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Medicaid Expansion Pays for Itself in Montana

The only discussion of Medicaid expansion in the Legislature this year was a failed attempt by Trumpy Republican legislators, scared of both Barack Obama and Billie Sutton, to prevent the Governor from expanding Medicaid without Legislative approval.

It’s too bad South Dakota continues to resist Medicaid expansion. Montana expanded Medicaid in 2016. Thursday, a University of Montana economist told the Montana Legislature that Medicaid expansion is creating jobs, boosting the Montana economy, and paying for itself:

The hundreds of millions of federal tax dollars that Medicaid expansion is bringing to Montana have added thousands of jobs here and significantly boosted the state’s economy. It’s enough of a boost to pay for Montana’s share of the jointly-funded health program.

That’s according to a new report by Economist Bryce Ward with the UM’s Bureau of Business and Economic Research. He summarized it for a legislative oversight committee Thursday.

“When you have that much new money circulating in our economy, you get a bunch of economic activity. We estimate that it is roughly 5,000 jobs and roughly $280 million in personal income each year” [Corin Cates-Carney, “Montana Medicaid Expansion Pays for Itself, UM Economist Says,” MTPR, 2018.03.08].

Bryce Ward and Brandon Bridge’s presentation explains that, thanks to expansion, Montana spends less on traditional Medicaid and inmate health care; may spend less on substance use disorders, mental health, and uncompensated care; and enjoys more revenue from increased economic activity. Total fiscal impacts:

Bryce Ward and Brandon Bridge, "The Economic Impact of Medicaid Expansion in Montana," presentation to Montana legislative oversight committee, 2018.03.08.
Bryce Ward and Brandon Bridge, “The Economic Impact of Medicaid Expansion in Montana,” presentation to Montana legislative oversight committee, 2018.03.08.

$57.8 million more in the Montana state budget in 2017. Even in 2020, when the state share of Medicaid expansion rises to 10%, Montana still comes out ahead $16.8 million.

South Dakota’s population is 20% smaller than Montana’s. So let’s just say, wild and crazy, that the fiscal impacts in South Dakota would be 20% less than those in Montana. We’d see something like $40 million more in the state coffers this year, and that’s almost the entire increase in general funds that the South Dakota Legislature just passed yesterday. Turn Congress Democratic this year to ensure Trump can’t repeal Medicaid expansion, and by 2020, South Dakota would be $13 million to the good every year ongoing.

Senator Billie Sutton has been saying Medicaid expansion would be a fiscal and economic boon for the state for years. (So have the hospitals!) Sutton says as Governor he would expand Medicaid. Heck, by expanding Medicaid, Sutton could even stake his own claim in the debate Kristi Noem is trying to have with Marty Jackley about reducing crime:

University of Montana economists added Thursday that other national research shows that Medicaid expansion reduces crime by more than 3 percent in areas where it has passed, and that it reduces medical debts and improves credit scores for low-income borrows [Cates-Carney, 2018.03.08].

Expand Medicaid and you reduce crime, create jobs, save your state budget… and help sick people get well. Good grief! Montana shows the only downside to expanding Medicaid is that Republicans have to admit they let their anti-Obama fanaticism get in the way of doing what’s right for South Dakotans.


  1. mike from iowa 2018-03-10 14:49

    CBO or another gubmint organization stated wingnut efforts to repeal ACA will cost 6 million people their insurance and cost 33 billion bucks. Nice returns. 33 billion is only 4 billion more than the taxcuts Warren Buffet and Berkshire Hathaway got.

  2. leslie 2018-03-10 17:59

    Billie will take over this problem while “i hate that” daugaard wrings hands over the budget in SD

  3. Debbo 2018-03-10 20:38

    Rigid Republican Ridiculosity.

  4. Dana P 2018-03-11 09:09

    Expanding Medicaid is a no-brainer (as then NJ GOP Gov Christie said at the time, “we can’t afford NOT to”)

    Playing with people’s lives, money, etc —– just to score political points is disgusting. Shame on Gov Daugaard. And to stand at the podium and give sad eyes about the lack of revenue in SD, where he had within reach a partial “fix”. And that money would actually HELP people!! It is a head shaker.

  5. OldSarg 2018-03-11 14:38

    The hundreds of millions of “”””””federal tax dollars””””” that Medicaid expansion is bringing to Montana

    It is STILL OTHER PEOPLE’S MONEY! It makes NO money. It is just spending our money. It is taking money off the plates of other people and forcing them to spend it where the people who earned it did not choose to spend it. It is no more than “Theft”. It is not National Defense. It is not a permanent fix. It is a temporary influx of money stolen from those who choose to go where the work is, get the training to do the work and work! There should be no pride in using the hard work of others for one’s self.

