Why I'm Supporting Representative Buttrey's Medicaid Reform and Integrity Act

The 2015 Montana legislature passed the Medicaid Expansion program in Montana, providing healthcare coverage to low income and disabled individuals. Importantly this act included work/training programs, premiums, as well as a 4 year expiration “sunset” date to allow the legislature to review the data and consider whether to leave the program unchanged, make reforms or discontinue it.

Initially the Federal government paid for 100 percent of the program, tapering down to 90 percent by 2020. The program is set to sunset in June of 2019, unless the legislature acts.

The legislature is now debating two competing proposals to deal with the expiring Medicaid program. One bill is sponsored by Democrat Representative Mary Caferro, the Keep Montana Healthy Act, which essentially only removes the sunset, making the current program permanent.

Republican Representative Ed Buttrey has another proposal, called the Medicaid Reform and Integrity Act. This proposal makes the following reforms: it includes work requirements for able-bodied adults, asset tests to ensure it is used by the people who most need it, citizenship requirements and importantly it will also include another sunset date, again allowing the legislature to review the program in the future.

There is also a third option some folks are pursuing – doing nothing and allowing the program to expire, ripping health coverage away from roughly 100,000 Montanans.

The folks who are advocating the position to eliminate Medicaid coverage to these 100,000 Montanans like to claim their position is in line with the “will of the people” who rejected the 2018 I-185 ballot initiative to make the Medicaid program permanent, by a margin of 53 to 47 percent. Yet recall the group opposing the initiative was not named “Montanans Against Medicaid” but rather “Montanans Against Tax-Hikes.”

There were many arguments against the initiative. One that the new tobacco tax of $2 per pack of cigarettes would be a declining revenue stream as less people smoked. Another that the tax would not fully fund the Medicaid program, and was a regressive tax on the poor. The initiative was also attacked as unconstitutional due to the voters appropriating money at the ballot, rather than the legislature. Absent from the I-185 opponent’s mailers and TV ads was the argument the Medicaid program should not be continued altogether. Those who now choose to characterize I-185’s results as a referendum on the future of Medicaid, rather than the simple rejection of a tax increase, are doing so because the outcome fits nicely with their own narrative. 

I am planning to support Representative Buttrey’s Medicaid Reform and Integrity Act because I believe in the reforms contained within it and I believe this proposal is in our district’s best interests, given our Sidney Health Center Board of Trustees sent me a resolution asking me to support continuation of the Medicaid program due to its importance to the future of our hospital.

While thinking about this issue, I remembered a very appropriate quote from former President George W. Bush, when he was describing the importance of compassionate conservativism. He said, “It is compassionate to actively help our fellow citizens in need. It is conservative to insist on responsibility and results. And with this hopeful approach, we will make a real difference in people’s lives.”

Thank you for allowing me to be your representative.