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

Media Trackers Montana: 50 State Legislators Discuss Free Markets at Montana Policy Institute Forum

A total of 50 state legislators and approximately 130 people met this weekend to discuss free market principles for Montana.

The two-day event was hosted by the Montana Policy Institute (MPI) and focused on gearing up both state legislators and the general public for the upcoming 2013 legislature. The forum featured discussions and presentations on important issues for the upcoming legislature and was highlighted with a presentation by Wall Street Journal Editorial Board Member and Senior Economics Writer Stephen Moore.

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Montana Pig Tales

Once upon a time there was a wonderful land with untold riches. This land had fertile soil to grow more food than the locals could eat, gems and minerals that were sought after worldwide, trees for their houses and abundant fuel for their stoves. This wonderful land was filled with opportunity, and happy families prospered with each generation better off than the previous.
There were also helpful folks in the land’s Capitol City who worked for the happy families and did the kinds of things that everyone could benefit from. They built roads and schools and made sure everybody played by the same rules. And they kept the king in far-away DC Land from trying to run their lives. But then something happened, something awful and selfish.

The people in DC Land and Capitol City stopped working for the happy families and started ruling over them. They grew larger and larger and decided to regulate and tax and dictate more and more parts of the happy families’ lives. The land of opportunity became a land of limitations. Laws were passed to protect people from themselves instead of just from each other. Rules were made keeping the happy families from using all the riches that the land offered and pitting them against each other. The land with untold riches became one of the poorest in the kingdom. The happy families could no longer pass on opportunities they had enjoyed. And so the once-happy land got older and poorer, until finally the only people who could enjoy its beauty came from other places. The land of opportunity became a land of futility. And the once happy families were scattered to the winds.

Montana is still that happy land of opportunity, but we won’t pass that heritage along to our kids if we continue the current path of bigger government, more regulation, and control by Washington bureaucrats. We still have the riches that made Montana the Treasure State, but we’re losing the legacy of opportunity that those riches could provide. We increasingly have a government that has become its own special interest instead of our employee. And we’re being tied down with one size fits all solutions that may be great for New York or Mississippi, but not for Montana.

Welcome to “Pig Tales: Wasted Treasure in the Treasure State” — a one-stop shopping guide to Montana government. This is the second in a biennial look at Montana state government, our people, and our opportunities.

Our simple goal is help provide as much useful information as possible so that as the people who represent us make decisions that affect our lives and our families, we will have a confident and informed voice. Enjoy the tale!

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Interested in a hard copy or two? We’ll have them for purchase right here coming soon. Can’t wait? Call us at 406-219-0508 to place your order or email us at In order to break even, we will be charging $3.50 for quantities up to 10 and $3.00/copy for quantities over 10. These prices include shipping and handling.

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.


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.


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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


Montana’s Legislature Pushing Back on Obamacare

By: Carl Graham, President, Montana Policy Institute

Montana is often mischaracterized as a Red state so it’s forgivable and unsurprising for people to assume in us an independent streak that rejects top-down federal management like that envisioned in Obamacare. But that assumption is too often wrong, making it all the more surprising that our legislature is actually pushing back, and hard.

In fact, Montana is mostly conservative but has deep union roots and is dependent on the federal government for about half our state budget. Both of our senators are liberal and Democrat, as are all of our constitutional officers from the governor to the state auditor. We tend to vote Republican for president, but everything else is a coin toss in any given year.

In 2010 toss brought in solid Republican majorities for both chambers of our biennial legislature, and although they’re turning out to be somewhat wobbly on fiscal issues, they’re taking a hard stand on federal health care “reform” and will likely force the governor to either stand with them against this federal overreach that will, by his own admission, break our state budget, or stand with the liberal wing of his party and wear out the nib on his veto pen. The jury is still out, but we’ll probably see a little of each.

At Montana Policy Institute, we’ve been working against a federal healthcare takeover since 2009 so we’re naturally tracking the bills and trying to add to the conversation here in the state. Here’s what we’re seeing so far. First, at least 25 bills have been introduced relating to or aimed at the PPACA in this year’s legislature. Remember, this is a true citizen legislature that meets for 90 days every two years. Twenty five bills on a single topic is a lot, and reflects the fact that each side sees this as a critical battleground in the war for Montana’s future.

Next, we’re finding that the bills fall into three primary categories: Those that would implement Obamacare; those that oppose Obamacare; and those that propose reforms in their own right, but would probably be overridden by Obamacare’s restrictive provisions.

In the first category, at least three bills sponsored at the administration’s behest attempted to revise statutes or appropriate funds in support of Obamacare and/or create a state exchange. These all died early and inglorious deaths, leaving the Health and Human Services Secretary reportedly seeking ways to implement the law absent legislation. Unfortunately there’s a very good chance she’ll be able to pull that off at least to some degree with the legislature absent for 21 months after this session ends in April, especially since the two bills that would have specifically barred public employees from taking steps to implement the law also died.