  6. Kent Frerichs 2018-03-11 15:02

    Don Walton (Lincoln Journal Star Reporter) (402-473-7248 or reports that after six years of unsuccessful attempts to earn legislative approval for Medicaid expansion that would extend health care coverage to 90,0000 Nebraskans, supporters Friday launched a petition drive to take the issue directly to Nebraska voters in November. The news article pointed out that 32 states and the District of Columbia have expanded Medicaid to give people a path to a healthier life. Voters in Maine approved a Medicaid expansion measure last fall and Idaho is engaged in a ballot initiative now. South Dakota needs to elect Democrats to make a positive difference in providing the health care our people deserve. Expanding Medicaid would also boost local economies and help sustain health care facilities, especially rural hospitals.

  7. bearcreekbat 2018-03-11 15:05

    Should there be pride in greed – seeking to hoard money that one does not need, rather than allowing that extra money to be used through taxes to help others?

    Maybe so? “Pride” and “greed” are two of the seven deadly sins that seem to frequently interface.

  8. OldSarg 2018-03-11 18:23

    Give what you have bearcreek and then come back and act as the holy one.

  9. mike from iowa 2018-03-11 19:57

    Taxes are the price you voluntarily pay to live in this once great land and living here allows OldSmokey’s South Dakota beans to work up their blow.

    Now complain about how I called you a name and then scream victimhood.

  10. bearcreekbat 2018-03-12 09:42

    OS, that is good advice – thanks. Meanwhile, speculation about other folks’ personal failings doesn’t change the fact that “pride” and “greed” still are included in the Seven Deadly Sins – something to contemplate before complaining about paying taxes that you can easily afford to pay.

  11. OldSarg 2018-03-12 11:43

    bearcreek: So is Gluttony, Greed and Sloth and all of those are applicable when a state declares profit from the toils of the people. . . as it also applies to those who leech off of our society.

  12. bearcreekbat 2018-03-12 12:02

    OS, the tough question becomes whether we will consider those seven deadly sins when we make our own personal decisions. For example, if I object to paying taxes I can afford, am I committing any of the seven deadly sins? Seems a question worth asking if I want to avoid engaging in one or more of these sins. And if these sins don’t matter to me, why would I criticize others for their similar disregard?

  13. Dana P 2018-03-12 12:05

    Let’s see…….pre ACA, uninsured people were flocking to ER’s in this country for a wide variety of medical “treatments”.

    Who paid for those uninsured people? WE THE TAXPAYERS! Also, it jacked up insurance rates for those that were insured. ACA/Medicaid Expansion started taking the sting out of this and health insurance market was beginning to stabilize just as we entered the land of Trumpistan. Now, we are going backwards. (figures)

    Glad you mentioned “greed”, OS. It is the greed of health insurers, enabled by paid off politicians, that have gotten our country to where we are on accessible and affordable health care. (other industrialized nations do pretty darn good with their health care.)

  14. Dana P 2018-03-12 12:11

    Glad to see that OS is calling for stopping the use of “other people’s money”. We still give subsidies to the tobacco industry. Tobacco industry makes buttloads of money – yet, we as a country treat people with tobacco related illnesses, and it is costing us mega dollars.

    Oil and gas comps still get “other people’s money” (aka subsidies), yet bring in mega profits. Isn’t it time for us to stop giving oil and gas comps “other people’s money”?

    The beef and dairy industries still get “other people’s money” (aka subsidies), yet bring in mega profits. Isn’t it time for us to stop giving these industries “other people’s money”?

    In states that have expanded Medicaid, it is working. The pay off is great. Job creation, healthier people (which in turn, saves us money), etc. That’s a good thing. A evidence based good thing. Why people like SD governor and OS are against it? Politics.

  15. Cory Allen Heidelberger Post author | 2018-03-12 12:43

    OldSarg, as usual, you miss the point. I know you’d rather stick to your rehearsed lines, but I’m going to demand that you deal with new facts.

    Montana proves that, at the state level, Medicaid pays for itself. Montana is seeing more jobs, more revenue, and more people getting medical care. The benefits are clear and proven.

