Posts

Bozeman Daily Chronicle Op Ed: Improve Medicaid Before Expanding It

 

Gov. Bullock waited until nearly 60 of the 2013 legislative session’s 90 days had passed before making a Medicaid expansion proposal that essentially said “do what the feds want.” That’s a wasted opportunity. Since Medicaid rules are made in Washington, D.C., we frittered away a chance to negotiate reforms that could better meet the needs of Montana’s most at-risk population while also being fair to taxpayers.

Continue reading here

Legislature Watching

I’ve been a little out of sorts the past few days with whatever it is that’s making the rounds, but that’s given me a chance to sit and watch the legislature on my fancy computer gadget box in the basement. It’s like magic. The Legislative Services Division has really done a nice job of making information on the 2013 session visible and easily accessible. You can look up bills, find your legislator, watch or listen to hearings and floor sessions, and much more. Kudos to them.

But that’s not what I wanted to talk about. I’m going to be lazy today and just redirect you to some work we’ve already done at MPI on two issues that are currently hot in Helena.

The first is Medicaid expansion. Rob and I have been beating this to death here and here , I know. And you can get all the facts and date you need from our policy note. But you really need to tell your legislators how you feel about creating an entirely new dependency class of young, able, childless adults. The arguments and facts and data are all in the blogs and policy notes we’ve done, but they mean nothing if you don’t show your concern. You can bet the victim industry and hospitals who stand to gain enormously are lobbying the hell out of our reps up in Helena. Somebody’s got to stand up for the taxpayer and for the basic morality of a system that rewards earned success rather than punishes it.

The other hot topic is campaign finance reform. I laid out the argument here that the problem we have isn’t money in politics, it’s politics in money. And so whatever ‘reforms’ we try are for nothing if we don’t reduce the size, scope and power of the government to pick winners and losers. Anything else is putting the cart before the horse. This issue divides those of us on the right and there are legitimate concerns on both sides of the issue. But please take a look at arguments against limiting free speech before letting emotional arguments take the day.

MPI Policy Note 01-13: Medicaid Expansion Can Wait

Proponents of Medicaid expansion argue that it would insure more people, that it takes advantage of “free” federal money and that it will create jobs and pump up local economies. But the fact that barely half the states are taking action to expand Medicaid indicates that this federal giveaway may come with unacceptable risks and costs, including:

  • Expansion will dump more people into a system that provides poorer access to care and poorer health outcomes than private insurance.
  • Federal matching funds are neither free nor guaranteed, potentially leaving the state with an unsustainable funding requirement.
  • Expanding Medicaid without fundamentally reforming it perpetuates its shortcomings and will crowd out other public spending priorities.


There is no cost to delaying, but expansion is forever. This decision should wait until we can learn more.

There are alternatives to Medicaid expansion that will actually provide quality care at lower costs, and without creating an entirely new dependent class of young, able Montanan adults. Our policy note gives you all the information you need to see why and how we should take a pass on expansion and concentrate on true reforms.

Medicaid Expansion Policy Note

Let Other States Experiment with Medicaid Expansion – Part II

Medicaid expansion is supposedly a no-brainer. It’ll provide insurance for a lot low income people. It’s free federal money. And it’ll create jobs and pump up local economies. So why are the 50 states almost evenly divided on whether to take this gift horse or send it out to pasture?

It’s because a lot of governors and legislatures have decided that at best the jury’s still out on whether expansion is a good idea; and more likely it’s a bad idea that will hurt many of the people it’s supposed to help and turn into an albatross around taxpayers’ necks.

I’m open to being proven wrong, but I agree with those who say that Medicaid expansion as laid out in Obamacare is both bad welfare policy and bad economic policy. It’s bad welfare policy because it shifts primarily young, able and to a large extent childless adults into a system with demonstrably inferior access to care, and then traps them there. Forty four percent of the newly eligible would be adults under the age of 34, and seventy five percent would be childless.[i] In addition, a fourth of all new enrollees would be dumped into Medicaid from private insurance plans that almost always provide better access to care than Medicaid.[ii] The difference is in having health insurance versus getting health care.

I have a fishing license. That gives me the right to stand in a river waving my fly rod around, but it doesn’t guarantee that I’ll catch any fish. Same goes for health insurance versus health care. Medicaid recipients encounter barriers to primary care at nearly twice the rate of those with private insurance.[iii] Because of this lack of access to primary care, they then show up in emergency rooms at rates nearly twice those of the privately insured, but sicker and much more expensive to treat.[iv] Shoveling well over 70,000 new Montanans into this system[v] while also decreasing provider reimbursements under Obamacare won’t make access to quality care any easier for these folks or for anyone else in the state.

Medicaid expansion is also bad economic policy. In fact, it’s pure crony capitalism. You can’t swing a dead cat in Helena right now without hitting a hospital or pharmaceutical lobbyist trying to get their surgical gloves into taxpayers’ wallets. Yes, there’s good evidence that the “free” money coming from Washington may create around twelve thousand jobs in Montana; but will those jobs create health benefits that are commensurate with their costs? If not, the money is better left in the private economy where it can be spent more productively. A recent New England Journal of Medicine article said that “Treating the health care system like a (wildly inefficient) jobs program conflicts directly with the goal of ensuring that all Americans have access to care at an affordable price.”[vi] And anyway, it’d be much cheaper for Montana taxpayers to just put those who are eligible for federal subsidies into the new exchanges and let Washington pay their entire bill. It’s free money, right?

Except that it’s not. It’s taxpayer money whether you write the check to Helena or to Washington. The net cost to Montana taxpayers of Medicaid expansion through 2021 is over $50 million according to one estimate,[vii] and closer to $100 million according to another.[viii] That’s after the “free” money and jobs and tax revenues, and assumes the federal government will keep its promise to cover 100% of expansion costs in the early years and 90% later on, despite the fact that even the President’s own past two budgets included reductions in those commitments.[ix]

In reality nobody knows what it will cost, but there’s precious little precedent for entitlement spending coming in below or even near initial estimates. In 1965 Medicare was estimated to cost $9 billion annually by 1990. The actual cost in 1990 was $67 billion.[x] There’s no reason to think Medicaid expansion estimates will fare any better, and Montana taxpayers would be on the hook for the difference since it’s politically unlikely that these entitlements would be reversed once they’re put in place.

So why not wait a couple of years? Let’s see how things go in California and Illinois and other bastions of state fiscal responsibility, and then take a look at what’s working and what’s not so we can make an informed decision. Or, we could try true reform and turn Medicaid into a system that really does provide quality access to quality care for more people who need it. We’d do that by reconnecting the patient to the provider and the cost to create responsible consumers rather than filtering both the funding and the care through a self-perpetuating bureaucracy. But that’s a topic for another day.

 


[i] The Urban Institute, “Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could gain Health Insurance Coverage,” August 2012,  pp. 8-9.

[ii] University of Montana Bureau of Business and Economic Research, “An Estimate of the Economic Ramifications Attributable to the Potential Medicaid Expansion on the Montana Economy,” January 2013, p. 6.

[iii] 16.3% of Medicaid patients encountered barriers versus 8.9% of those with private insurance. Annals of Emergency Medicine, “National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries,” 2012, p. 4.

[iv] Ibid

[v] Urban Institute, op. cit., p. 18 and BBER, op. cit., p. 7.

[vi] Katherine Baicker, Ph.D. and Amitabh Chandra, Ph.D, The New England Journal of Medicine, “The Health Care Jobs Fallacy, June 28 2012, p. 2435.

[vii] BBER, op. cit., p. 29.

[viii] The Heritage Foundation, “Obamacare and the Medicaid Expansion: How Does Your State Fare?” March 5th 2013, http://blog.heritage.org/2013/03/05/obamacare-medicaid-expansion-state-by-state-charts/.