The second category contains bills that would explicitly forbid or temper the effects of Obamacare provisions. These include things like HSA, high deductible, and individual insurance inducements designed to level the playing field for non-third party buyers; rejection of mandates through constitutional and statutory provisions; compelling Montana’s Democratic attorney general to join the Florida lawsuit; self directed or privatized Medicaid; requiring state agencies to obtain legislative approval to spend PPACA grants; a prohibition against exchanges; and others. Most of these bills have passed at least one chamber and many will likely pass both; and several are already sitting on the governor’s desk awaiting his decision, including the Florida lawsuit bill.

And then there are several bills that are just good ideas in their own right; things like allowing health care sharing ministries, medical liability reform, allowing policies across state lines, two separate interstate compacts, and a few other odds and ends that refute the “do nothing” accusations of Obamacare acolytes against those who just think it’s bad policy.

There is simply no way to know which, if any, of these bills will actually become law or the enthusiasm with which they will be implemented even if the governor decides not to buck the 57% of Montanans who favor outright repeal, according to recent poll. But it is heartening to see the battle lines being drawn, the good fight being fought, and each side being forced to show their true colors as we enter the 2012 arena.


For Immediate Release

699 Words


Carl Graham is president of the Montana Policy Institute, a nonprofit policy research and education center based in Bozeman, MT.

He can be reached at:

67 W. Kagy Blvd., Ste. B

Bozeman, MT 59715

(406) 219-0508

First Year Shows “Reform’s” True Costs

By: Carl Graham, President, Montana Policy Institute and Michael Tanner, Senior Fellow, CATO Institute

In the days before the new health care law passed Congress last year, then-House Speaker Nancy Pelosi famously said that we would “have to pass the bill to find out what is in it.” Well, it has now been a year since the Patient Protection and Affordable Care Act passed, and we are now learning what was in it – much to the detriment of Montana taxpayers, businesses, doctors, and patients.

Here’s some of what we now know:

First, you probably will not be able to keep your current insurance plan. Although the president constantly reassured us that Americans would not be forced to change their current insurance plans, that claim increasingly appears untrue.

For example, nearly 29,000 Montana seniors currently participate in the Medicare advantage program. The Congres¬sional Budget Office predicts that PPACA “could lead many plans to limit the benefits they offer, raise their premiums, or withdraw from the program.” And, the Medicare program’s chief actuary has testified that more than a quarter of seniors could be forced out of the program.

If you get your insurance at work, you will almost certainly have to change plans. The administration itself now admits that more than two-thirds of companies could be forced to change the coverage they currently offer their workers. For small businesses, the total could reach 80 percent. The new plans will have to offer additional benefits and meet new federal requirements, likely making them more expensive.

Already, thousands of Montana workers with Flexible Spending Accounts have seen how much can be contributed to the accounts cut in half, and FSA funds can no longer be used to purchase over-the-counter medications. Workers with Health Savings Accounts (HSAs) remain in limbo, awaiting rules from the federal Department of Health and Human Services to determine whether their plans will even survive.

Moreover, the law’s individual mandate continues to pose a threat to Montanan’s ability to keep their current coverage. That mandate not only requires everyone to buy insurance, it requires insurance to meet strict government requirements, offering the benefits that the government thinks you should have, not necessarily the benefits you want or need.

Second, “reform” will cost more than advertised. The Congressional Budget Office officially “scored” the health care bill as costing $950 billion. However, those numbers do not reveal the new law’s true cost. For example, CBO’s estimates do not include roughly $115 billion in implementation costs, such as the cost of hiring new IRS agents to enforce the individual mandate. The arcane budget rules of Medicare, Social Security, and the law’s new long-term care program, also allow the government to double count savings, while ignoring future costs outside the budget window. Finally, the law front ends taxes while deferring costs, providing a misleading 10-year budget outlook. True accounting suggests that the law will cost as much as $2.7 trillion over 10 years of full operation, and add $823 billion to the federal deficit.

Third, your premiums are going up. Any Montanan opening their health insurance bills recently can see that their premiums are not going down. In fact, CBO estimates that premiums could double over the next 6-10 years. Worse, some estimates suggest that the law’s new regulations have already added 7-9 percent to the cost of insurance.

And finally, your taxes are going up. The PPACA imposes more than $569 billion in new or increased federal taxes over the next 10 years. And, it’s not just federal taxes that are rising. PPACA will add more than 70,000 people to Montana’s Medicaid rolls, driving up the cost of the state’s program by more than $80 million by 2019. That mean’s either state taxes will go up, or other state services will be cut.

Now that we’ve had a chance to see what is in the bill, Montanan’s should simply say “no thank you.”


For Immediate Release

636 Words


Carl Graham is president of the Montana Policy Institute, a nonprofit policy research and education center based in Bozeman.

Michael Tanner is a senior fellow at the CATO Institute, a libertarian policy center in Washington, D.C.

Graham can be reached at:

67 W. Kagy Blvd., Ste. B

Bozeman, MT 59715

(406) 219-0508

Tanner can be reached at: