Eric Moore 

Legislative Report

 

April 11, 2019



Health Care, the 900# gorilla.

The 2019 legislature is in the home stretch, and I, for one, am anxious to wrap up our work and get home. There are crops to be planted and calves to be branded.

At the end of March, the legislature voted on one of the most important and controversial bills of the session. That was whether, and in what form, the state should retain or discontinue the Medicaid expansion bill passed in 2015. I spend a goodly amount of time researching this issue, and I now know more about medicaid waivers and federal healthcare law than I ever thought I would. Its a monstrously complicated issue, but I'll hit the high points:

1) The reality of the situation is that there are not enough votes in the legislature to kill medicaid expansion. Even if there were, the governor would keep calling us back into special session until a bill was passed. The governor has the bully pulpit, the communication staff, usually the press, and a bill would eventually get through.

2) The bill that passed the House was NOT the same policy that was rejected by the voters last fall in I-185. First, this is NOT paid for with new taxes. Rather, those who benefit the most from the influx of federal dollars (large hospitals and insurance companies) are asked to pay a major portion of the state's share. They are still way better off. Second, this bill has work requirements, asset tests, and premiums for insurance. Should the work requirements be thrown out by a court, the program automatically discontinues. The governor's bill had none of these provisions.

3) I am not, and never have been, a supporter of Obamacare. However, it cannot be denied that Republicans had two years with the Presidency and both houses of Congress. They had their chance to come up with a better alternative, and they failed to do so. Now it appears that Obamacare will be the law of the land, at least for a while. States have to react to the current situation as best they can. I will continue to hope our federal government will act.

4) Healthcare is not a free market so long as we, as a Judeo Christian country decide that we will not deny healthcare to those who cannot pay. So supply cannot be rationed. That leaves us with finding the most efficient method of delivery. And that is NOT emergency rooms. In other words, kicking the expansion population off medicaid does not eliminate the cost of their healthcare to society. We just pay for charity care through higher insurance premiums, and we risk losing our rural and critical access hospitals.

5) Another big difference between this bill and the governor's proposal that was defeated in I-185 is that the funding has to be approved by the legislature every two years. The original HELP act, passed in 2015 was funded by what is called a statutory appropriation. That means the funding continues unless both the legislature AND the governor decide to stop it. By being in the regular budget, this program will have to prove its worthiness every two years.

I had hoped for more in the bill in terms of minimum work hours required as well as a maximum number of months any individual can be on the program. Surprisingly, these are not allowed under federal waivers, even under President Trump.

Politics is the art of the possible. It would have been much easier for me to vote no on any kind of medicaid expansion. The republican caucus in the House was divided on the issue. Out of 58 total members, 7 voted for no medicaid expansion whatsoever, 31 voted for the governor's plan, and 20, including myself, voted for the conservative version mentioned here. It passed the House 61 to 37 on March 30th, and is now in the Senate. I believe that this bill was the best republican solution we could get under federal law, and that doing nothing was not realistic and put too much risk on our rural hospitals. Thank you for allowing me to be your representative. Contact me any time.

Eric Moore

 

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