By Dustin Hurst | Watchdog.org
HELENA – Following his final budget presentation ever Thursday night, Democratic Gov. Brian Schweitzer, always the consummate showman, handed reporters $2 calculators, the simple tool he says he used to balance the state’s books during his 8-year tenure.
Perhaps he’s fibbing a bit about using a single tool to bring the financial books into the black, because his latest budget reveals Schweitzer can peer deeply into the future’s stormy bowels.
Too bad the grandstanding governor didn’t share his crystal ball, too.
And his Etch A Sketch.
In his latest budget write-up, Schweitzer calls for expansion of the Medicaid program, a move prompted by the Patient Protection and Affordable Care Act, also known as the 2010 health care reform law. Expansion means 80,000 Montanans could join Medicaid’s ranks starting in January 2014.
The swelling, Schweitzer said, would cost Montana a mere $5 million in administrative expenses.
To arrive there, Montanan must increases its eligibility to 133 percent of federal poverty level, or about $30,000 for a family of four. The health care law requires the state to increase its Medicaid ranks, but the U.S. Supreme Court rolled that back in June, saying states decide if they want to jump into the plan.
Swelling Medicaid’s ranks stands as a sweet deal for Montana’s government now. The feds, under the health reform law, cover 100 percent of the costs for newly eligible enrollees from 2014 through 2016 and then gradually reduce federal payments down to 90 percent in 2019 and beyond.
That contrasts with the standard for already enrolled Montanans. In 2011, for example, the feds covered about 67 percent of Montana’s Medicaid expenses and the state carried the rest.
Schweitzer’s touting the Medicaid expansion as health care on the cheap, but he hasn’t always been so hot to trot on the program — or expanding it.
In an Aug. 29, 2010, C-SPAN interview, Schweitzer offered an unsettling assessment of Medicaid.
“The second problem we have is that one of the least effective programs in terms of health care, in the history of this country, is something called Medicaid,” the governor said. “About 20 percent of America is on a Medicaid program and they would like to shift it and grow it to somewhere around 25 or 30 percent. In Montana’s case alone it would add $115 million to our costs in our state, as our match. Now Medicaid is a system that isn’t working, almost everyone agrees.”
That wasn’t the only avenue Schweitzer traveled to voice his disdain.
“I thought, ‘My gosh, if I’m going to have to double my patient load and run the risk of bankrupting Montana, why wouldn’t I look at a system that a neighbor is using for those people that are in the Medicaid population?” Schweitzer offered in an October 2011 Yes Magazine interview.
Yet, Schweitzer grabbed his Etch A Sketch, rewrote his stance and positioned the state firmly at the federal government’s supposed free money trough.
“Medicaid expansion isn’t even a rounding error, and you have 80,000 Montanans covered with health care,” he said, as reported by The Missoulian.
The Montana Policy and Budget Center, a liberal think tank, praised the move, saying it the governor exercised simple common sense.
“The governor’s budget includes the expansion of Montana’s Medicaid program — a decision that will provide health care for tens of thousands of hardworking Montanans, from ranchers to restaurant workers, and create well-paying jobs across the state,” said MPBC Director Tara Veazey.
“Other than relatively small administrative costs associated with expanded eligibility, 100 percent of the costs of this expansion are covered by the federal government for the first three years, allowing Montana’s leaders to find state-based solutions to our health care challenges and grow the program in a way that capitalizes on our state’s unique opportunities and characteristics.”
Some analysts remain skeptical about the deal, wondering if the feds will — or can — hold up its end of the bargain. The Cato Institute’s Michael Tanner wrote earlier this year that states should view with healthy skepticism the federal government’s pledge to pick up 90 percent of new enrollee costs past 2019.
“Given the enormous debt facing the federal government, promises of future funding are far from written in stone,” Tanner wrote.
Further, Tanner notes, even 10 percent of new costs represent a large sum for states.
“It is true that at first the federal government will pick up nearly 100 percent of the cost for new enrollees made eligible by the expansion, but within the decade these federal subsidies are reduced to 90 percent, leaving state taxpayers on the hook for 10 percent of the cost — and 10 percent of a very large cost is still a very large cost,” he warned.
Over at the Heritage Foundation, analysts advise against trusting the feds on the 10 percent payment rate anyway. Alyene Senger notes in her September piece that President Barack Obama has already proposed lowering the match rate starting in 2017.
That assessment, from a right-wing think tank no less, dovetails nicely with Schweitzer’s own projection – well, before he Etch A Sketched away his original feelings on Medicaid expansion.
“And if you believe that this bill is not going to change between now and ’17, ’18, and ’19, when a lot of this kicks in, then you are smoking your own belly button lint,” Schweitzer said in July 2009.
While Schweitzer’s duty calls for his focus solely on state matters, he ignores that Medicaid expansion will cost bundles and bundles of cash. Through the next decade, the federal government could spend upwards of $642 billion on the new expense.
Montana’s expansion, however, is hardly a sure thing. Incoming Gov.-elect Steve Bullock remains unsure if he’ll pursue expansion. He said he’ll decide later this year when he releases his tweaks to Schweitzer’s spending proposal.
The Republican-controlled Legislature, too, could also serve as a blockade to expansion.
Contact Dustin Hurst at Dustin@Watchdog.org or @DustinHurst via Twitter.