HELENA, Mont. — As Republican legislative leaders in Montana girded for this 12 months’s battle over whether or not to increase Medicaid enlargement within the state, they took intention at one of many program’s greatest backers: hospitals.
If Montana’s hospitals wished to increase the federal government medical insurance program that value taxpayers about $1 billion in 2024, and profit from that income, they need to give one thing again, resembling extra group well being care providers and advantages, GOP leaders argued because the session started in January.
However as an alternative, they discovered simply how formidable a political power the state’s hospitals will be. The hospitals not solely helped steamroll Medicaid enlargement via the legislature, however in addition they defeated almost all makes an attempt so as to add new necessities to this system and to put new laws on hospitals themselves.
Hospitals opposed and defeated payments to impose value caps and to prominently publish their costs and killed an try and redirect Medicaid funds raised by a hospital tax.
Most Montana hospitals are nonprofit organizations which might be largely exempt from state revenue and property taxes. Legislators requested drafts of a number of payments to scrutinize hospitals’ “group advantages,” the providers they supply without spending a dime or at discounted prices that justify their nonprofit standing, however didn’t introduce them through the session.
The solely such invoice launched has been considerably amended, on the hospitals’ request.
The state hospital lobbyists’ political pull has annoyed conservative lawmakers in management positions who’re looking for extra oversight of and transparency from the hospitals.
“Hospitals don’t appear to wish to come to the desk to debate something, whether or not it’s transparency, controlling prices, or offering extra data to the general public on providers,” stated Republican state Sen. Greg Hertz, who sponsored the price-cap invoice that was rejected on the Senate ground this month.
Hospitals say they’re keen to debate methods to enhance well being care in Montana, they usually level to Medicaid enlargement as a program whose advantages move to all corners of the state.
But in relation to laws they regard as onerous or criticism that they’re uncooperative companions on well being care coverage, the hospitals aren’t shy about pushing again.
“I don’t suppose I’ve ever been approached by any of them on reforming the well being care system,” Montana Hospital Affiliation president and CEO Bob Olsen stated of the hospitals’ critics within the legislature. “I believe that we’ve demonstrated that we work on every kind of well being insurance policies.”
Republicans maintain huge majorities this legislative session and their conservative leaders — most of whom opposed extending Medicaid enlargement — have usually seen hospitals as a political foe.
However Montana’s hospitals have at all times been a robust foyer within the state, with bipartisan attraction. The state’s 63 hospitals make use of about 30,000 folks, in accordance with the MHA, together with most of the state’s physicians, and have a number of lobbyists on the Capitol, each on their very own and thru the hospital affiliation.
Additionally they have a robust ally in state Rep. Ed Buttrey, a average Republican who is also on the board of administrators of Benefis Well being System. Buttrey sponsored the unique 2015 Montana Medicaid enlargement invoice and payments to resume this system in 2019 and this 12 months.
Up to now 12 months, hospitals labored to type a coalition with companies, well being clinics, doctor teams, insurers, and advocates for folks with low incomes to push for extension of Medicaid enlargement, which offers authorities well being protection to about 74,500 low-income, nondisabled Montanans.
Medicaid enlargement had been set to run out this June, however the invoice extending it breezed via the legislature, passing by snug margins in February, with bipartisan help. Republican Gov. Greg Gianforte signed it into regulation final month.
The MHA has a political motion committee that donates to a number of lawmakers of each events. In 2024, it paid specific consideration to allies of Medicaid enlargement.
The PAC gave $61,000 to the Montana Democratic Occasion and $75,000 to a political committee that supported average Republicans in contested GOP legislative primaries final June, in accordance with filings with the state commissioner of political practices.
The majorities that handed Medicaid enlargement in February included each Democrat within the legislature and most of the average Republicans supported by the political committee financed partly by the MHA.
Democrats even have been voting nearly universally towards payments that may impose new laws on hospitals.
Hertz’s invoice, which might have capped bigger hospitals’ costs at 300% of the Medicare fee for many procedures, failed on the Senate ground this month on a 26-24 vote. All however one Democrat and 9 Republicans voted towards it.
State Sen. Cora Neumann, a Democratic member of the Senate Public Well being, Welfare and Security Committee, additionally voted towards a invoice requiring nonprofit hospitals to indicate that their group advantages meet or exceed the worth of their property tax exemptions.
Neumann stated she helps higher entry to reasonably priced care in Montana however that “the insurance policies now we have been offered with are usually not effectively thought out and lift considerations for me about authorities overreach.”
State Rep. Jane Gillette, a Republican who chaired the legislative panel overseeing well being care spending within the state price range, tried final month to redirect a small portion of Medicaid enlargement funds — $7 million a 12 months — to sure hospitals. The cash is a part of $365 million generated yearly by a tax on hospital providers, and the corresponding federal match, in accordance with Olsen, the hospital affiliation chief.
Half of the $7 million would go to smaller, impartial hospitals and the opposite half can be distributed to hospitals displaying “distinctive well being outcomes and efficiencies,” she stated.
The Home Appropriations Committee agreed March 24 to insert her proposals into the session’s predominant price range invoice.
However per week later — after hospitals lobbied towards the change — the identical committee torpedoed language in a separate invoice that may have carried out the adjustments. The subsequent day, on the Home ground, all however one Democrat and 25 Republicans shaped a two-thirds majority to take away the funding change from the price range invoice.
“That tells you what a stronghold the hospitals have,” Gillette stated. “Even a slight variation to our present system just isn’t acceptable to them.”
Olsen stated the change would have taken cash from some bigger hospitals and moved it elsewhere, and never essentially to the smaller hospitals Gillette hoped to assist.
“She approached us, however by no means tried to work with us,” he stated. “It wasn’t going to succeed in these hospitals that she wished to succeed in.”
Senate President Matt Regier, a Republican, made a final try and insert Gillette’s modification into the state price range invoice on the Senate ground on April 17, however it was rejected on a 27-23 vote, with all 18 Democrats and 9 Republicans voting no.
Hospitals are, nonetheless, working with Regier on his community-benefit reporting measure — the last-standing invoice that may impose new laws on hospitals.
The invoice says if the group advantages reported by nonprofit hospitals don’t equal or exceed the worth of their exemption from property taxes, they need to pay the distinction right into a fund that may be distributed to small, “essential entry” hospitals.
Through the invoice’s preliminary listening to April 2, Regier — a Medicaid enlargement opponent and typically sharp critic of the hospitals — stated he was open to amendments that hospitals may discover acceptable.
The unique invoice cleared the Senate April 5 on a party-line, 30-18 vote, with Republicans in favor. Then, in a Home committee assembly on April 17, Republicans connected amendments that had the hospitals’ blessing and despatched the invoice to the Home ground.
The adjustments delay the regulation’s efficient date till 2027 and extra particularly outline the group advantages that should be reported and the potential property tax legal responsibility to which hospitals should match their profit.
Olsen stated the MHA will help the amended invoice.
“The reality of it’s, hospitals have at all times far exceeded the tax exemption for group advantages, on the spending they do,” he stated. “Some may fall quick, infrequently — however over the lengthy haul, they exceed these exemptions.”
Regier’s try and quantify the quantity and evaluate it to nonprofit hospitals’ tax exemption just isn’t unreasonable, Olsen stated: “I’m assured hospitals can do it.”
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