Holy Spirit in Action

The S.S. Medicaid Expansion has successfully navigated the legislative shoals and is on its way to safe harbor, where Gov. Bullock awaits, pen in hand. The legislation will have to be renewed in 2025. HB2, the general state budget bill, which contains increased spending for targeted case management, remains bottled up and may not see landfall before the end of the month.

Five days before Easter, Montana Medicaid Expansion has been resurrected on a 28-22 vote by the state Senate. The amended bill now goes back to the House for a final set of votes. The bill  includes work requirements, an improved asset test and premium increases for people who stay on the program for more than two years.  Some Republi can senators had withheld support last week, hoping to secure passage of a bill that prolongs coal energy production in the state. But the coal bill failed on third reading in the House on Tuesday, 60-38. The  idea could be amended into another bill in the final 10 days of the session.

Lots of political gamesmanship going on, with Medicaid Expansion hanging in the balance. 

The state Senate is voting Thursday afternoon on Medicaid Expansion. It's going to be very close. 4 p.m. update: HB 658, the bill extending Medicaid Expansion, FAILED on a 25-25 vote. Some 96,000 low-income Montanans will lose their health care coverage in two months. Another vote will be held on Saturday after a  second reading of the bill .   The next 24 hours are crucial! Contact the senators  below  as soon as possible and tell them that 100,000 Montanans’ healthcare is on the line. (406) 444-4800 or   leg.mt.gov/web-messaging Sen. Ankney Sen. Hoven Sen. Richmond Sen. Tempel Sen. Welborn Sen. Thomas

Heart flutters at the state capital Friday as the Medicaid Expansion bill carried by Rep. Ed Buttrey, R-Great Falls, was tabled by a Senate committee. But that turned out to be a parliamentary maneuver by the bill's Senate sponsor to assure it a more friendly committee hearing. The bill still should pass the Senate and be signed by the governor, most observers predict, as it has the support of Democrats as well as more moderate Republicans. Some Republicans opposed to Medicaid Expansion point to a failed statewide referendum last year that would have funded the program through an increase in tobacco taxes, suggesting that the current effort thwarts the will of the people. Opposition to the ballot measure was heavily financed by tobacco companies.

Oh, this is interesting. Wonder how it will affect Montana's bill.

Rep. Ed Buttrey, R-Great Falls A compromise bill to extend Medicaid Expansion, passed narrowly by a House committee Tuesday night, has until just April 1 to be sent to the Senate. A heavily amended bill carried by Rep. Ed Buttrey, R-Great Falls, adds some work requirements but broadens exemptions from his original bill. Audits will monitor the number of people suspended due to failure to meet work requirements and if a court finds them invalid, the program ends in 2025—but could be extended. The bill is expected to pass the House, possibly with more amendments, then goes to the Senate. If passed by both houses, Gov. Steve Bullock would have to decide whether to sign it or veto it.

Hours before a House committee was set to vote on competing bills to extend Montana Medicaid, a new study commissioned by Montana hospitals indicates even larger economic benefits for the state in the past two-and-a-half years. Among the findings: • The expansion has led to an additional $2 billion of economic activity in Montana, using a common economic multiplier effect. It supported or created an additional 9,700 jobs during that time period and nearly $800 million of associated wages. • In fiscal 2017, about 8 percent of Montana’s population was covered by Medicaid expansion — about the same as Washington and Colorado, but less than Oregon (10.8 percent) and more than North Dakota (2.7 percent). South Dakota, Wyoming and Utah did not have expanded Medicaid that year. • Montana’s rate of people without health insurance dropped 56 percent from 2013 to 2016, in large part because of Medicaid expansion. The only other state in the region with a higher percentage drop was Ore...

The number of Medicaid Expansion enrollees in Montana could be cut in half under a bill carried by Rep. Ed Buttrey, R-Great Falls, according to an analysis by the governor's office. Buttrey's work and reporting requirements would force recipients off the rolls, the governor's office said. The analysis relies in part on a previous study by George Washington University. 

Saturday's rally at the state capitol for Medicaid Expansion was timed for the start of the hearings before the House Human Services Committee on two bills with competing visions of how best to continue coverage before it expires at the end of June. As t he deadline for the full House to pass an expansion bill and send it over to the Senate is April 1, expect some fireworks in the next two weeks.

Now that HB 658, carried by Rep. Ed Buttrey, R-Great Falls, which adds "community engagement" requirements to Medicaid Expansion has been introduced, it is now possible to analyze the differences between that bill and the one carried by Rep. Mary Caferro, D-Billings. And the Montana Budget and Policy Center has done just that . Bottom line, 40,000 Montanans could lose their health care coverage under Buttrey's bill, including many in Missoula. Here is a look at how Medicaid Expansion has benefited Missoulians and Missoula businesses (taken from the appendices to the MBPC report). The initial hearing on both bills will be on Saturday.

