In 2015, when the Legislature expanded Medicaid to cover another 100,000 Montanans, it sought to guarantee that all of us — our families, kids, friends and neighbors — would have access to health care. Expanding Medicaid was a significant bipartisan accomplishment: The bill was carried by a Republican senator, passed on a bipartisan vote, and signed by a Democratic governor. And no wonder: it reflected our common conviction that we all — particularly kids — should have access to medical care when we need it.
But now that guarantee of health care is being unwound, and hundreds of thousands of Montanans are being deprived of their Medicaid coverage, and access to health care.
Medicaid is provided by the states, including Montana, in partnership with the federal government, which picks up a lion’s share of the cost. During the pandemic, Congress required the states to maintain the then current enrollment, which protected individuals from losing coverage and protected all of us by making sure everyone had access to health care during a critical public health crisis.
In 2023, Congress ended that protection and required states to redetermine eligibility for Medicaid recipients, increasing red tape and government hurdles for programs that keep our kids safe and healthy. While some states maintained or expanded enrollment, the Gianforte administration chose to kick hundreds of thousands of adults and kids off Medicaid and CHIP (the kids’ health insurance program), forcing eligible participants to go through the bureaucratic process of re-applying for something they had already been determined to be eligible for.
Between April and November of 2023, one in four Montanans enrolled in Medicaid in the 16 counties that make up the western Congressional district of Montana were kicked off.
Any effort to help people reapply was lackadaisical at best. But some did, and regained coverage. Others were ruled ineligible. And still others were told that they hadn’t supplied the information needed for enrollment.
At the end of December 2023, Montana had the third highest cancellation rate of any state in the country. More Montana kids lost insurance than in 47 other states.
This dysfunction and inaction by the Gianforte administration is unwinding the Medicaid expansion that keeps our rural hospitals open, expands the labor pool for Montana’s small businesses by backstopping available insurance, and covers 100% of care to our Native American population. In 2025, the Legislature will have to reauthorize Medicaid expansion, and already extremists on the right are making plans to end it.
If we lose Medicaid coverage, there’s more than simply the health of our fellow Montanans at stake. In states that have refused expansion, rural hospitals have closed at an alarming rate. In Montana, the current drop in enrollment has meant that agencies that provide services to Medicaid patients aren’t getting paid and are struggling.
The crisis is particularly acute for Tribal Nations in Montana, where the health of Native Americans is already seriously compromised. When hospitals, agencies and providers are forced to shut down, people doing important work lose their jobs, and local economies suffer.
Ending Medicaid will end many Montana communities, by closing rural hospitals, and reducing an already too-small labor pool essential for our local businesses.
In Congress I will support robust funding for Medicaid, advocate for fair pricing for prescription drugs and oppose any attempt to weaken or repeal the Affordable Care Act, which provided for Medicaid expansion. I will insist states live up to their part of the bargain, and not allow hostility, indifference, chaos and inaction to end this vital program that keeps our Montana communities stable and safe.
Monica Tranel is an attorney and Democratic candidate for Montana’s western district U.S. House seat.
