Medicaid Failure in Montana: How We Got Here

by William Skink

Sure, the Republicans who want to keep punishing poor people by denying Medicaid expansion are craven, hypocritical partisans, especially if one looks at what happened in Helena on Friday through a Democrat partisan lens, which is all the author of that post is capable of. Luckily I don’t have that affliction and am therefore able to add a little bit more context to how we got to this point in Montana.

Two years ago there was a very good chance of getting Medicaid expanded in Montana. What happened? Freshman Democrat legislator, Tom Jacobson, pushed the wrong button:

Some states have declined to expand Medicaid because they oppose Obamacare. Others worry about the financial burden of expanding the entitlement. But there appears to be only one state where the Medicaid expansion failed due to a Democratic legislator accidentally voting against it.

Congratulations, Montana.

“We’re tremendously sorry about what happened,” Minority Leader Chuck Hunter, a Democrat, said of the mistaken vote. “Montanans are the losers in this outcome.”

The mistake sent the bill back to committee to die. It was terrible. And trying to change the mistake wasn’t possible because the provision of addressing mistakes like this could only be used in situations where the change wouldn’t effect the outcome of legislation. In this case it would have, so the wrong vote stood.

After this embarrassing debacle I hoped Montana Democrats would regroup and speak with a unified voice about the dire need of 70,000 Montanans. That hope quickly dissipated when it became clear that Medicaid expansion was going to be a political football used by the Bohlinger campaign.

While Democrats were busy bickering among themselves, Montana AG, Tim Fox, successfully stalled the signature gathering for the Healthy Montana Initiative.

Then, in 2014, Democrats got their asses handed to them and now here we are. The result? Montanans will continue to suffer, hospital expenses will continue to balloon (the cost of which is passed along to all of us) and over 10,000 jobs WON’T be created.

Most of the blame should be directed at the Republican ideologues who never miss a chance to bash poor people in our state. I despise them more than words can effectively convey.

But I’m not a partisan hack, so I extend my disdain to Montana Democrats, who can’t seem to get their shit together to alleviate the suffering of 70,000 Montanans.

This is a sad situation for Montana. Those on the ground of the class war don’t have the luxury of political posturing. We desperately need Medicaid dollars. Placing blame solely on Republicans may serve political purposes for Democrats, but it doesn’t tell the whole story of how we got here.

  1. Elizabeth

    Supposedly a Republican legislator also pushed the wrong button so the two cancelled each other.

    • lizard19

      if Jacobson had voted his intention, it wouldn’t have been a tie. Medicaid expansion would have gotten a vote. there is no way to spin that reality.

  2. steve kelly

    How we got here?

    One must at least consider the 1993 “Harry and Louise” tv ads credited with killing “Hillarycare.” Democrats, however, controlled both houses of Congress and the White House.

    Then there is our own former Senator Max Baucus to consider. Baucus chaired the committee hearings that stalled the process and killed the “public option.” Baucus took single-payer off the table before any debate could emerge. He hired Liz Fowler, a Wellpoint lobbyist, to rewrite “Romneycare,” originally an initiative of the Heritage Foundation. Baucus sold the farm to insurance companies plain and simple. Democrats controlled both houses of Congress and the White House.

    We remain the only industrialized nation without universal health care for its citizens.

  3. Of course I have to wonder, since “mistakes” always seem to work against us, if Jacobson really committed an error or followed instructions of party leadership. There are, after all, many Republicans who run as Democrats, since that party has such low accountability standards.

  4. lizard19

    Pete’s takeaways of the Mansfield dinner include weak support for environmental issues and an early lockdown of support for Hillary.


    • petetalbot

      Hey, liz, it wasn’t all bad. Really. Mostly good and it’s still early but yeah, the environmental message was lacking.

      • lizard19

        was anyone talking about Medicaid?

        • petetalbot

          Oh yeah, early and often. They said the battle isn’t over, yet, but I have my doubts.