John Adams (Montana Free Press) conducts an excellent discussion with two of the principal actors in this year's Medicaid Expansion debate--Rep. Mary Caferro, D-Billings, whose bill, HB 425, would continue the program as is, and Rep. Ed Buttrey, R-Great Falls, who is drafting a bill that would add what he calls "community engagement" requirements. The in-depth discussion really adds to one's understanding of the debate, and even though it's 40 minutes, it's well worth the listen. (You can always break the listening up into chunks.)

Published in today's Missoulian ( Sunday, March 10, p. E3 ): Medicaid Expansion Works As Is We at Holy Spirit Episcopal Church, drawing on our religious traditions, scripture, and the ministry and example of Jesus, support continuing Medicaid Expansion to care for those who simply cannot afford other health care.   Former Archbishop of Cape Town, South Africa, Desmond Tutu, once said, “...the good news to a hungry person is bread.” He could just as well have said that the good news to a sick -person is health care. Jesus' ministry was filled with healing the sick. He cured them, gave them back their health, renewed life, and restored.   He told us to do likewise. Medicaid Expansion in Montana will expire in June unless continued by the State Legislature. Few people have anything but praise for this program. Some 95,000 Montanans have coverage they didn't have before. They receive medical care earlier, which many recipients say has improved thei...

Montana Free Press has a new website that allows you to track the status of all legislation introduced in this biennial session of the Montana Legislature, and also to see each legislator's voting record. Check it out!

Medicaid Expansion has proven a huge boon to Native Americans in Montana. If work and reporting requirements were imposed as a condition of renewing the largely federally funded program, many reservation residents would find it difficult to comply because Indian Country lacks sufficient employment opportunities and infrastructure. The result would be loss of coverage, poorer health and increased costs for the already overstretched Indian Health Service, according to a recent report from the Montana Budget and Policy Center.

Think of case management as the glue that holds a troubled or disabled person’s life together. When that glue was dissolved by huge state budget cuts in 2017, the lives of some people on the margins began to crumble. Now, the legislature is trying to restore perhaps $3 million for case management, but it may be too little, too late or too dissipated to help all those who were affected, especially in rural areas. That, in essence, is the message of the Behavioral Health Alliance, which represents addiction and mental health providers in Montana. A leading indicator of the impact of the budget cuts is that involuntary mental health commitments are up, according to Mary Windecker, executive director of the alliance. More people are being treated in the hospital, a much more costly result, than in a community setting, and often the first point of contact is with law enforcement, with officers often taking hours to deal with mental-health crises.

Is Medicaid expansion a welfare program, as many conservatives believe? Or is it a healthcare program, plain and simple, as many liberals believe? Is it “shelter from the storm”or is it a “destination vacation”? Is the cost sustainable because other costs are reduced or is the cost ultimately unsustainable? These and other issues surrounding Medicaid are discussed in t his 2018 article published in a   conservative Washington, D.C. newspaper. Now, a year later, many of the the same arguments are playing out in Montana. In the upcoming debate over Medicaid Expansion, work requirements for Medicaid recipients will be one of the main bones of contention. Opponents of the requirement are pointing to Arkansas’ troubled experiment with such requirements.

The following letter was written by HSP parishioner Glenn Hladek: I am writing in support of Medicaid Expansion in Montana.  I am not arguing the moral imperative of health care as a right for all citizens of Montana.  Rather I am writing in support of maintaining a Montana way of life.  We are a rural state, we are an agricultural state, we are a ranching and farming state.  Without Medicaid expansion I am worried that this way of life will disappear.  Just as small communities depend upon schools, they depend upon readily-accessible health care.  Without the ability to educate and to provide health care for their families, I fear a forced migration from rural communities to urban cities. Of the 216,000 Montanans who access health care coverage through Medicaid, nearly half are children in Healthy Montana Kids program.  As of May 2017, 95,000 Montanans have enrolled in Montana's Medicaid expansion plan.  Of these individuals, nearly 48% ...