[ix] Charles Blahous, Mercatus Center, “The Affordable Care Act’s Optional Medicaid Expansion: Considerations Facing State Governments,” 2013, p. 32.

[x] Conn Carroll, The Foundry, “Health Care Reform Cost Estimates: What is the Track Record?” August 4th 2009, http://blog.heritage.org/2009/08/04/health-care-reform-cost-estimates-what-is-the-track-record/.

More On Medicaid Expansion

Had a good time on KMMS this morning talking about Medicaid expansion so I thought I’d jot down a few notes from the show.

If you’re on MPI’s website you’re already active and aware on policy issues so I won’t belabor the point with a lot of background, but in a nutshell the Governor is about to roll out his plan to expand Medicaid as our masters in Washington have directed to include people earning up to 138% of the federal poverty level. That’s a bad idea for several reasons, as I argued in an Op Ed back in January. We’ll have a lot more on this soon, but here’s a quick outline:

  1. It’s bad welfare policy: According to an Urban Institute study that pretty much everyone is using, 43% of those added to Medicaid in MT would be under 35 years old and 75% would be childless. Unless they’re disabled, putting young, unfettered individuals on public assistance without some kind of work or payment in kind system is unfair to taxpayers, creates all the wrong incentives, and traps them in an entitlement web that’s tough to get out of.
  2. Will cost taxpayers more than just the expansion: Hospitals claim it will save taxpayers and those who are privately insured money because putting more people on Medicaid will reduce their unreimbursed or charity care costs. Don’t believe it. In states like Maine where they’ve already been down this road, those costs increased as people moved from private insurance to Medicaid and uninsured numbers remained virtually unchanged. Just think about it: how will adding 50,000 people from an at-risk population (lower incomes equate to poorer health) to a program with low and sinking reimbursement rates save money?
  3. Job numbers are probably overstated: We need to do a little more homework on this – and will – but claims of more jobs from “free” federal money have been wildly overstated in the past and probably are now as well. And besides, as argued in a New England Journal of Medicine paper called “The Health Care Jobs Fallacy,” if the same health care outcomes can be achieved with fewer resources that leaves more for schools, transportation, safety, and other public priorities.
  4. And finally, it ain’t free money: Over 30% of the “free” money will be borrowed by the federal government, and the remaining will either paid for by you on April 15th or come out of other spending priorities. Direct costs to Montana taxpayers of expansion range from $50 million to around $150 million depending on whom you believe, and there are few examples of entitlement program cost estimates being understated. President Obama’s last two budget submissions included increasing the states’ share of Medicaid reimbursements, so talk of 100% federal cost share is doubtful in the future, and so-called circuit breakers that would cancel expansion if the feds renege are meaningless. Nobody is going to take away this benefit once it’s been granted, so let’s wait a couple of years, see how they like it in other states, and then make an informed decision.

Pitfalls of the Patient Protection and Affordable Care Act for Montanans

“If you think health care is expensive now, wait until you see what it costs when it’s free.”    

  – P.J. O’Rourke

By Glenn Oppel, MPI Policy Director

The Patient Protection and Affordable Care Act (PPACA) was signed by President Barack Obama on March 23, 2010. If and when it is completely implemented, the ACA stands to radically change the landscape of the health care market and drive federal and state governments deeper into debt in the middle of the Great Recession.

Fundamental Threat to Liberty

The ACA will rewrite the relationship between the people and their government. It amounts to a violation of individual liberty by compelling individuals to consume a product while financially penalizing them if they fail to comply. If the ACA survives constitutional scrutiny it will open the door for the federal government to exercise increasing control over the economic decisions of Americans.

Unpopular

A June 2012 New York Times/CBS News Poll of 976 adults showed that 68 percent of them hope that the U.S. Supreme Court overturns the law. As for Montanans, a December 2010 poll of 600 Montana voters commissioned by the Montana Chamber of Commerce found that 60 percent opposed the federal health care reform. Interestingly, the same survey found that the top “financial or pocketbook concern” of Montanans was overwhelmingly “health care costs.” Obviously, Montanans do not see the ACA as a solution to the number one concern affecting their finances.