          • lizard19

            the cost of another two years without Medicaid expansion is hard to describe because it’s happening to invisible poor people. who really represents them in Helena?

      • Here’s where party politics loses me:

        One, Hillary Clinton is a Neocon. She wants war, military confrontation, domination and military spending, just as Cheney does. Having a “D” by her name sanitizes that? Can you not see beyond the ‘D’?

        Two, the environmental message is not there because the party financiers are not in any way supportive of any such thing. Democrats broach the subject at their own risk.

        Three, Angela McLean cannot ascend to higher office unless she is adopted by some significant financial backers and has an advertising image constructed for her, as was done for Tester. People do not rise in the party by force of nature. Money dictates.

        This treatment of party politics as if it were grassroots is all pretend. It does not work that way. Not for a second.

      • Matthew Koehler

        Thanks for the update Pete, and for sharing your thoughts about the “nonexistent” “strong environmental” message at the M & M dinner.

        Seems to me that your final question: “Are these the constituents who stayed away in droves at our last midterm election?” was discussed on various blogs post 2014 election and some people mocked the notion, and claimed the environment was only a ‘pet’ issue of a very tiny segment of Montanans. Thanks again Pete.

        Pete wrote:

        “For me, the element lacking last night was a strong environmental statement. There was the oft-repeated “public lands in public hands” message, a good one to be sure, and mention of clean air and water, but strong environmental language was nonexistent. Climate change was only mentioned once and that was by the keynote speaker, Louisiana native James Carville.

        Organized labor got many kudos, and rightfully so, but to exclude an environmental message is to dismiss a large segment of the Democratic Party’s constituency. Are these the constituents who stayed away in droves at our last midterm election?”

        • Conrad Burns championed a movement in 1996 to transfer management of federal lands into state control, the object of which was, according to Tom Keating, “… of course, to privatize these lands.”

          In response, with MWA, we came up with a “keep public lands in public hands” campaign, a nice catchy phrase that resonated. I still have postcards in my office with that sentiment on them.

          Later it was stolen and used by Montana Wildlife Federation. Glad to see Democrats still use it.

  5. Maybe the legislators knew that expansion does nothing to improve the overall health of low earners.

    • Did you read it?

      Health insurance is a financial product that is aimed at providing financial security by protecting people from catastrophic health care expenses if they become injured or sick (and ensuring that the providers who see them are paid). In our study, Medicaid coverage almost completely eliminated catastrophic out-of-pocket medical expenditures.

      People are not bankrupted by health care costs. Would you rather that they were, or had no access?

      The focus of your study on hypertension is odd, as I am not sure that the non-Medicaid population is any better off with the drugs, called statins,used to treat the disease.

      I read, for instance, that drug companies claim a 33% reduction in heart attacks with use of the statins. That’s a clever lie. Here’s what it means: If you take 100 people above a certain age, three of them are likely to have heart problems in a given time frame. If all of them take statins, that number is reduced to two, but they have NO IDEA which one person of the 100 will have the positive outcome.

      So for your study to focus on hypertension is weird, at best. In the general non-Medicaid population, it’s a wild card. So should it be in the Medicaid population.

      • If your the type that sits on the couch swilling brewskis and chain smoking Camels then hypertension/hypoglycemia is extremely relevant. After all we need the statin junkie cart riders living as long as possible for the next election cycle.

        And I did read it.

        “Hypertension, high cholesterol levels, diabetes, and depression are only a subgroup of the set of health outcomes potentially affected by Medicaid coverage. We chose these conditions because they are important contributors to morbidity and mortality, feasible to measure, prevalent in the low-income population in our study, and plausibly modifiable by effective treatment within a 2-year time frame”.

        • What I am reading here is your usual disdain for poor people, as if they mostly the ones taking statins and antidepressants. Those drugs are huge profit centers and are in in widespread use, and are largely ineffective, so by definition they are going to be ineffective among poor people too.

          That’s all the study measured. I am not surprised.

