Cure-all 

Ballot initiative aims to correct legislature's Medicaid mistake

Now is an interesting time for democratic self-government in Montana. Unfortunately, it is interesting in the sense of the proverbial Chinese curse. This year pitted our legislators against the presumed will of voters, and now they may just get an opportunity to ignore our wishes explicitly.

Fans of farce and parliamentary procedure may remember the last week of the 2013 legislative session, when House Speaker Mark Blasdel used a nearly unprecedented parliamentary procedure to kill Medicaid expansion in Montana. His colleagues missed overruling him by one vote, partly because Rep. Tom Jacobson, D-Great Falls, accidentally voted the wrong way.

It was the legislative equivalent of Bill Buckner letting a ground ball roll between his legs. As Bostonians are more likely to remember that ignominious moment from the 1986 World Series, those most likely to remember the 2013 session are the 70,000 uninsured Montanans who would have qualified for expanded Medicaid if their representatives had let them have it.

That's 7 percent of the state's population—more than three times the margin of victory in last year's gubernatorial election. In functional politics, 7 percent would be an irresistibly sweet plum. No sane legislator in a working democratic system would miss the chance to please 7 percent of the electorate, especially when doing so would cost no more than saying "yes" to billions of federal dollars.

But Montana's is not that system, and the House Republican caucus is not those legislators. We've known as much since April's narrow victory of obstinacy over incompetence. The legislature abdicated its duty to provide for the general welfare, and now, like a father who spent his kids' vaccination money on a really sweet bottle of tequila, it sleeps.

I mention this because certain instruments of popular will are still awake. Last week, a coalition of groups—including the Montana Nurses' Association, the Montana Primary Care Association and the Association of Montana Public Health Officials—launched a ballot initiative to let voters decide whether to expand Medicaid in Montana. In order to put Medicaid expansion on the ballot, the newly consecrated Healthy Montana Initiative will need 24,175 signatures from registered voters by next June.

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That number should be easy to reach; it's little more than a third of the people who would qualify for expanded Medicaid, after all. There's no reason Montanans shouldn't get to vote on Medicaid expansion in 2014, but then again it was hard to identify a reason why the legislature would block expansion last spring.

Senate President Jeff Essman, R–Billings, told Mike Dennison of the Missoulian that the legislature rejected Medicaid expansion because it was "a whole lot of money for the state of Montana, and it doesn't work." Joe Balyeat, the Montana director of Americans For Prosperity, echoed Essman's remarks, saying that expansion would cost too much without improving health care.

"If the press does a good job of fully reporting both sides of this debate," he said, "I think it's possible that voters in Montana will decide they do not want Medicaid expansion."

So having reported their argument, let us do a good job and consider the other side. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of expanded Medicaid coverage for newly eligible beneficiaries until 2016, and half the cost of administering the program.

Between 2017 and 2020, the state share of coverage costs will gradually increase to 10 percent, with the federal government paying 90 percent of the cost of expansion for 2020 and beyond. A report prepared for the Montana Commissioner of Securities and Insurance by the University of Montana estimates the total net cost of Medicaid expansion in Montana from 2014 through 2021 at between $34 million and $52 million.

By comparison, the House Republican caucus unanimously supported House Bill 230, a property tax rebate whose estimated cost was $219 million over the next four years. Consider the reasoning of a group of legislators that used every means at their disposal to stop health insurance for 70,000 of their constituents, on the grounds that it was too expensive, only to throw their support behind a tax rebate that cost five times as much.

We live in interesting times. This spring, our representatives jeopardized the health of 7 percent of the electorate to spite a federal law that had already passed. Next fall, we might get to watch Montanans contradict our own legislature with a ballot initiative.

The only problem is that a ballot initiative can't actually appropriate the money to expand Medicaid. The 2015 Montana Legislature would still have to vote to do that—but they'd have to, right? If the whole state votes to insure the poorest among us by accepting free money from Washington, Helena will have to go along. They'd be crazy not to. Then again, they were crazy to thwart 7 percent of the population in the first place. Like I said, we live in interesting times.

Dan Brooks writes about politics, consumer culture and lying at combatblog.net.

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