False Promises of Universal Coverage

Individual Mandate: Although the centerpiece of the ACA, how young and healthy individuals respond to the mandate presents a major problem that will undermine the intended purpose. Many young and healthy individuals will opt to pay the penalty rather than obtain coverage for the simple fact that the penalty is less of a financial burden. This is exactly what happened in Massachusetts after passage of that state’s health care reform, which, ostensibly, the ACA is patterned after. Health insurance plans rely on participation from the young and healthy in order to achieve actuarial soundness and, therefore, affordability and profitability.

Employer Mandate: Although the employer mandate has the same purpose as the individual mandate – universal health insurance coverage – it also will have unintended consequences that will defeat its purpose. Employers will be inclined to drop health insurance benefits for their employees because it is less expensive to pay the ACA’s penalty of about $2,000 per worker. The penalty costs are modest compared to providing health care for an employee. Furthermore, the ACA amounts to a federally mandated increase in the cost of hiring new employees. When the nation’s unemployment is hovering over 8 percent and Montana’s over 6 percent, the timing of the ACA’s negative impact on job creation could not be worse.

Exchanges: The purpose of the exchanges in the ACA is to allow individuals and workers in small companies to create larger risk pools to achieve economies of scale enjoyed by larger companies. The exchanges are predicated on the theory that market share will enable the bargaining down of prices and therefore reduce premiums. It is not as though the exchanges will operate free from heavy federal and state regulation, so it is hardly fair to label the exchanges a competitive environment when insurance plans in the exchanges must comply with the ACA. The Massachusetts health care reform set up an “exchange” scheme called the “Connector.” It was predicted to reduce premiums by 25 to 40 percent, but premiums still went up 11 percent.

Insurance Market Overregulation

The ACA’s insurance regulations will increase premiums, reduce choice, and drive consumers to government-run insurance. When it comes to the litany of insurance regulations, the ACA violates the principle that “there is no such thing as a free lunch.” Currently, health insurers do have some latitude to hold down costs by structuring plans so that consumers shoulder some costs. The ACA bans many of these practices that hold down costs predicated on consumer responsibility, including:

 ban on denying coverage and underwriting based on health status except for older patients and smokers;

 ban on rescissions (revoking coverage);

 ban on lifetime limits;

 limits on deductibles;

 maintain medical loss-ration (insurers must maintain a ratio of benefits paid to premiums collected of 85 percent for large groups and 80 percent for small groups and individuals);

 allow parents to keep their children on until age 27; and

 agency power (wide latitude given to the U.S. Secretary of Health and Human Services to promulgate rules to administer the new market and to singlehandedly create public policy when unanticipated situations arise).

Massive Expansion of the Welfare State

Massive expansion of Medicaid: The ACA mandates that the states expand Medicaid to cover all with incomes below 133 percent of the federal poverty level, with generous matching grants from the federal government. Between 2014 and 2019, federal spending on Medicaid is projected to increase $443.5 billion while state outlays will increase $21.1 billion. Imposing an eligibility threshold of 133 percent of FPL in Montana will dramatically increase enrollment and cost in our Medicaid program. Depending on participation rate assumptions, by 2019 Montana will see Medicaid additional enrollment increases in the range of 57,000 to 79,000, with an additional cost burden for the state budget ranging from $100 million to $155 million.

Subsidies for individuals not eligible for Medicaid: Individuals with incomes too high to qualify for Medicaid but below 400 percent of poverty or $88,000 will be eligible for subsidies to assist purchase of private insurance. The subsidy will be in the form of a refundable tax credit that will increase federal costs about $457 billion between 2014 and 2020.