          We are in Phoenix and have attended two ball games. These are your Republicans, well-off, time on their hands. If ever there was a place where overweight people are “swilling brewskis and …” where …” hypertension/hypoglycemia is extremely relevant…” and where “… we need the statin junkie cart riders living as long as possible for the next election cycle,” it is here. Among your people Swede.

          Outside the stadium they smoke Camels and pack sidearms. It’s a slice of redneck down here. And not poor by any stretch.

          • At least my fat fan boys are paying their own way.

            We’re in agreement tho. Medicare expansion does increase chemical dependency both legally and illegally.

            • JC

              “At least my fat fan boys are paying their own way.

              But are they? Is their employer-provided health insurance subsidized by me, the tax payer? Did the company they work for get some form of corporate welfare. Did the pipeline/power corridor company they work for condemn some poor farmer/rancher’s land and take it for their own? Did the oil company they work for dump oil in the river and then do a half-ass job cleaning up private and public lands they impacted? Did they get mortgage interested deductions on their taxes? Do they use electricity provided by corridors built through rural electrictrification projects paid for by taxpayers? Do they fly using airports financed and operated by taxpayers?

              No, Swede, your fat fan boys just suck on the government tit in other ways.

              • $22 Trillion worth JC?

                “Since that time, U.S. taxpayers have spent over $22 trillion on anti-poverty programs (in constant 2012 dollars). Adjusted for inflation, this spending (which does not include Social Security or Medicare) is three times the cost of all military wars in U.S. history since the American Revolution. Despite this mountain of spending, progress against poverty, at least as measured by the government, has been minimal.”

              • JC

                citation? In any case, add up QE, corporate tax subsidies, farm aid and employee tax credits for health insurance and it equals far more than that.

          • They also wear jerseys with players’ names on the back. Why do they want to be someone else? Why don’t they just put the truth on the jersey? Instead of “Pujols” it should say “My Life Sucks!”

  6. steve kelly

    “Republicans have been accused of abandoning the poor. It’s the other way around. They never vote for us.”

    Dan Quayle

  7. steve kelly

    Buy one, get one free. What’s wrong with that?

  8. Eric

    Well Mr. Skink, let’s talk about the 800lb gorilla in the room you are ignoring; the reason 34 States have opted out is because the Federal Government is broke. It is borrowing 43 cents of every dollar it spends. That’s a fact, and it is undisputed.

    There is no way that the Government will be able to keep up it’s funding promises, and when they don’t the States who were suckered in are going to have massive costs, and massive tax increases. It’s not a matter of ‘If’ but ‘When’.

    If Gov Bullock thinks this is going to be a winning issue he’s very mistaken. I expect this issue, plus his NRA-‘F’ rating he’ll haveby then to help us replace him, so the GOP can keep undoing some of the damage caused by Gov. BS.

    • lizard19

      oh my lord, you’re right. the only responsible thing for conservatives to do is stop accepting more debt, like federal highway funds and ag subsidies, otherwise this poor-bashing may look…selective.

    • lizard19

      oh, does your Gorilla eat subsidized corn?

      • Less TAX is NOT a subsidy. Cutting someones TAXES is NOT a subsidy, as it THEIR money to start with NOT the government’s.

        • JC

          From your buddies at Cato: “The U.S. Department of Agriculture distributes between $10 billion and $30 billion in cash subsidies to farmers and owners of farmland each year.”

          A good chunk of that is corn subsidy. Want to talk about subsidies for corn derived ethanol?

          • The price of corn is manipulated by the ethanol mandates. The price of all grains is heavily influenced by govt. contracts and crop reports. We’re in agreement, let the free market rein.

            Same goes with the stock market.

  9. steve kelly

    Why then Swede do timber/grazing landowners in Montana pay less property tax per acre to counties than comparable federal lands? Is that not a subsidy? Aren’t counties and states gouging the federal taxpayer to offset local taxes?

  10. Just a guy

    I feel obliged to point out that a bill is soon to be introduced (by a Republican, no less) to expand Medicaid to the oft mentioned 70,000. Of course certain strings will be attached. The ones I am aware of seem reasonable enough. We will see when the bill drops this week.

