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Today in Montana: Big Win on Medicaid Expansion

Today, Montana Governor Steve Bullock signed SB 405 into law, making Montana the 29th state in the country to expand health coverage for low-income residents through Medicaid expansion.

Thanks to this bill, up to 70,000 Montana residents who are currently uninsured will be eligible for quality, affordable health coverage for the first time. It’s a big victory for Montana families and communities. But it didn’t come without a fight.

To an outside observer, the odds may not have looked good going into the 2015 legislative session. Medicaid expansion had already failed to clear the Montana Legislature once before. And the Montana chapter of Americans for Prosperity (AFP is the flagship organization in the Koch network) was throwing all its weight behind ginning up opposition and trying to scare moderate lawmakers away from the negotiating table.

But the Healthy Montana Campaign, a statewide coalition of 10 core partner organizations working in support of Medicaid expansion, was undeterred. Through three years of disciplined organizing, the coalition sent a clear message: when it comes to quality, affordable health care, we’re in it to win it. And that’s exactly what they did.

The Montana Organizing Project (MOP), an affiliate of the Alliance for a Just Society, played an integral role in the organizing that made this victory possible, mobilizing its base of members and leaders across the state, including in rural and eastern Montana, to join the fight.

MOP and HMC partners knew it would require a large-scale grassroots effort to overcome the Koch money on the other side. So they started early. And never quit.

In 2014, when MOP ran a nonpartisan civic engagement project focusing on low-income women voters that logged 19,000 phone calls, 3,500 doors knocked, and more than 3,000 “I pledge to vote” cards. They not only boosted turnout in their target universe – they also built a list of Medicaid expansion supporters, and prepared those supporters to take action.

As the 2015 session got underway, MOP mobilized its supporters to turn out at rallies, testify at legislative hearings, make calls to key legislators, and write letters to the editor.

Leaders in the Campaign expected an onslaught of opposition from Americans for Prosperity. But at the first legislative hearing, the Healthy Montana Campaign rallied 250 supporters, including businesses and statewide organizations. Americans for Prosperity turned out fewer than a dozen people in opposition.

Through this show of strength in numbers, partners in the HMC highlighted the difference between their grassroots support from Montana families and AFP’s astroturf opposition.

That set the tone for the debates to follow. And when AFP tried to run town hall meetings in the home districts of swing legislators to drum up opposition, they got out-smarted and out-organized: the targeted legislators showed up, won the crowds over, and turned them against AFP.

The final deal on Medicaid expansion in Montana isn’t perfect. It includes some provisions the HMC strongly opposed – like mandatory premiums (up to 2 percent of the recipient’s income), a co-pay of up to 3 percent, the ability to remove people who earn above 100 percent of the poverty level and fail to pay their premiums from the program, and a sunset provision.

But the Campaign won on its two most important goals: making sure the final deal accepts all of the federal funding available for Montana, and ensuring that everyone earning up to 138 percent of the poverty level (about $16,000 for a single person) will be eligible. That means up to 70,000 low-income Montanans who’ve had nowhere to turn will be eligible for quality, affordable health coverage thanks to Medicaid expansion.

The passage of Medicaid expansion will also help small, rural hospitals across Montana – hospitals that may otherwise have faced closure due to funding shortfalls – to remain solvent, preserving access to health care for rural communities and preserving good-paying health care jobs in those communities.

The work for quality, affordable health care in Montana isn’t over, of course. While today’s signing of Medicaid expansion is a great stride in expanding health coverage, there’s still a lot of work to do to make sure getting health coverage translates into getting health care, especially for women, Native Americans, and rural residents. MOP and the HMC partners look forward to engaging in the Waiver process to ensure that as many Montanans as possible get covered and get on the path to quality care.

There’s a lot more organizing and more fights ahead to make health care reform fulfill the promise of eliminating race and gender-based disparities in health access and outcomes in Montana. The Montana Organizing Project will be in the thick of that work.