Subsidies for small businesses: Businesses that have 25 or fewer employees with average wages less than $50,000 are currently eligible for tax credits. To be eligible, the business must provide insurance to all full-time workers and pay at least 50 percent of the costs of coverage. Once exchanges are operational, businesses with 10 or fewer employees with average wages below $25,000 will be eligible for a tax credit of up to 50% of the employer’s contribution toward a worker’s insurance. According to a July 2011 member survey by the National Federation of Independent Business, by overwhelming margins small employers believe that the ACA will not reduce health care inflation, will not reduce the administrative burden, and will add to the federal deficit. The survey also found that small employers believe that low-wage employees with large premium cost-share will have a powerful incentive to leave an employer’s health plan for the newly established and heavily subsidized exchanges. If employees begin to leave for an exchange, 26 percent of small employers that currently offer insurance say that they are very likely to explore dropping their health insurance plans while another 31 percent say they are somewhat likely to do so.

Undermining Consumer-Directed Health Plans

The ACA places considerable new restrictions on HSAs and FSAs. For example, the ACA increases tax penalties for HSA withdrawal and narrows the definition of “qualified medical expense” (QME) so that common expenses such as over-the-counter medications are not a QME. Of course, as mentioned, the fact that the ACA is likely to squeeze high-deductible, catastrophic plans out of the new market could be the demise of HSAs since federal law requires HSAs to be couple with such plans. As for FSAs, the ACA cut the maximum tax-exempt contribution to these accounts in half from $5,000 to $2,500 starting last year. The new definition of QME also will be applied to FSAs.

Mind Boggling Cost in the Deficit Age

The ACA is projected to cost the federal government $2.7 trillion over 10 years of full implementation, which, after accounting for aforementioned penalty revenue and new tax revenue (see below), will add $823 billion to the national debt. It is hard to predict how the State of Montana will fund the additional $100 million to $155 million in Medicaid expenditures through 2019. It may be true that Montana is currently projecting a $600 million surplus for the 2015 Biennium, but the structural deficits in the state budget due to unfunded liabilities in various public employee and teacher pension systems dwarfs the surplus. The additional costs associated with the ACA’s Medicaid mandate gobbles up resources that Montana could use to address its structural deficits.

New and Increased Taxes During the Great Recession

If there is one way to impede economic progress and deepen a recession, it is to raise taxes. The ACA imposes over $629 billion in new or increased taxes in its first 10 years of operation. When you couple the ACA’s new and increasing taxes with the possibility that the Bush Administration tax cuts could expire at the end of 2012, America could plunge even deeper into recession. These taxes include:

 taxes on “Cadillac” insurance plans;

 payroll tax hikes;

 taxes on investment income;

 higher threshold to itemized deductions for medical expenses;

 tax on prescription drugs;

 tax on medical devices;

 additional taxes on insurers; and

 taxes on tanning beds.

Taxpayers likely are leery of the fact that the Internal Revenue Service will add 11,800 additional agents, auditors, and examiners for enforcement of the ACA.

 

Consumer-Directed Healthcare Reform

As the U.S. Supreme Court nears its decision on the constitutionality of federal health care reform, the Montana Policy Institute endeavors to emphasize the need for true reform centered on the patient consumer. We believe that patients and their doctors are best equipped to make decisions about what care is best, not bureaucrats in Washington, DC, or our state capital of Helena. The root problem lies in the fact that there is a vast wedge between patients and their healthcare providers caused by heavy government intervention and the unintended consequences of a third-party payer system. The following consumer-directed options will help individuals and families make – and own – their decisions.

Individual ownership of insurance policies. Equalize tax treatment by extending to individuals the tax deduction that allows employers to own insurance. Also make those plans portable when workers leave or change jobs.

Leverage health savings accounts. Coupled with affordable high-deductible plans, HSAs empower individuals to monitor their health care costs while establishing incentives for individuals to use only those services that are necessary. HSAs are growing in popularity but will be undermined by federal healthcare reform.

Allow interstate purchase of healthcare insurance. Allowing consumer to shop for plans beyond their state borders will enhance competitiveness in the health insurance market. Because of fewer state regulations, plans in other states are more affordable. Because it will empower consumer choice through competition, interstate purchase will drive down prices and, possibly, force states to deregulate.