    The way the community activist set has been shrieking, you might have thought the world had reached its end when HB 249 went down. I suspect that has more to do with the moderate GOP stealing a pillar of Governor Bullock’s agenda than it does concern about the whole #70,000Can’tWait thing.

    • JC

      Glad that bill makes you republicans happy. What’s an asset test and a 2% forced premium payment plus copays for someone living below poverty level?

      I guess it’s either a 2% forced payment to Medicaid, or $695 penalty forced payment to the IRS in 2016 if you don’t do the Medicaid. In either case, you republicans get to extort money out of the poor.

      That should make you happy. Makes it harder for them welfare queens to buy cigs and booze.

      • You mean cigs, booze and drugs.

        • JC

          No, they’ll get plenty of drugs via prescriptions that you’ll pay for. Prescription drug abuse is the leading driver of addiction these days.

          Hell, plenty of poor medicaid patients make a great supplemental income selling their prescriptions on the black market. It’s a thriving growth industry.

          Then again, so do folks using private health insurance who are in a common pool with you, (if you are in a private pool), or in a government pool.

          Ya jess can’t win one, can ya? Who said the “free market” in the u.s wasn’t full of innovation?

      • Just a guy

        Conflating the requirement of a 2% of income annual premium in exchange for health insurance with extortion is a pretty bold statement.

        Any sympathy for the people who currently pay for these folks’ healthcare through their private insurance bill, and who may soon pay for them through their tax bill? I thought I read somewhere that the Democrats were the party of the middle class…

        • JC

          Go try and live on less than a poverty wage. Then tell us that the state mandating 2% one way or another isn’t extortion.

          I said every step of the way during the ACA build up that allowing the IRS to enforce it was fascist. And now some republicans want to mandate people onto Medicaid, and then hit them with a forced 2% fee… this year — it will be $695 IRS penalty in a few years, almost 10% of the take home pay of a poverty level worker if they don’t pay the 2% tithe to the state.

  11. Eric

    I feel that the GOP proposal would expand into a budget-buster also. I hate paying for insurance that my family never uses. For years we were self-insured – if somebody got sick – go to that walk-in clinic. write a check, and go pay for your prescription. We averaged about $400 per year in health costs. Now I spend that a month on very good ins. for the family.

    If I could scrape together enough money to become a Democrat I might change my mind, and want to pay for everybody else’s insurance also, but that’s not a likely scenario!

    • lizard19

      you already pay for the uninsured through sky-rocketing medical cost. you don’t seem capable of understanding that, though. and you pay for BILLIONS in unnecessary administrative cost. are these words too big for you? are these concepts too complex?

    • I think Eric is hopelessly mired in free market economics, a world where nothing works and the only possible explanation for failure is government. It’s a rabbit hole.

    • JC

      Eric, I know you understand the concept of insurance, but not everybody can be self-insured. All it takes is one accident, and you got a quarter million dollars in bills. Then you’d go bankrupt and we’d all pay for your care.

      Actually, what you’ve just discovered is the idiocy that is American free market health care insurance. If we had real singe payer, everybody would be covered, and you’d pay a small percent on your income, like you do for SSI.

      Insurance is a racket game guaranteed by government mandates intended to enrich a few companies and their shareholders.

      Health care, on the other hand is an essential ingredient to a happy life, and usually needed in small steady doses with occasional bouts of random urgency that tend to be incredibly expensive.

      • I would argue that the concept of “insurance” does not work in health care any more than it would in any other utility. Imagine having to buy an “insurance policy” in case you needed electricity in your home. It’s crazy.

        Government-run or single-payer works so well where it is used because it is done on a mass scale paying wholesale for everything we need, rather than retail. That’s why even the relatively inefficient (by European standards, not ours) Canadian system is one-third less expensive while serving 100% of its clients, and yielding better outcomes and more satisfied customers.

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