Montana’s Medicaid Expansion Battle: Hospitals Flex Political Muscle
By Mike Dennison
HELENA, Mont. — The debate over extending Medicaid expansion in Montana has once again highlighted the power and influence of the state’s hospitals in shaping health care policy. Republican leaders in the legislature, who were skeptical of extending the program, found themselves at odds with hospitals, who not only helped push through the extension but also successfully defeated attempts to impose new regulations on them.
GOP leaders had proposed that hospitals should provide additional community health care services in exchange for supporting the extension of the government health insurance program, which cost taxpayers approximately $1 billion in 2024. However, hospitals proved to be a formidable political force, lobbying against measures such as price caps, mandatory posting of charges, and redirecting Medicaid funds raised by a hospital tax.
Despite calls for greater oversight and transparency, hospitals managed to thwart most legislative efforts to impose new requirements. Nonprofit hospitals, which are largely exempt from state income and property taxes, escaped scrutiny of their community benefits, which justify their tax-exempt status.
Republican Sen. Greg Hertz, a proponent of price caps, expressed frustration with hospitals’ unwillingness to engage in discussions about transparency, cost control, and public information sharing. However, hospitals maintain that they are open to improving health care in Montana and argue that Medicaid expansion benefits all residents of the state.
The Montana Hospital Association (MHA), a powerful lobbying group, played a key role in securing bipartisan support for the extension of Medicaid expansion. With strong ties to lawmakers from both parties, the MHA’s political action committee donated to candidates who supported Medicaid expansion, influencing the passage of the extension bill.
Efforts by lawmakers to redirect Medicaid funds to certain hospitals were met with resistance from the MHA, highlighting hospitals’ influence in the legislative process. Despite some lawmakers’ attempts to impose new regulations on hospitals, the MHA successfully negotiated amendments to a bill requiring nonprofit hospitals to report their community benefits.
As the debate over Medicaid expansion continues, hospitals remain a dominant force in shaping health care policy in Montana. Their ability to mobilize support, influence lawmakers, and navigate the political landscape underscores the significant role they play in the state’s health care system.
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