    To make your point, you can’t just keep bleating tropes. You need to show me the evidence that the revenue transfer from elsewhere (from people who were taxed, not victims of theft or any other crime) has caused harms elsewhere that outweigh the payoff that Dana P rightly says is great.

    Evidence-based policy versus trite ideological bleatings—I pick evidence-based policy almost every time.

  16. mike from iowa 2018-03-12 12:54

    Remember all them wingnut pols screaming you can’t trust the Fed to uphold their end of the Medicaid expansion bargain? How true it was with wingnuts doing everything possible to destroy the ACA and Medicaid right along with it. Another self fulfilling wingnut prophecy.

  17. OldSarg 2018-03-12 13:05

    Dana: I don’t like the health insurance companies either and we all pay for a lot of coverage we have no need of. That being said “It is the greed of health insurers” profits for health insurance companies is limited by federal law to 6% except for the insurance companies that are under contract to provide us with Medicare and Medicaid.

    Oil and Gas comps? They get the exact same deductions all other corporations and businesses do. They are also pulling our country out of the financial pit the uncontrolled government spending has gotten us into.

    Medicare and Medicaid are not “working”. They are simply additional bureaucratic crap between the insurers and the customers. The government contracts with insurance companies to do the government’s work. But don’t think you aren’t still paying the government for them hiring someone else to do the work. We are paying government employees to monitor the business between you and the insurers and if you think they can do that even half well then you are mistaken. As someone who has years of experience within the government I have to tell you, you have put your faith in the wrong place. . . The government IS NOT doing the work. The money flows from your paycheck, to the government who gives it to civilian insurance companies to provide limited care that, By-law, would not be allowed of insurance companies who are licensed to do business in the USA.

  18. Dana P 2018-03-12 14:04

    Wow, OS. Just sticking to the Medicaid Expansion in Montana, which this blog was about – I hope you read the article. It boosted the economy!! (reminder, that’s a good thing) It created jobs, thus more economy boost (reminder, that’s a good thing) It is making Montanans healthier – when they are healthier, they can get out of the house (since that is a big bone of contention with you) and get to work, which helps the economy (reminder, that’s a really good thing)

    Are there people abusing Medicaid? Ripping off the Medicaid system? YES! The percentage of the flunkies ripping it off and abusing it? A fraction of people. So we really shouldn’t throw out the baby with the bath water on this. And I’m so glad that if I lose my source of income or that if I become disabled and can’t work, that Medicaid will be there for me.

    South Dakota really needs to grab an oar and start rowing (expand Medicaid) because it is costing us in the economy, putting a big strain on rural hospitals, and hurting South Dakotans healthwise and pocketbook-wise. This is a GOOD use of taxpayer money. Or I guess we could spend $20 million on a military parade.

  19. Cory Allen Heidelberger Post author | 2018-03-12 17:51

    Medicaid is most clearly working in Montana, in multiple ways. OldSarg has again failed to offer any evidence to the contrary, just more shouting.

  20. OldSarg 2018-03-12 18:59

    The money comes from the people. No matter how much you wail and cry about it, it is still other people’s money, not yours. Any expansion, whether the state gets more money or not someone else has that much less to feed their own family, send their own kid to college or pay their own medical bills that do not qualify for government aid. That is beyond “evidence”. tThat is called “fact”. Only an idiot would argue against “fact”.

  21. mike from iowa 2018-03-12 19:20

    How many citizens could pay their own medical bills with the 27 billion Drumpf gave Warren Buffet in taxcuts. The koch bros probably got more. Many korporations pay no income taxes and yet get hefty checks from stoopid freaking wingnuts of other [people’s monies. Drumpf’s military parade figures to cost 30 million. That would feed all homeless veterans for a long time. Those are facts.

    You pay taxes. That is a fact. That money is no longer yours. it belongs to the Nation to be used for the benefit of all- not just billionaires.

  22. mike from iowa 2018-03-12 19:27

    Here’s more facts- Buffet, the koch bros and other korporations that just made a killing in taxcuts didn’t overpay those taxes. Their tax rates were cut just recently and they benefited mightily from being given huge amounts of someone elses money.

    Money stored offshore can be repatriated for a few cents on the dollar. Those bucks belong to Uncle Sam as part of the 35 % korporate tax rate korporations hide their profits offshore from.

  23. OldSarg 2018-03-12 20:12

    “it belongs to the Nation to be used for the benefit of all- not just billionaires.” as he picks up his welfare check, gets energy assistance, section 8, SNAP, Medicare and handouts from those willing to be charitable. . .

