Former Gov. Brian Schweitzer used to be outspoken in his reservations about Medicaid expansion, saying the cost burdens could eventually bankrupt the state.

Now, however, he is backing legislation that would expand Medicaid because it includes a termination safeguard that would take effect if federal funding declined.

“That solves the problem as I see it,” Schweitzer said. “If they pull back on their funds, then we will pull back on our support for Medicaid.”

Under the Affordable Care Act, the federal government will pick up the additional costs of expanding Medicaid for the first three years, but after that federal support could decline. That potential to be saddled with an incrementally growing cost burden has governors and legislatures across the country pondering whether to expand their Medicaid rolls.

A Medicaid expansion bill sponsored by Rep. Chuck Hunter, D-Helena, and supported by Democratic Gov. Steve Bullock was introduced Wednesday. 

It would add an estimated 70,000 Montanans to Medicaid, but it includes a “contingent termination” clause that would end the state’s commitment to the expansion once the share of federal funding for it drops below 90 percent.

“If the federal money isn’t there, well, you are no longer on Medicaid,” Schweitzer said from his home on Georgetown Lake.

But Republican lawmakers are skeptical about the political likelihood of scaling back an entitlement program once it is in place with thousands of new beneficiaries.

“Once you put 70,000 people on a government program, are you going to throw them off” just because of a termination provision in the legislation? House Speaker Mark Blasdel asked.

Blasdel said there would be incredible political pressure to keep the program intact, regardless of the financial burden on Montana taxpayers.

“I just do not see how you kick that many Montanans off a program once you start it,” he said.

Blasdel said Republicans also object in principle to vastly expanding the state’s reliance on federal funding.

“How do you get into an agreement with a partner that is $16 trillion in debt? I mean, they can’t even pass a budget” in Washington, D.C., he said.

Schweitzer is dismissive of that position, saying Republicans should make the same argument about accepting millions in federal transportation funding.

Schweitzer has long acknowledged that the federal government’s largesse to the states eventually will decline, but in the meantime, he says it makes no sense to pass on federal dollars that will be spent elsewhere. The Montana Legislature is powerless, he said, “to put the federal government on a diet.”

Bullock and Hunter tout their Access Health Montana bill as a vehicle for creating jobs and containing health-care costs.

Schweitzer seized on the latter as being a worthwhile pursuit for the sake of competitiveness and economic growth in Montana.

The thousands of people who would be covered by Medicaid are otherwise left uninsured and at the mercy of receiving the most costly, 11th-hour health care. The costs of that health-care delivery are commonly shifted to insurance policy owners and people who can pay their bills, he said.

That is a cycle that is driving up health-care costs in Montana with the potential for making the state less competitive with other states that go along with Medicaid expansion, he added.

“If we have even incrementally higher health costs ... then new companies are going to look at Montana and say, ‘I don’t think so,’” Schweitzer said.

Blasdel said Republicans are frustrated that Hunter’s bill was introduced so late — just 18 legislative days before a transmittal deadline for revenue bills — because its details deserve serious scrutiny.

Blasdel said he prefers something along the lines of what Wisconsin Gov. Scott Walker is pursuing. Walker is taking advantage of flexibility in the federal health-care law to roll back the number of people on Medicaid, transferring adults to a federally subsidized health care exchange.

People who purchase insurance through the regional exchange are subsidized based on their income; the less they make, the greater the subsidy. 

“That puts the burden on the federal government rather than state taxpayers, and the state’s not at risk for the long-term costs,” he said.

In the debate over expanding Medicaid in Montana, Blasdel said he is emphasizing that new enrollees will be able-bodied adults whom he believes would be better served through an exchange.

Reporter Jim Mann may be reached at 758-4407 or by email at jmann@dailyinterlake.com.