Reduce mandated benefits. Other than consumer overutilization caused by insulation from actual cost, there is nothing that contributes more to the inflation of healthcare costs than state benefit mandates. States should reduce or eliminate mandated benefits to empower consumers to work directly with health insurers to tailor plans to their needs. Consumers won’t be able to do this unless health insurers have flexibility to fulfill the needs of individuals. In a freer health care market, there is no reason to assume that insurers will treat the insured any differently than, say, the grocery store treats its customers by providing many products at prices consumers are willing to pay.

Block grant federal Medicaid funding to give states flexibility to create voucher programs for low-income individuals to purchase their own insurance. An income-based sliding scale voucher program is an effective reform option that states such as Florida have enacted to give low-income individuals more control, fight costly fraud and abuse, and save on considerable administrative costs of running a large bureaucracy.

Eliminate unnecessary scope of practice laws and allow non-physician healthcare professionals to practice to the extent of their education and training. Enhancing the provider pool increases competition without compromising access to quality care. It empowers patients to decide how best to get the care they need.

Reform tort liability laws. Defensive medicine needlessly drives up medical costs and creates an adversarial relationship between doctors and patients.

 

Government Healthcare Takeover

President Obama and his allies in Congress said they wanted to provide quality health care to all Americans at a lower cost. Those are worthy goals. But the law they passed in March 2010 simply doesn’t do those things. It will create a multi-trillion dollar government takeover of healthcare that gives too much control to Washington, DC, and not enough to patients and their doctors, and imposes a top down one size fits all “solution” on all Americans.

UNCONSTITUTIONAL: Americans are faced with an unprecedented action taken by Washington, DC – forcing consumers to purchase a good or service – in this case health insurance. Most Americans are dumbfounded that the government would meddle so cavalierly in something as personal as one’s healthcare decisions.

COST: The law will increase spending by $1.15 trillion and will add as much as $530 billion to the federal deficit over the next 10 years. Cato Institute analysts believe that spending will be $2.7 trillion while adding $823 billion to the deficit over the same period. Medicaid expansion in Montana will cost as much as $155 million by 2019.

MORE TAXES…REALLY?: While the national and state economies are deep in the doldrums of the Great Recession, the law creates or increases 18 separate taxes that will cost $629 billion over the next 10 years. It actually taxes health insurance plans, brand-name prescription drugs, and medical devices. Amazingly, it limits the deductibility of medical expenses.

WRONG REFORM: Intended or not, the new law will insert the government’s tentacles even deeper into the lives of consumers and health care markets to the point that single payer, government-run health care is an inevitability. The law undermines consumer-directed reforms such as Health Savings Accounts, incentivizes employers to drop health insurance benefits, and forces the young and healthy to subsidize care for the old and wealthy. The proponents of the law promised Americans that they’d be able to keep their healthcare plans but independent experts believe that the law will force Americans into government plans.

ROBBING PETER TO PAY PAUL: The law takes $417 billion over 10 years from Medicare’s trust fund. This includes $136 billion in cuts to Medicare Advantage, which allows beneficiaries to receive their coverage through private insurance plans. 10.2 million use Medicare Advantage and Medicare’s chief actuary predicts that 7 million will be forced out and back into traditional Medicare. This represents an obvious disdain for the private market.

PICK POCKETING: The law authorizes the federal government to penalize individuals for not obtaining, and employers for not providing, health insurance coverage. The Congressional Budget Office estimates that from 2014 to 2019 individuals will pay $17 billion in penalties while employers will pay $52 billion.

UNACCOUNTABLE BUREAUCRATS: One of citizens’ biggest fears is unelected bureaucrats making decisions that affect our most fundamental decisions. The government healthcare takeover creates a panel of 15 of these bureaucrats – called the IPAB – to determine what treatments patients can receive.

