Poisoning Medicaid: Will Winning Mean Losing for the Poorest in Montana?

by William Skink

Economic pressure will keep widening the cracks and unraveling the strings of the safety net. The latest housing report shows prices climbing across nearly all housing sectors. In those lower brackets that’s really going to hurt. Why? Medicaid expansion.

What is being celebrated as a bipartisan bill making its way to the Governor’s desk could be a poison pill. When asked, Pogie had this reply:

While Democrats would certainly prefer the more sensible bill they promoted before Art Wittich killed it, SB 405 is better than nothing. The Montana Budget & Policy Center explains it better than I could:
Even with our concerns about the additional hurdles SB 405 places on low-income families, we will support this legislation and we hope policymakers will seriously consider this compromise. We’ve been saying it for over a year now – 70,000 can’t wait. We cannot ask our fellow Montanans to continue to wait for health care. This is too important. –
See more at: http://www.montanabudget.org/the-montana-help-act-a-new-pathway-to-insure-70000-montanans/#sthash.DJgwkVnZ.dpuf

We can agree on that last sentiment, the catchy slogan 70,000 can’t wait, because it’s true. Viscerally so.

But is this bill really better than doing nothing? Conner, at Flathead Memo, disagrees:

The unanimous Democratic support for the blast is proof that Gov. Bullock and the Democratic Party have embraced the perverse axiom that the needs of the few outweigh the needs of the many. In this case, the few are the up to 70,000 Montanans who might be helped by SB-405, and the many are the 165,600 poorer people already on Medicaid and CHIP whose incomes will be reduced two percent by SB-405.

That’s right. The people most down and out will have their piggy banks robbed to help people who are not as poor. It’s an economically regressive policy that’s the inverse of everything Democrats say they stand for. But the poorest of the poor are the least likely to vote, so picking their pockets won’t result in payback at the polls.

Is this true? I haven’t read the specific language of this bill, but the link Pogie provides goes into a little more detail:

However, as part of any compromise, there are concerns regarding provisions of this bill. The HELP Act will charge new enrollees a premium for access to health care coverage. While the premiums will be limited to 2% of enrollees’ modified adjusted gross income, this could be a real stretch for Montana’s low-income families. Additionally, the bill requires new enrollees to pay co-pays for certain services (up to another 3% of their modified adjusted gross income). This cost sharing can add up to 5% of their modified adjusted gross income – that is the maximum allowed under federal law. The good news is that co-pays will not be applied to preventative health care, health screenings, immunizations, or generic pharmaceuticals for chronic medical conditions.

Another concern is the penalties for failure to pay premiums. For Montanans who are below 100% of the poverty line ($11,770 for an individual or $20,090 for a family of three), there is no disenrollment for nonpayment, however the unpaid premiums become a collectable debt by the state. For Montanans who are above 100% of the poverty line, failure to pay within 90 days of notice will result in disenrollment. They can be reenrolled upon payment.

The Governor has yet to overtly signal if he’ll sign this “compromise”. If it gets that far, I hope he vetoes it.


  1. Why? Given that there is no chance that the House will pass a clean bill that simply gives coverage to the 70,000 the Bullock bill would have protected, what’s the rationale for vetoing this alternative?

    It’s not perfect, but it’s better than the status quo.

    • JC

      Is it?

      Poor people between 100-133% of poverty can buy a subsidized policy on the Exchange. If this bill goes through, those people will be shuffled off of a much better policy onto Medicaid, and encumbered with all of the negative policy requirements about assets, home ownership and income tests.

      The best part of Obamacare in a state without full Medicaid coverage is that those >100% poverty can and have gotten a decent Silver 95 policy starting at at $20/month, with no deductible and max $800 out of pocket from the Mt Health Coop.

      Who in their right mind thinks that forcing all of those people off of private insurance onto Medicaid is good policy?

      Democrats by acquiescing to the republican plan here are endorsing class warfare.

      • Yeah, those well-known conservatives like Mary Caferro, who has done more for the poor in her life than you can imagine, must be committed to the goal of “class warfare.”

