Montana House Speaker Grapples With How To Fund Medicaid After ACA Repeal

Montana’s Republican House speaker is worried about how Big Sky Country will pay for expanded Medicaid access after the Affordable Care Act is repealed in Congress.

In an interview with the Billings Gazette published Tuesday, Austin Knudsen said that if Congress repeals the ACA, including federal funding for states to expand Medicaid, Montana may have a hard time paying for the program on its own.

However, he said he couldn’t imagine the state just kicking the estimated 60,000 people who benefit from the Medicaid expansion.

“You’re going to tell me that we’re going to put 100,000 people on the Medicaid rolls and then when the federal government takes the money away we’re just going to jerk the rug out from under them? I don’t see that as being a realistic answer,” Knudsen told the Billings Gazette. “The state of Montana is going to have to look at trying to help keep those people covered. Whether I like the bill or not, it passed. It was signed into law. We covered a whole bunch more people.”

Montana’s legislature voted to expand Medicaid in 2015 with a majority-Democratic vote, attracting enough Republican support to pass and then be signed by the Democratic governor. Montanans who were eligible for the expanded program were just able to sign up in January 2016.

The state House speaker’s concerns over how to fund the program if the federal government repeals Obamacare reveals the tension that is expected to come should Republicans in Congress make good on their promise to repeal the ACA right away. On the one hand, Republicans in states across the country, including Montana, have railed against the program (in Montana, rising premiums caused some insurers to simply drop out of the exchanges, making insurance more expensive for those who remained). But full-out repealing the law without a clear replacement leaves some state lawmakers worried about how to fund the Medicaid expansion in that uncertain future.

Republicans in Congress have tried to quell those concerns by arguing there will be a two- to three-year transition period to ensure that no one is hurt by a repeal, but multiple health care experts and think tanks have said that repealing the law without a clear replacement may still send the insurance market into a death spiral.

Moreover, congressional Republicans have had seven years to come up with a replacement for the ACA and have not done so. Some worry that Republicans may never find enough consensus to actually come up with a replacement plan.