Two leaders of Montana’s successful Medicaid expansion movement told Kansas expansion advocates Monday that persistence, organization and discretion were keys to getting it done in their state.
Dozens of people who represent Kansas groups that favor Medicaid expansion gathered in Topeka to hear from Kim Abbott of the Montana Human Rights Network and Tara Jensen of the Montana Budget and Policy Center.
The pair said that when the broad-based coalition started its push for expansion in 2013, few people thought it would happen. But before the end of the Montana legislative session that year, the coalition moved a compromise plan to the floor that failed by only one vote.
“It really got people’s attention in the state,” Abbott said.
It took two more years, but last month Montana became the 30th state to expand Medicaid, opting for a revised plan that provides access to private insurance, offers job training assistance and requires some cost-sharing, like premiums and co-pays.
Monday’s event was hosted by the Sunflower Foundation, a nonprofit focused on improving the health of Kansans. The foundation is one of six members of the Kansas Grantmakers in Health, which last week released a report indicating Medicaid expansion would pay for itself in the state.
Billie Hall, the foundation’s president and CEO, said the Kansas advocates are where the Montana advocates were in 2013 — getting organized and hashing out what core principles must be included in any Medicaid expansion plan.
“We have just started modeling a community campaign along the lines of Montana, but we have not had the amount of time they’ve had,” Hall said. “But I feel very positive about it. Because from what we can tell, most Kansans, when you have a little information, understand the importance of Medicaid expansion.”
Like Kansas, the Montana Legislature is controlled by conservative Republicans resistant to expanding Medicaid under the Affordable Care Act, which is commonly called Obamacare.
But Montana has a Democrat governor, Steve Bullock, who pushed publicly for expansion. Abbott said that was a big help.
In Kansas, Republican Gov. Sam Brownback opposes expansion as part of Obamacare.
Montana also had a budget surplus, while Kansas is facing a financial hole of more than $100 million for the second straight year. After next year states will have to start picking up a percentage of the tab for expansion, which is currently funded entirely by the federal government.
“It’s important to flag what’s similar and what’s different (between the two states),” Abbott said.
But she and Jensen both said there were lessons Kansas advocates could take from Montana.
One was to bring expansion advocates together in an organized way. The failed 2013 vote turned out to be a blessing in disguise, Jensen said, because it forced the Montana advocates to coalesce around a set of concepts rather than take opposing stances on elements such as premiums and co-pays.
“We knew that our dream legislation, for all of us, was not going to happen,” Jensen said. “We did not have the votes at all, so you have to get to a place where you all agree. … We needed to show a collective unified force, so the votes we needed could be a collective, unified force.”
The Montana groups shared funding and coordinated messaging.
Persistence also was a key, Abbott said. The coalition met within a week of every legislative defeat or setback and kept the pressure on legislators both at the Capitol and in their districts.
They also were careful about how they deployed their resources, focusing on a core group of “targets” in the Legislature that they thought could be moved to vote for their side.
And they did not lobby the conservative leaders.
“We weren’t moving them,” Jensen said. “They were never moving.”
Abbott said the coalition focused on 19 legislators in the Montana House and nine in the Senate. Coalition conversations about those legislators came in closed meetings, and those discussions were confidential.
Some of the Montana coalition’s experiences were directly applicable to Kansas. Rural hospitals in both states face financial woes that could be eased by Medicaid expansion.
Abbott and Jensen said their coalition urged Montana hospital administrators to speak with their legislators privately about financial struggles if they weren’t willing to air them publicly.
The Montana coalition also faced resistance from a group of legislators who argued that Medicaid’s medical coverage should not be expanded until support services are funded for disabled Kansans on waiting lists.
The Brownback administration has made the same argument.
Abbott said a group called Disability Rights Montana countered that argument, which frequently came from legislators not previously concerned about the waiting lists.
“Those guys and a couple other groups really took the lead on saying, publicly, ‘Yes this (waiting list) needs to be addressed, absolutely this needs to be addressed, here’s how we address this, but don’t you dare say we can’t do this (Medicaid expansion) — that is a distraction,’” Abbott said.
Abbott and Jensen also said getting uninsured Montanans to share their stories publicly was important. The Montana coalition estimated that about 70,000 people could gain coverage through expansion there.
In Kansas, an estimated 150,000 people would gain coverage if eligibility is expanded to non-disabled adults earning up to 138 percent of the federal poverty line, which is annually $16,105 for an individual and $32,913 for a family of four.
The Kansas coalition hosted a forum last month in Wichita on an Indiana Medicaid expansion plan that gained approval from a Republican governor and GOP majorities in the Indiana Legislature.