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From No To Yes: Tempel Discusses Evolution Of Medicaid Expansion Bill

Sen. Russ Tempel, R-Chester, has been at the center of Helena political intrigue for the past five days.

“You can’t believe the calls and threats I got,” Tempel said Tuesday.

Last Friday, Tempel cast the deciding vote to kill the proposed Medicaid expansion bill in the Montana Senate. That’s when the threats started coming in.

“It was pretty intense.”

Supporters had expected Tempel, a co-sponsor of the bill, to vote for the measure. Instead, the hottest issue of the 2019 legislative session went down on a 25-25 tie because of his vote and those of a few other Republican senators.

On Monday, after considering some of the changes made to the bill over the weekend, Tempel cast the deciding  vote in favor of Medicaid expansion. This time, it passed 26-24 on second reading. On Tuesday, the bill passed third reading with two additional votes.

Over the weekend, Tempel learned a lot about Helena hardball politics.

“You should see how tall the stack of emails is,” Tempel said in an exclusive interview with The Havre Herald.

“Some were downright nasty,” he said.

One of the messages said: “Send me your home address so I can mail you the obituaries of everyone who dies because of your vote.”

It’s hardly the kind of message that convinces a lawmaker to vote for a bill, he said. Indeed, he was wondering how he could ever vote for the proposal, given the tenor of the responses.

“Even today, I’m getting swamped with emails. The stack is at least an inch thick, just today’s,” he said Tuesday afternoon.

It’s not exactly what he was hoping for as a legislator, but “it is what it is.”

Tempel said he was concerned about the status of hospitals, especially of small rural hospitals such as Liberty Medical Center in his hometown.

The picture was not always as rosy as it was painted, he said.

The same hospitals lost money when patients gave up private health insurance for Medicaid expansion. Private insurance pays the full amount of the bill, while Medicaid pays about 70 percent and the hospital is out the rest.

But Medicaid expansion has done good things for the hospitals, he said.

What convinced Tempel that the bill should be approved were the changes made to see that undeserving people are taken off the rolls.

He said his vote was for the rural hospitals. “It was not for the 35-year-old, jobless, living in their parents’ basement, overweight, tattoos, playing video games unshaven and drinking beer.”

Then he added that he might be able to overlook the unshaven and beer.

Tempel said he heard of people with good-paying, full-time jobs asking that their hours be cut so they could qualify for Medicaid expansion.

“In my mind, even  though that may be legitimate, it is not right.”

Tempel traced the history of his decision to support the bill.

Rep. Mary Caferro, D-Helena, presented the Democratic version of Medicaid expansion. It called for continuation of the law as is, which Tempel said was totally unacceptable.

Rep. Ed Buttrey, R-Great Falls, designed a compromise bill and sought support from Democrats and at least some wavering Republicans.

There were three parts of Buttrey’s bill that Tempel liked, that prompted him to change his vote:

  • The Democrats wanted no ending date on the law. Buttrey’s bill calls for a sunset in 2025.
  • Buttrey’s bill calls for work or community service requirements for able-bodied recipients.
  • Under the old law, income verification for recipients were very lax, Tempel said. That situation will improve under the new law, he said.

Tempel heard reports of injured people waiting in the emergency room while doctors attended to Medicaid expansion recipients who had a case of the sniffles. If recipients had some “skin in the game,” incidents like that would be less likely to happen.

Tempel would like to have seen a co-pay provision added, but realized there were legal problems.

The legislation will accomplish two things that he was stressed about.

It will continue to help rural hospitals, some of whom are in dire financial trouble, and it will thin the ranks of undeserving patients.

He estimated that between 20,000 and 30,000 people will lose Medicaid expansion benefits.

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