Mike Dennison
HELENA, Mont. — As Republican legislative leaders in Montana girded for this 12 months’s battle over whether or not to increase Medicaid growth within the state, they took purpose at one of many program’s greatest backers: hospitals.
If Montana’s hospitals wished to increase the federal government medical insurance program that cost taxpayers about $1 billion in 2024, and profit from that income, they need to give one thing again, resembling further group well being care companies and advantages, GOP leaders argued because the session started in January.
But as a substitute, they discovered simply how formidable a political drive the state’s hospitals could be. The hospitals not solely helped steamroll Medicaid growth by way of the legislature, however additionally they defeated almost all makes an attempt so as to add new necessities to this system and to position new laws on hospitals themselves.
Hospitals opposed and defeated payments to impose price caps and to prominently post their charges and killed an try to redirect Medicaid funds raised by a hospital tax.
Most Montana hospitals are nonprofit organizations which might be largely exempt from state earnings and property taxes. Legislators requested drafts of a number of payments to scrutinize hospitals’ “community benefits,” the companies they supply at no cost or at discounted prices that justify their nonprofit standing, however didn’t introduce them throughout the session.
The only such bill introduced has been considerably amended, on the hospitals’ request.
The state hospital lobbyists’ political pull has annoyed conservative lawmakers in management positions who’re searching for extra oversight of and transparency from the hospitals.
“Hospitals don’t seem to want to come to the table to discuss anything, whether it’s transparency, controlling costs, or providing more information to the public on services,” mentioned 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 growth as a program whose advantages circulate to all corners of the state.
Yet with regards 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 think I’ve ever been approached by any of them on reforming the health care system,” Montana Hospital Association president and CEO Bob Olsen mentioned of the hospitals’ critics within the legislature. “I think that we’ve demonstrated that we work on all kinds of health policies.”
Republicans maintain huge majorities this legislative session and their conservative leaders — most of whom opposed extending Medicaid growth — have usually seen hospitals as a political foe.
But Montana’s hospitals have at all times been a robust foyer within the state, with bipartisan enchantment. The state’s 63 hospitals make use of about 30,000 individuals, in response to the MHA, together with lots of the state’s physicians, and have a number of lobbyists on the Capitol, each on their very own and thru the hospital affiliation.
They even have a robust ally in state Rep. Ed Buttrey, a average Republican who is also on the board of directors of Benefis Health System. Buttrey sponsored the unique 2015 Montana Medicaid expansion bill and payments to resume this system in 2019 and this year.
In the previous 12 months, hospitals labored to type a coalition with companies, well being clinics, doctor teams, insurers, and advocates for individuals with low incomes to push for extension of Medicaid growth, which offers authorities well being protection to about 74,500 low-income, nondisabled Montanans.
Medicaid growth had been set to run out this June, however the invoice extending it breezed by way of the legislature, passing by comfy 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 explicit consideration to allies of Medicaid growth.
The PAC gave $61,000 to the Montana Democratic Party and $75,000 to a political committee that supported average Republicans in contested GOP legislative primaries final June, in response to filings with the state commissioner of political practices.
The majorities that passed Medicaid expansion in February included each Democrat within the legislature and lots of the average Republicans supported by the political committee financed partly by the MHA.
Democrats even have been voting nearly universally in opposition to payments that will impose new laws on hospitals.
Hertz’s invoice, which might have capped bigger hospitals’ costs at 300% of the Medicare charge for many procedures, failed on the Senate ground this month on a 26-24 vote. All however one Democrat and 9 Republicans voted in opposition to it.
State Sen. Cora Neumann, a Democratic member of the Senate Public Health, Welfare and Safety Committee, additionally voted in opposition to a invoice requiring nonprofit hospitals to indicate that their group advantages meet or exceed the worth of their property tax exemptions.
Neumann mentioned she helps higher entry to inexpensive care in Montana however that “the policies we have been presented with are not well thought out and raise concerns for me about government overreach.”
State Rep. Jane Gillette, a Republican who chaired the legislative panel overseeing well being care spending within the state finances, tried final month to redirect a small portion of Medicaid growth funds — $7 million a 12 months — to sure hospitals. The cash is a part of $365 million generated yearly by a tax on hospital companies, and the corresponding federal match, in response to Olsen, the hospital affiliation chief.
Half of the $7 million would go to smaller, unbiased hospitals and the opposite half can be distributed to hospitals exhibiting “exceptional health outcomes and efficiencies,” she mentioned.
The House Appropriations Committee agreed March 24 to insert her proposals into the session’s major finances invoice.
But every week later — after hospitals lobbied in opposition to the change — the identical committee torpedoed language in a separate invoice that will have applied the modifications. The subsequent day, on the House ground, all however one Democrat and 25 Republicans formed a two-thirds majority to take away the funding change from the finances invoice.
“That tells you what a stronghold the hospitals have,” Gillette mentioned. “Even a slight variation to our current system is not acceptable to them.”
Olsen mentioned 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, but never tried to work with us,” he mentioned. “It wasn’t going to reach those hospitals that she wanted to reach.”
Senate President Matt Regier, a Republican, made a final try to insert Gillette’s modification into the state finances invoice on the Senate ground on April 17, nevertheless 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 bill 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 will be distributed to small, “critical access” hospitals.
During the invoice’s preliminary listening to April 2, Regier — a Medicaid growth opponent and generally sharp critic of the hospitals — mentioned he was open to amendments that hospitals would possibly discover acceptable.
The unique invoice cleared the Senate April 5 on a party-line, 30-18 vote, with Republicans in favor. Then, in a House committee assembly on April 17, Republicans connected amendments that had the hospitals’ blessing and despatched the invoice to the House ground.
The modifications delay the regulation’s efficient date till 2027 and extra particularly outline the group advantages that have to be reported and the potential property tax legal responsibility to which hospitals should match their profit.
Olsen mentioned the MHA will help the amended invoice.
“The truth of it is, hospitals have always far exceeded the tax exemption for community benefits, on the spending they do,” he mentioned. “Some might fall short, from time to time — but over the long haul, they exceed those exemptions.”
Regier’s try to quantify the quantity and examine it to nonprofit hospitals’ tax exemption just isn’t unreasonable, Olsen mentioned: “I’m confident hospitals can do it.”
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