Montana legislators were able to shut down Democratic Governor Steve Bullock’s attempts to expand ObamaCare in Big Sky Country for two years. But in 2015, with the help of Ohio Governor John Kasich and some legislative trickery, Bullock and his pro-ObamaCare allies got their way.
A small group of moderate Republicans joined with the Democrats to change the legislature’s procedural rules and yanked the bill to the floor for a vote. The bill passed narrowly, making Montana the only state in 2015 to legislatively authorize ObamaCare’s Medicaid expansion. (Alaska Governor Bill Walker unilaterally expanded Medicaid in 2015, despite a clear statutory prohibition. He and the legislature are now battling it out in court.)
But before Montana’s expansion even began, it was already breaking promises to taxpayers and putting the truly needy at even greater risk.
Montana opened enrollment to able-bodied adults for its new ObamaCare program last fall, with coverage set to begin January 1, 2016. The state’s administrator for the expansion projected just 18,600 Montanans would enroll in the first six months, with enrollment growing only modestly thereafter.
However, by December 2015, more than 20,000 able-bodied adults had already enrolled, putting Montana’s ObamaCare expansion over-budget on Day 1.
Expansion supporters have been quick to spin this enrollment explosion as an early sign of “success.” But higher-than-expected enrollment means higher costs for taxpayers and less money for other budget priorities, including schools, roads, and law enforcement. Worst of all, it means even less money to take care of truly vulnerable Montanans, including hundreds of adults and children with developmental disabilities, severe mental illnesses, or other disabling conditions.
Ultimately, these overruns should come as no surprise: every expansion state with publicly-available data has exceeded their maximum enrollment projections, signing up more able-bodied adults than these states said would ever possibly enroll, at any point in the future. In many states, more able-bodied adults have signed up for ObamaCare expansion than state officials thought would even be eligible.
Montana officials initially expected enrollment to reach 23,000 by June 2017. But they’re already close to that mark, 18 months early, and this enrollment explosion isn’t going to subside any time soon. In fact, Montana’s waiver agreement with the Obama administration almost guarantees that this enrollment nightmare will get worse.
As part of its Medicaid expansion deal with the federal government, Montana promised to implement “continuous eligibility” for able-bodied adults. This allows enrollees to continue receiving Medicaid benefits for twelve months, even after they become ineligible. Montana’s decision to provide welfare benefits to those who aren’t even eligible will keep enrollment high and leave taxpayers holding the bag.
But there’s more: in order to receive approval for continuous eligibility, Montana officials accepted reduced federal funding for expansion, starting this year. Instead of receiving 100 percent “free” federal money this year, state taxpayers will begin paying for nearly three percent of the costs right away. The state share will go up to nearly 8 percent next year and nearly 13 percent in later years, assuming the federal government actually keeps up its end of the bargain. And that’s a bad bet for policymakers because Congress has already sent a bill to President Obama’s desk that completely eliminated the expansion funding.
Lawmakers in other western states, including South Dakota and Wyoming, are examining their governors’ own ObamaCare expansion plans. Those policymakers should pay close attention to the disaster that is already unfolding in nearby Montana. Expanding Medicaid under ObamaCare is unaffordable, unpredictable, and immoral. They would be well advised to swiftly reject Gov. Mead’s and Gov. Daugaard’s expansion plans and instead fight to protect the truly needy.