  24. Dana P 2018-03-13 14:12

    sigh OS. Like Cory said, no proof or evidence why it is bad, just “get off my lawn” comments.

    It is called return on investment. Investing tax payer dollars that are paying huge dividends. FANTASTIC R.O.I.

    Just like infrastructure “investment”. When/if something is done along those lines, investing tax payer money up front, creates jobs/helps economy/extends time when infrastructure needs repairs/replaced…..saves tax payer money in the long run. If I’m reading you correctly OS, you WANT to save tax payer dollars. Me too! GREAT return on investment. Medicaid is doing the same thing. Job creation, helping economy, saves tax payer dollars in long run. WIN/WIN (by the way, if you missed it OS, the documented evidence is posted above. You might think about checking that out)

  25. leslie 2018-03-17 21:51

    In the continuing effort of good people that may help educate redneck haters like Old Sarge, Black Elk Peak supporters are walking from Rosebud thru Pine Ridge to Ft. Laramie beginning April 13 to highlight a four year commitment to shed light on the necessity of treaty enforcement. Harney was a signer of the 1868 treaty and the Black Hills are at the spiritual heart of the Great Sioux Nation. Ignorant Gov. (again, “I hate that! Grandmas’ dependency”) Daugaard prefers to distract from positive economics of Medicaid expansion with further injury to Indian health care (e.g. racism). Two for one!! Obama AND Lakota Dakota Nakota people. Still going strong in Red Neck Republican South Dakota!!

    In related matters (Old Sarge as a clint eastwood-type hating on little people he characterizes as “leeches”):

    Then, there’s just for Old Sarge, “How Blood-Plasma Companies Target the Poorest Americans” H. Luke Shaefer and Analidis Ochoa–
    Medicaid, housing subsidies, and SNAP (Supplemental Nutrition Assistance Program)—these are some of the things that make up the backbone of the U.S.’s social safety net. And the federal government, guided by President Trump’s proposed budget for 2019, is seeking to make deep cuts to all three of them.

    So why oh why?

    “…by the George W. Bush years, the moderate Republican foreign-policy establishment no longer had a political base inside the GOP. The conservative movement had taken over the party. And its think tanks like the Heritage Foundation and American Enterprise Institute, publications like The Weekly Standard and networks like Fox News—overwhelmingly backed the war. By the early 21st century, arguing inside the GOP for a foreign policy based on diplomacy, containment, and the embrace of international institutions was about as popular as arguing for higher taxes or gun control….In Pompeo [the hawk], Trump is turning to a new Republican foreign-policy elite: one whose ideological lineage dates not to Eisenhower but to McCarthy, not to Nixon and Kissinger but to Goldwater, not to George H.W Bush but to Dick Cheney and George W. Bush. The conservative movement, long hostile to its party’s moderate foreign policy establishment, is creating a new foreign policy “establishment” of its own…. Pompeo is part of a cadre of influential, foreign policy-oriented, Republican politicians that includes Tom Cotton, Marco Rubio, and Ted “frying bacon on his hot sexy military AR15 assault rifle barrel” Cruz. All four were elected to Congress with support from the Tea Party, a movement that depicted moderate Republicans —as Goldwater once depicted Eisenhower and Nixon—as complicit with the welfare state. Pompeo has close ties to the TEA PARTY’s most important funders, the KOCH Brothers–the right has historically oscillated between isolationism and crusading interventionism. The Koch Brothers and Rand Paul lean toward isolationism. Rubio and Cotton lean toward crusading interventionism. What they all share is self-righteousness. The United States is pure; its adversaries are wicked….

    Tillerson acknowledged that America was contributing to climate change, and should participate in global agreements aimed at mitigating it. Pompeo disagrees.This same insistence on America’s moral purity has informed his fervent refusal to acknowledge that the United States committed torture….A final aspect of the right-wing foreign policy is its penchant for finding enemies at home. If you see compromise as surrender, America’s enemies are demonic…. Like Cotton, Pompeo had a distinguished military career. Like Cotton and Cruz, he graduated from Harvard. While his worldview overlaps heavily with those of Steve Bannon, Sebastian Gorka, and Mike Flynn, Pompeo enjoys a prestige they never did. His rise offers a glimpse into a Trumpism that can outlast Trump….” Peter Beinhart CUNY

    And meanwhile Trump himself:

    We are heading towards war-N. Korea, Russia, China. Thanks, again, “evil” Republicans. Old Sarge?

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