what Steve Hinebauch has to say
There has been a lot of talk about Medicaid Expansion (Obamacare). Here is some of what I know. One of the first things I look at when I see a bill is the Fiscal Note. This bill had a fiscal note of about $1.4 Billion for the biennium, which would cause one of the largest spending increases ever in the state of Montana. To put it in perspective, that would be approximately $1400 for every man, woman and child, or $5600 for a family of four. That is a lot of money for each family to be responsible for to give insurance to able bodied people, ages 18-64. 90% of the $1.4 Billion comes from the Federal taxpayers, you and me. 10%, which is $140 million, comes from the state taxpayers, again, you and me. That is unless the Feds change the rules and decide to pay less which would make the state pay more. In order to get the state’s $140 Million, the bill sponsors had to decide who to steal it from. There were lots of ideas because there is never a bad tax when it comes to liberals: cigarettes, workman’s comp, private health insurance and many others. One of the big ideas was to raise the bed tax on sick people in the hospitals. The hospital bed tax was raised to $70 per day. So, the next time you, or one of your family, are in the hospital remember that part of your bill is a tax so able-bodied Montanans can have free health insurance.
Go to his facebook post here.
Medicaid improper payments
medicaid improper payments
A Wall Street Journal op-ed November 19, 2019 by Brian Blase and Aaron Yelowitz cites a recent CMS study showing that at least 20% of Medicaid payments are improper. Many improper payments are due to ineligibility.
Montana has about 250,000 recipients. Costs are about $2.2 billion a year.
20% of that is $440 million.
reimbursement rates
Our 2nd highest in the nation provider reimbursement rates are above national average by 50%. The average state pays Medicaid providers 72% of Medicare; we pay 109%. (109% - 72%)/ 72% = 51%
There's $1.1 billion.
If Montana eliminated improper payments and paid national average provider reimbursement rates, we would spend about half as much as currently, saving $1.09 billion a year. Divided equally among all Montana households, that’s $2,594 each.
Sources:
https://www.wsj.com/articles/why-obama-stopped-auditing-medicaid-11574121931
https://dphhs.mt.gov/helpplan/medicaidenrollmentdashboard
https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/
https://leg.mt.gov/content/Publications/fiscal/FR-2021/FR-2021-SECTION-B.pdf
https://www.cato.org/blog/medicaid-improper-payments-are-much-worse-reported
https://leg.mt.gov/content/Publications/Audit/Report/17P-02.pdf
There are 2.38 persons per household in Montana. (Census.gov)
The Mercatus report November 25, 2019
Method:
If all improper payments were eliminated, the reimbursement rate calculation would be based on a lower spend, so the combined number would be less than $1.54 billion. Lowering $2.2 billion by 20% yields $1.76 billion “proper payments.” Reduce by 34% for the premium reimbursement rates we pay (from 1.09 to .72) and you arrive at $1.11 billion. That’s what the state would spend a) with no improper payments, and b) paying providers at the national average. $1.11 billion as opposed to $2.2 billion equals $1.09 billion. ($2.2 billion minus $1.11 billion.) Divided equally among all Montana households, that’s still $2,594 in “overspending.”
A factor that could reduce the calculated “over-spend”:
Not all improper payments are due to ineligibility. Not all improper payments are overpayments. Read the CMS.gov report linked above.
A factor that could increase the first of the two calculations ($440 million): The improper payment rate could be not just 20%, but higher than 25%. See the Cato.org blog post linked above.
Data complied by Rep Tom Burnette
Letter
Dear Pat, Tammy and the Bitterroot Leadership Class
Thank you so very much for hosting the Candidate Forum yesterday. It was very nice to meet you all, and thanks so much for taking an interest in politics. I remember when I was being recruited to run I was told “just because you don’t have an interest in politics doesn’t mean politics doesn’t have an interest in you!” And I have found that to be true. Somebody has to do it.
We covered a lot of ground in a short period of time yesterday at the Candidate Forum. I’d like the opportunity to complete the loop on some of the issues I made reference to, but could not effectively communicate the details in the time allotted. Attached is a few of the links to articles and information that I talked about yesterday.
Sadly, time is proving what the citizens of Ravalli County and conservative Republican legislators knew all along - Obamacare/Medicaid Expansion is a MESS! A big, bloated, enormously expensive, unaccountable, murky mess…to put it bluntly. I’m known for that. 
:-)
Sixty percent of Ravalli County citizens voted NO on the Medicaid Expansion initiative on the last ballot, and their decision should have been respected. But instead of honoring their “no” and the integrity and independent nature of our Montana citizens, 20 Republicans teamed up with the Democrats to pass it anyway. This vote went against the will of the people and the majority of the Republican caucus, not to mention the constitutional directive we’re given in Article II of our State Constitution- “All political power is vested in the people…and founded upon their will only…”
When Medicaid X was originally carried by a “Republican” and passed in 2015, it added over 96K, working aged adults, without children to the Medicaid enrollment figures. Our enrolled population went from 5% of citizens who truly need services, to todays figure of 25% of our entire population being enrolled in Obamacare/Medicaid Expansion. The result is that those with actual disabilities who truly need Medicaid are seeing their services rationed.
Enrollment in the program is incentivized. Every dollar spent by the state is matched with 9 federal dollars. We are now realizing that FAR TOO MANY truly ineligible (able bodied, working aged adults, without children) people have been enrolled in Medicaid. We have an enrollment error ratio somewhere between 20 and 50%! No, that’s not a typo. Audit results are forthcoming. In other words, we’re stealing money from the federal government to sustain this House of Cards and it’s only a matter of time before it all comes tumbling down upon us. The federal government is going to want their money back, one way or another. It's affecting our credit rating and our ability to sell bonds for our infrastructure building projects.
I’ve attached a few links to recent articles and studies that makes this clear.
I’ve also attached a link from the state web site to the activity of the actual Medicaid Expansion bill. I thought it might be fun for the Bitterroot Leadership Class to become familiar with the state web site and all the information that’s available at their fingertips, should they ever want to make use of it. Every legislative aspect the bill went through can be tracked from the link provided below. The actual language of the bill, the video archives of the hearings, as well as the specific vote tallies on who voted for and against it are recorded there. Many of the entries on the spread sheet are hyper links that lead to additional information, and you’ll just need to spend some time clinking on them to see where they lead. “First reading”- which is the initial committee hearing a bill receives. “Second reading”- which is the debate on the House and Senate floors, and finally “Third reading”- which is ultimately the final vote in the House and the Senate can all be viewed through the link below. Link to Obamacare/Medicaid Expansion HERE-
Notice the “work requirements” touted by the proponents of the bill on page 1 and 2. The actual language is “community engagement” and includes volunteering, going to school, attending rehab or probation, and work force training for those between 18 and 55 years old, 80 hours per month. So while “we added work requirements” makes for a palatable political sound byte, it’s disingenuous IMO, and a bit insulting to those who actually work for a living.
Also, I’m quite certain I heard Rep Ballance say she “did not raise taxes” in her closing remarks yesterday. Sadly, that’s a patently false claim and needs to be recognized as such. Let us recall how Justice Roberts justified imposing Obamacare on us in the first place - by calling it a tax.