        Of course, she’s not the one arguing that 70,000 people can go without coverage because of his imaginary fear of losing his coverage. But you know all about class warfare, right?

        • ♪ We don’t need no education.
          We don’t need no thought control.
          No dark sarcasm in the classroom.
          Teachers leave those kids alone. ♪

        • JC

          “That means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.”

          – President Obama

          So, now Montana democrats are going to be complicit in helping Obama with his lying ways?

          • Yes.

      • petetalbot

        Serious question, JC: why aren’t all, or at least most of those making between 100-133%, signed up for the Silver 95 Co-op Plan? Wouldn’t that make a bunch of folks, out of the 70,000 uninsured, insured at an affordable price? I appreciate your comment and my initial research confirms what you’re saying. Why hasn’t this happened?

        And what about those making under 100%?

        I’m really torn on this one. Conner makes a good argument but knowledgeable, progressive legislators are saying this is better than nothing.

  2. JC

    Pete, I’m going to answer you down here.

    Why aren’t they signed up? I guess not everybody wants to sign up for insurance, even if heavily subsidized. The paperwork for self employed persons filing taxes is onerous. You can’t file 1040EZ anymore if you’re a minimum wage worker. The penalty is less than the premium — for now. I know quite a few people who qualify but are of the young and invincible attitude. Some people are conservative or libertarians who don’t believe in insurance, or subsidized health care. Some are lazy, or just don’t know.

    The way O-care was conceived was that everybody up to 138% poverty would go on Medicaid because it was the cheapest way to provide healthcare. But if the state didn’t take Medicaid, subsidies would go down to 100%.

    The bill the state is considering could just cover folks up to 100% poverty, and leave those above to the exchanges and subsidies. Some states were trying to figure out ways to get some of the folks under 100% on to O-care.

    Anyways, the whole thing was, is, and will be a terrible patchwork until it implodes and is replaced, which may happen in June when the Supreme Court rules on the current case before it on the legitimacy of subsidies on the federal exchanges. And if O-Care subsidies go down, the whole system of health insurance in the country will unravel.

    And “knowledgeable, progressive legislators” don’t talk to people on Medicaid, or who don’t have Medicaid to understand their concerns. If they did, they wouldn’t be saying or doing what they are doing.

    Obamacare was meant to be the salvation of the democrat party. It has been so horribly handled, and is still being horribly handled as the legislators in Helena are proving, that it probably is as much to blame for the fall of democrats as anything.

    Why won’t poor people turn out at elections? Force them on to Medicaid, take 2-5% of their pittance wages, make them file with the IRS and the state, limit their assets, test their income, penalize them for noncompliance, make them feel like lesser citizens, and turn them into a battleground for petty and vindictive politics.

    This is better than nothing if you can find a doctor to see you when you need. But you feel like an outcast when the person in front of you at the dentist pays less for a procedure because they have insurance. And then the receptionist refuses your Medicaid card, and you have to pay 25-50% more, cash, than the insured person just to get in the door, and you know you’re subsidizing out of your minimum wage job the person who is middle class and has employer-provided and taxpayer (the minimum wage worker included) subsidized insurance.

    Yes, health insurance is completely based in class warfare.

  3. Co-pays, coinsurance and deductibles are sold to us as a means to discourage people from overusing the health care system. In reality, they are a device to discourage people from seeking care, needed or not. People living not the edge, and people already burdened with high premiums. will avoid seeing doctors unless a situation is urgent.

    Insurance company executives know this. That’s part of the game, to keep their medical payouts down.

    Also, it appears Democrats can be sold just about any bill of goods as a better-than-nothing alternative. Even though they see themselves as a better alternative, they act just like Republicans, only talking different.

  4. steve kelly

    There isn’t a single legislator Helena who would accept this for their own family, or for themselves. But they really care, just ask them. Single-payer is not being discussed even as a goal anymore. The talk is of retreat, and how far. Three-little-pigs politics in spades.

  5. steve kelly

    http://www.ew.com/article/2015/02/23/sesame-street-puts-three-little-pigs-spin-house-cards




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