Montana Women Vote and other organizations are staging a rally for Medicaid Expansion at the Capitol at noon on Saturday, March 16 Montana's Medicaid Expansion provides health insurance to nearly 100,000 (1 in 10) Montanans, but without legislative action, the program will expire in June. Some legislators are calling for changes to the program that would kick up to 43,000 Montanans off their health insurance. Join us for a rally to protect Medicaid expansion in Montana. Carpools available! If you would like to carpool, email Ella at ella@montanawomenvote.org

No, we don't mean banking by phone! We mean participating in a phone bank to  advocate for Medicaid Expansion and help people call their legislators., hosted by one of the best organizations around--Montana Women Vote. Three Mondays, starting Feb. 25. Email Danielle at danielle@montanawomenvote.org

A large mosaic of Norman Rockwell’s 1961  Golden Rule  hangs outside the General Assembly of the United Nations in New York City. May God bless us with a restless  discomfort about easy answers, half-truths, and superficial relationships, so that we may seek truth boldly and love deep within our hearts May God bless us with holy  anger at injustice, oppression, and exploitation of people, so that we may tirelessly work for justice, freedom, and peace among all people. May God bless us with the gift of  tears to shed for those who suffer from pain, rejection, starvation, or the loss of all that they cherish, so that we may reach out our hand to comfort them and transform their pain into joy. May God bless us with enough  foolishness to believe that we really can make a difference in this world, so that we are able, with God’s grace, to do what others claim cannot be done.

A new plan for public health spending in Montana, restoring many of the cuts made in 2017 , has been approved by a legislative subcommittee on health and human services, The committee okayed many of the budget proposals made by Gov. Steve Bullock, including support for the Children's Health Improvement Program (CHIP) and foster care,  as well as higher Medicaid provider rates and slightly higher wages for people who help the elderly and those with disabilities or mental health issues. The measure now goes to the House for approval.

The upcoming battle over Medicaid expansion in Montana this spring will probably focus on work or “community engagement” requirements, favored by Republicans as a condition for continuing the program covering 95,000 Montanans. Here are links to several articles and studies opposed to the work requirements for various reasons: 1) Work requirements could reduce enrollment in Medicaid expansion by a third . ( Once Representative Buttrey’s bill has been introduced, legislative fiscal analysts will come up with their own estimate of how much it will cost to implement.) 2) Work requirements would disproportionately hurt rural Montanans . 3) Montana’s existing HELP-Link program meets workforce needs better than work requirements.   Why are work requirements even being considered? In essence, it's a conservative theory adopted by the Trump administration, and urged upon states, that " sustained employment or other productive community engagement leads to improved he...

Keenan Caferro Buttrey Big Fork Republican Bob Keenan says he will introduce a third bill to decide the fate of Medicaid expansion in Montana. Keenan appears to be focusing on reducing the number of people enrolled through more rigorous screening and putting more responsibility on recipients to get healthier. His bill would also extend Medicaid expansion for just four years. Keenan's bill would join a bill still being drafted by Great Falls Republican Ed Buttrey, who wants to add work or "community engagement" requirements for recipients. Democrat Mary Caffero's bill would pretty much maintain Medicaid expansion as it is now written. Hearings on these bills are not yet scheduled but expected around mid-March.

In an op-ed in Wednesday's Missoulian supporting Medicaid expansion, ACLU executive director Caitlin Borgmann makes two additional points that haven't received much attention: 1) Medicaid expansion enhances public safety . Unsurprisingly,  crime rates fall with increasing access to mental health care and treatment for substance use disorders. This relationship was recently emphasized by UM's Bureau of Business and Economic Research , which found that social benefits from reduced crime due to Medicaid expansion amounts to the billions of dollars. 2) Medicaid expansion " also helps those on probation and parole successfully find their way out of the system" again through greater access to health services for mental health and substance abuse issues.

Members of Holy Spirit's advocacy group have written and sent letters supporting Medicaid Expansion to the Joint Appropriations Committee on Health and Human Services. Here are the letters: February 6, 2019 Rep. Eric Moore, House District 37 487 Signal Butte Rd. Miles City, MT 59301-9205 Dear Rep. Moore: Thank you for your service in our citizen legislature for the past decade and particularly as current chair of the Joint Health and Human Services Committee. We appreciate the difficult choices you must make.  Holy Spirit Episcopal Church in Missoula, with approximately 850 members, is part of the Episcopal Diocese of Montana, as is Emmanuel Episcopal Church in Miles City. Under the guidance and leadership of our national church and state diocese, and as Christians, we take seriously Jesus’ example of caring for the marginalized: those who are poor, widowed, ill, and orphaned—people who lack power and influence.  "Truly I ...

Medicaid Expansion would become permanent and there would be no work requirements, according to a bill, HB 425,  introduced by Rep. Mary Caferro, D-Helena. The bill would raise about $15 million in fees on hospital beds and outpatient revenue and it asks the Legislature to appropriate $6 million to  fund the state’s innovative HELP-link work training program, a voluntary program unlike the language in the Republican bill that would mandate work or "community engagement."

