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A bill to continue Montana’s Medicaid expansion cleared an initial vote in the state House on Friday, a mile marker for one of the most high-consequence policies lawmakers are debating this session.

The legislation, sponsored by , would lift the 2025 sunset on the low-income health care program that insures roughly 75,000 Montana adults between the ages of 18 and 65. The jointly funded state-federal program has been in place since 2015. It survived another cliff in 2019 when a bipartisan group of lawmakers voted to maintain it with a termination date of this summer. 

On Friday, 63 Republican and Democratic House lawmakers voted in favor of . All 37 opponents to the bill were Republicans. It is the first Medicaid bill to receive a debate before a full chamber of the Legislature, though it’s not the only major proposal lawmakers are considering. As of Friday, a bill that would by prohibiting new enrollment after September of this year is still pending in the Senate. Another bill to maintain the expansion program, sponsored by Rep. Mary Caferro, D-Helena, last month.

Buttrey and other lawmakers on Friday cast the expanded Medicaid program as a critical safety net for workers and a financial lifeline for health care providers and rural hospitals. 

Citing a from the state Department of Labor and Industry, Buttrey said more than 20,000 Montana businesses had employed at least one person in 2023 covered by Medicaid expansion. That’s more than a third of private-sector businesses in the state.

“These businesses are the backbone of every Montana community, and they rely on our program to provide them with a healthy, trained and reliable workforce,” Buttrey said. 

Other lawmakers made personal references to how Medicaid has helped them or their family members. , said Medicaid helped him cover health care costs and stabilize his finances, giving him enough security to adopt his niece and nephew. 

“I’m proud that I can do that, that I’m able to have the capacity to be able to take care of two other human beings. And it was all because of Medicaid expansion,” Hawk said. “It was a huge help.”

Buttrey’s bill also received extensive remarks from lawmakers who oppose continuing the program. Some cited its roughly $1 billion annual price tag, 90% of which is paid by the federal government, a greater portion than the cost-sharing Medicaid programs for seniors and people with disabilities.

But if that funding rate were to change, some Republicans said it would kneecap Montana’s finances.

“I hope that we continue to really consider where we’re going to be if the [federal match] changes,” said . “Because the people that have been testifying will essentially be back and say, ‘We have to do whatever it will take to continue Medicaid expansion.’ And if the match isn’t 90-10, if it is like every other part of traditional Medicaid, right around 62-38, it is a financial burden that we could not afford to bear.”

Buttrey said that Montana’s original law from 2015 sets out criteria for the program to continue if the federal match were to decrease. that the Legislature take action or that the state health department increase premiums to make up the difference.

Lawmakers also debated the program’s benefit to rural hospitals and major health care systems, major industry groups that are lobbying in favor of Medicaid expansion, along with the Montana Chamber of Commerce. Buttrey sits on the board of the Great Falls-based Benefis Health System, but he said Friday that he does not have additional benefits or associations to disclose.

, said the program’s overall budget could be better spent serving rural health providers and helping get people out of poverty.

“This is not your only bite at the apple. There are a lot of bills in play right now that are coming down that have to do with improving Medicaid expansion, not just sitting with our old version of Medicaid expansion, which clearly has failed the taxpayers of Montana,” Gillette, who chairs the budget subcommittee that oversees the state health department, told fellow lawmakers. “We can do better. And we owe our constituents better than what we’ve been doing.”

Two other motions related to HB 245 failed to pass muster by the full chamber. One Republican-proposed amendment would have required the state health department to resubmit its Medicaid expansion waiver to the federal Centers for Medicare and Medicaid Services. Another Republican-backed effort to refer the bill to House Appropriations also failed in a 38-61 vote.

The bill must pass another vote before the full House before being transmitted to the Senate.