicans into as few districts as possible in an attempt to secure an advantage for Democrats.
Why? Because having I-151 & I-155 on the ballot spared voters who agreed with the initiatives but otherwise leaned Republican the necessity of choosing between a Republican legislative candidate who opposed expanding health insurance for children or increasing the minimum wage and a Democratic candidate who supported CHIP and increasing the minimum wage.”
Interesting how history is repeating itself, and how instructive success can be. Except the problem today is that the Montana Legislature is far more skewed towards tea party republicans. The 2013 legislature had republicans controlling the House 61-39, and the Senate 29-21. Do Montana dems really think they can pull off an appropriation in a similarly comprised Legislature for a Medicaid expansion for 70,000 poor Montanans? When the tea party has an ideological aversion to anything government-related (do they hate anything more than Obamacare, and it’s affiliated Medicaid expansion)?
I’m sure that many dems would like to think they’ll have a stronger presence in the 2015 Legislature (and maybe they’ll pick up a few seats) — but strong enough to battle for a Medicaid expansion appropriation? Especially when the debate will most likely be rolled into HB2 and left for the closing days of the Legislature to approve?
At that point, parts of the bill get jettisoned like ballast in a ship going down. The Medicaid expansion carries 10 times the funding level of the CHIP expansion, and it’s for “poor” people (“the downtrodden… gotta hate on ’em”). It easily could be the first thing to go in a battle to get HB2 approved, irregardless of the level of public support shown in the Initiative process.
So who is pushing the new Healthy Montana Initiative? It’s the same group that pushed through the Healthy Kids Initiative in 2008, initially funded this year by SEIU. So they’ve got a good track record, but have their work cut out for them. Not to mention that the tea party hates anything remotely associated with the SEIU… or any other union, for that matter.
But can dems still get 70% voter support for an initiative? Anything much less would garner a big yawn from republican appropriation bill authors. Want to try an appropriation with a smaller majority, say 60%, or a razor-thin 51% victory?
Ok, so that’s one path that is already underway.
But would you rather spend the money — from pushing an initiative and lobbying for its victory, and lobbying the 2015 Legislature — on lobbying during a single issue, focused special session? Can dems wangle Medicaid expansion into a wedge issue via a special session that may be used to elect Democrat legislators instead?
The question then becomes, is the strategy of leaving the appropriation of the Healthy Montana Initiative up to the 2015 Legislature a good thing? Which is where we need to weigh this with the possibility of the Governor calling a special session to tackle Medicaid expansion (he’s been quiet about it lately, since hinting about it at a special session). Governor Bullock had this to say after the 2013 Legislature:
“Governor Steve Bullock (D), a strong supporter of Medicaid expansion, says this was the biggest failure of the session.
“Let me be clear, we will reform healthcare in Montana. We will do it with or without the Legislature’s help,” Bullock said on the last day of the legislative session.
Bullock has hinted that he may call the Legislature back to a special session to address healthcare reform.”
What benefits does a special session have? Well, it takes the Medicaid expansion issue out of the insanity of an end-of-legislature appropriations process. It focuses the state and Legislature on a single issue, and its benefits: 70,000 people covered sooner than later, and a lot of side economic benefits from the billion dollar infusion of federal money into the state.
Dick Barrett, state senator from Missoula does a great job of tearing apart right-wing fear-mongering over Medicaid expansion:
“If you’re like me, you’ve probably found the relentless conservative Republican opposition to Medicaid expansion more than a little mystifying. After all, if here in Montana we agreed to Medicaid expansion under the terms of the Affordable Care Act, we would receive Federal funding that would create thousands of new jobs and hundreds of millions of dollars in new income. It would reduce hospital charges and private health insurance costs. And most important of all, it would provide good health insurance to 70,000 low income Montanans who now go uncovered. What’s not to like? How could legislators of sound mind and with the state’s best interests at heart turn down this opportunity? Anybody out there got an answer?
Well, yes! [Republican state] Senator Fred Thomas does.
But unfortunately, it makes no sense. Zero. Zilch. Nada.”
So we have a choice: special session or Initiative? I love the Initiative process in Montana, but given the way it succeeded in 2008/9, I have to wonder if the 2015 Legislature can get the stars lined up to push an appropriation through. Likewise, if Governor Bullock could be pressured to call a special session, would Medicaid Expansion supporters (and there are plenty in the ranks of republican voters) be able to force recalcitrant republicans to vote for, and appropriate the funds needed to implement a Medicaid expansion sooner than later?
And lastly, given Conner’s observations, is it in Montana dem’s political interests to tie republican performance on a Medicaid expansion in a special session to their electoral outcome (and 2015 Legislature balance)? Conner, again:
“Funding requires a majority in the legislature — and Democrats, partly because they put the issue on the ballot, instead of using it as a wedge issue in legislative elections, do not have the votes.
Democratic strategists and activists need to remember how they shot themselves in the foot with initiatives 151 and 155 before they start circulating petitions for an initiative regulating the payday loan industry in Montana.”
My sense is that a special session gives the opportunity for rational arguments to be put forth for the Medicaid expansion outside of the madness of a regular session appropriation battle. And it gives dems an issue to run against the tea party. But I respect the Initiative folks’ for doing the next best thing, outside of the Gov calling a special session. I just don’t see the political strategy for getting an appropriation through the 2015 Legislature. Answer me that question — outside of just saying that appealing to republicans with a rational argument during regular session appropriations wars will do it — and I’d gladly swing my support whole-scale behind an initiative.
But that “unforeseen debacle” that the MHRN referred above will come back to haunt any who try to push a Medicaid expansion appropriation through the 2015 Legislature, and dems who think they will take a majority of both chambers to push the appropriation down republican throats are hinging their success on a pipe dream.