The health of thousands of residents able to enroll in Medicaid with the advent of Medicaid expansion in Montana since 2016 has been improving, according to a new study commissioned by the Montana Healthcare Foundation. The study " shows that receiving coverage under Medicaid expansion has allowed Montanans to access needed medical care,” said MHCF CEO Dr. Aaron Wernham. “As a consequence, even so early in this program, many recipients already report that they are healthier.” Data now being reported monthly by the state Department of Public Health and Human Services indicate that: • More than 90,000 enrollees have received preventive health services. • Nearly 2,500 possible cases of colon cancer have been identified and averted. • Nearly 1,000 people have been newly diagnosed and treated for diabetes. • Nearly 40,000 people have now received outpatient mental health and substance use services, which is expected to help prevent more severe and costly residential and inpa...

A hard look by economists at the first two and a half years of Medicaid Expansion in Montana makes it clear that the program is paying for itself, while bringing more than $600 million into Montana that would not otherwise be here. "While the state pays a nominal amount for these benefits," the report's authors state, "the costs to the state budget are more than offset by the savings created by Medicaid expansion and by the revenues associated with increased economic activity." The report by the UM Bureau of Business and Economic Research, commissioned by Montana Healthcare Foundation and Headwaters Foundation, updates a previous report submitted 10 months ago. With mostly federal dollars, Medicaid expansion provided beneficiaries with nearly $1.4 billion of health care they would not otherwise have had, the report adds. The authors estimate that it will generate between 5,900 and 7,500 jobs and between $350-$385 million in personal income annually betw...

Here is the f irst look at the Republican approach to Medicaid Expansion , based on an interview by NPR with GOP Rep. Ed Buttrey of Great Falls, who is leading his party's effort. As expected, Buttrey's bill proposes some contributions from recipients, what Republicans call "skin in the game." There would be an  80-hour per month requirement to enroll in community engagement for certain people covered by the program. Buttrey anticipates that this requirement would cut the number of enrollees, but not by a lot. "Community engagement" could be hours worked on the job, or hours spent in a substance use disorder treatment, or in different types of counseling. And there would be some exemptions for people, such as for full-time caregivers, people with disabilities, people over the age of 65, pregnant women in their last trimester. Medicaid enrollees would have 180 days to comply.  To help pay for the higher cost for tMedicaid Expansion (and slightly lower f...

Here are a half-dozen super-helpful websites for understanding the Montana Legislature and what's going on this session: A good place to start is the Montana Legislature's website . It's deep, comprehensive, timely, informative and easy to navigate. It's the best way to stay up-to-date on bills, hearings and budget details, and great for finding and contacting legislators. There's also excellent explanatory information about how the Legislature works. That's also the mission of Ripple Rousers --lots of practical information about the Legislature. If you want to stay up-to-date on the issues for which we are advocating, these organizations and their websites are excellent: • Montana Budget and Policy Center focuses on families and economic security, children and education, health care, housing and state-tribal issues, as well as revenue and tax policy pertaining to all of these areas. Great reports, fact sheets and analyses. • Montana Women Vote has be...

Our rector's message in the 2018 Annual Report of Holy Spirit Parish underscores the importance of our advocacy work: "What’s ahead in 2019? As I said in last year’s report, the wider culture at home and worldwide is rapidly changing. Christianity has had to adapt in response to changing needs throughout its history. We must as well. We best serve as stewards of God when we responsibly carry on the work of Jesus with joy and hope. What is that work? To love as he loves us; to notice inequity and injustice, and act for change; and most importantly, to be open to what God is calling us to do today so that the message of Good News is effectively shared and received. When we pause and listen to those around us, seek the heart of their stories, their yearnings, their fears, we are already bringing Good News and the presence of God’s love into their lives. Jesus met people where they were and lifted them up by his very presence, a point from which much more would come. It ...

Missoula County Commissioner Dave Strohmaier, daughter Liezel Strohmaier and The Rev. Gretchen Strohmaier at MAC Day at the Legislature. Gretchen testified before the legislature in support of case management. By bus and by car, a dozen or so Holy Spirit parishioners made their way to Helena on a snowy Martin Luther King Jr. Day to attend hearings, meet legislators and participate in activities hosted by MAC, Montana Association of Christians. At the Capitol, many in the Holy Spirit delegation attended portions of a budget hearing focusing on funding on programs for the developmentally disabled. They heard impressive testimony from Missoulians, focused on the need for better case management, better overall funding for the behavioral health management system and continued Medicaid expansion. Holy Spirit is advocating this year on these issues and it felt good to have so many standing together. It was a good example, parishioners said, of the Holy Spirit in action...