Against Medicaid expansion? Explain yourself

Having served nine sessions in the Montana Legislature, it's a real honor to represent my constituents and serve Montanans. As citizen legislators serving in a part-time capacity, we are able to stay in close contact with those we represent.

Dave Wanzenried

Over the years, in both my legislative and business interactions, one issue continues to rise above all others: access to affordable health care. Those who have health insurance complain about rising health care and insurance costs. Those without it forego routine, preventive medical care because they cannot afford either health insurance or the medical care itself and, too often, relatively minor medical issues quickly mushroom into major complications.

In the end, those of us fortunate enough to have health insurance, including a majority of my legislative colleagues, all pay a huge, hidden cost each year to pay for those who require medical attention but cannot afford it. This hidden cost is "uncompensated care" for which no payment, or only partial payment is received. Each year in Montana, hospitals alone shift approximately $350 million in uncompensated care costs onto those of us with health insurance.

The result of uncompensated care? An increase in health insurance premiums.

In my book, that's the same as a tax increase. A hidden one.

During the recently concluded 2013 legislative session, legislators had two proposals that would have begun to address the challenge posed by 200,000 Montanans without health insurance. House Bill 590 and Senate Bill 395 proposed to expand Medicaid by using federal funds and thus ensuring 70,000 of our less fortunate neighbors have access to health care. While insuring more Montanans, both measures proposed fundamental reforms and cost-containment measures to the Medicaid program.

When the Republican majority in the House of Representative balked at these ideas, a group of us, Democrats and Republicans alike, rolled up our sleeves, and designed a 'Made in Montana' solution. House Bill 623 was amended by the Senate to authorize the use of federal Medicaid money to pay for health insurance premiums for 70,000 eligible Montanans on the private market.

The House Republican majority rejected this solution as well. It closed the door on low-income, hard-working Montanans and turned away nearly $1.5 billion in federal funding to cover 100 percent of the costs for our uninsured neighbors for the first three years. Unlike the Senate, the full House of Representatives never once discussed the challenging issue of providing health coverage.

And, so, the 2013 Legislature adjourned without doing anything to increase health insurance coverage. Nada. Nothing.

And, here is the tragic truth: More than 140 of the 150 legislators either avail themselves of taxpayer-funded state employee health insurance or take the same monthly payment ($733) and use it to offset the cost of their own private health insurance. And, guess what? Legislators begin receiving health insurance the day they are sworn in, unlike many Montanans who wait a month or more before receiving employer-supported health insurance. Also, unlike many Montanans, legislators do not contribute to the monthly health insurance premium for health insurance; the entire cost is paid for by Montana taxpayers.

That amounts to $8,800 per year per legislator. That's $1.23 million a year or nearly $2.5 million for two years. Not bad, considering that the Montana Constitution limits us to 90 days of work every other year ... we worked 87 days this year.

And, yes, there are other responsibilities like committee work and periodic constituent services between sessions. But, at most the number of days actually worked amounts to no more than 120 days over a two-year period.

So, for working the equivalent of 120 days over two years, legislators receive full health insurance coverage, paid for by Montana taxpayers. The cruel irony is that many of the 70,000 Montanans, who were denied health insurance coverage by a majority of Republicans, actually pay for the cost of the "denier's" health insurance.

My colleagues, who opposed providing access to health care for Montanans, should be asked to explain why they should continue to receive taxpayer-financed health insurance unless they are willing engage in a meaningful discussion regarding how we are going to provide access to healthcare in a cost-effective and efficient manner.

(Dave Wanzenried, a Democrat, is a member of the Montana Senate, representing Senate District 49 in Missoula.)