DUD: Because the law has government written all over it, it should be no surprise that analysts don’t think it will do anything to combat waste, fraud, abuse, and rampant inflation in the system. What the government has excelled at is causing these problems in the first place, and then rushing in to fix the problems it caused, and proceeding to make the problems even worse. The solution is to get the government out of the healthcare market as much as possible and allow people the freedom to make health care decisions based on their circumstances.

 

Montana Lawmakers Protecting Our Health Care Rights

By: Rob Natelson, Senior Fellow in Constitutional Jurisprudence at the Montana Policy Institute

Some say health care is a “right,” but there is a right far more fundamental. That is the right of choosing your own health care and your own providers, and contracting freely for services without government interference.

In America today, that right is under grave threat. Not only will “ObamaCare” take away many of your choices, but by expanding the system that has fueled huge price increases, it will raise the cost of heath care even more.

What can Montanans do? The U.S. Constitution provides a way we can protect ourselves-if we are willing to use it.

The American Founders wrote into the Constitution checks and balances designed to promote good government and preserve liberty. Everyone knows about the checks between the legislative, executive, and judicial branches. But most of the Founders considered the balance between state and federal governments to be even more important.

Both John Dickinson, one of the greatest Founders, and James Madison (“Father of the Constitution”) spoke of the duty of state officials to push back when the federal government exceeded or abused its power. You can read Madison’s views in Number 46 of the Federalist Papers.

All over America state officials are now responding in ways that come directly from Madison’s playbook.

Many Montana lawmakers are among those responding. But they are being fought tooth and nail by people who either do not understand our Constitution or don’t care very much about you being able to make your own decisions.

Consider what happened to Rep. Gary MacLaren’s House Bill 206. That measure would have permitted Montanans to vote on whether they wanted a state constitutional right to health care freedom. HB 206 was not “nullification,” as some have claimed. It was a reasonable, moderate measure of the kind already adopted by several other states. However, in Montana placing a state constitutional amendment before the people requires approval by a two-thirds of all lawmakers. Although HB 206 received a clear majority, Democrats in the legislature lined up against it for reasons best known to themselves. They denied you the chance to vote for protecting your health care freedom.

But Montanans may be able to vote on a weaker alternative. Rep. MacLaren also is sponsoring HB 609, which would let the people to decide on a law protecting health care choice. HB 609 would not be as strong as HB 206 because a law is not as strong as a constitutional right. But only a majority of lawmakers is necessary to let the people vote on a law. HB 609 already has passed the house and is awaiting action in the senate. If it passes the senate, then it will be on the ballot, because the governor has no power to veto referenda.

As to some other bills, the governor’s position is a concern. He recently issued an amendatory veto on Sen. Art. Wittich’s Senate Bill 125, which would block state officials from joining federal efforts to force us to buy government-approved health insurance. A related measure is SB 224, sponsored by Sen. Jason Priest. It prohibits state bureaucrats from signing us up for ObamaCare without legislative authorization.

Still another good proposal is Rep. Cary Smith’s HB 445, which would allow you to purchase health insurance policies from other states, thereby increasing competition and driving down prices.

Despite what you may have read in the press, none of these proposals constitute “nullification.” Nullification is a declaration that federal law does not apply within the boundaries of a state. Nullification is legally suspect and has a terrible track record. Madison opposed nullification, but favored the kinds of measures that are still alive in the Montana legislature. They exemplify just how the system was supposed to work-checks and balances to promote good government and protect liberty.

####

629 words

 

Rob Natelson is Senior Fellow in Constitutional Jurisprudence at the Montana Policy Institute in Bozeman. He served on the University of Montana faculty for 23 years, where he taught Constitutional Law, Advanced Constitutional Law, and Constitutional History. He also serves as Senior Fellow in Constitutional Jurisprudence at Colorado’s Independence Institute and Arizona’s Goldwater Institute.

 

He can be reached at:

67 W. Kagy Blvd., Ste. B

Bozeman, MT 59715

(406) 219-0508