The Big Story: Montana Legislature green lights Medicaid expansion as Congress considers program cuts
“The Montana Senate gave final legislative approval to the bill in a 30-20 vote Thursday, February 27. Expanded coverage had been set to expire on the safety net program that insures more than 76,000 Montana residents… The state renewed the expanded program in 2019, but set an expiration date for this summer. Under the latest bill, lawmakers would no longer need to periodically renew the program.”
The Bleeding Edge
3-minute read
You know the knives are out.
Some healthcare leaders aren’t waiting around for the cut.
In last Tuesday’s longest-ever presidential address to a joint session of Congress that went big on budget slashing, healthcare was treated like Voldemort – “that which shall not be named” – though healthcare spending accounts for 29% of the nation’s $6.4 trillion budget.
The silence was the signal. According to a CNN analysis, “healthcare” accounted for less than two minutes of the 90-plus-minute address. And “Medicaid”, proclaimed a “loved and cherished” program just five weeks ago? That third rail, now fully electrified, went wholly unmentioned.
With the silence on the issue from the dais, you could hear the sharpening of knives in the cloakroom.
Will the coming cuts to healthcare be called waste, fraud and abuse? Will they be inspired by the DOGE-desired evaporation of NIH grants? Simply throwing sand in the gears of Medicare, Medicaid and CMS’s machinery would be harmful enough. However you slice it, there will be fewer federal dollars for healthcare tomorrow than there are today.
Some healthcare leaders aren’t standing by to see the shape of the blade to act. They are effectively moving at the state level to support their organizations and the people they serve.
The latest case in point? A few days ago, Montana’s legislature comfortably voted to continue its expanded Medicaid program, ensuring access to healthcare for some 76,000 residents.
This reddest of red states legislature approved the measure with a 10-vote margin in the Senate and a 26-vote margin in the House.
This follows politically purple North Carolina expanding Medicaid in 2023 – just before a contentious election year – making nearly 350,000 of its residents eligible for insured care.
While the Washington power structure trembles from the disruptive Trump tsunami blowing through the federal government, healthcare action is happening at the state level.
Montana proves it’s possible to marshal the diverse state-level stakeholders who care about healthcare, and Medicaid specifically, and do so in a way that moves enough conservative votes to protect what’s important to patients, providers, businesses and all those who have a deeply vested interest in affordable access to coverage.
How? Let’s zoom in on Montana, a very fresh example and one that our firm was close to.
A few lessons worth highlighting:
- Proactivity: The ground game in Montana ran for more than a year. It was based on the idea that if the best time to plant a tree was 10 years ago, the next best time is In this case, healthcare leaders across the state recognized the risk early on and got to work.
- Message: A lot went into learning what messages would resonate with various audiences – and which ones wouldn’t. That takes time and research to identify what delineates different audiences and then the messages they’d respond to.
- Coordination: The organizations involved in advocating for reauthorizing expansion told real stories in a coordinated way. It wasn’t ad hoc. The stories were carefully selected and authentic.
- Method: How you engage matters. In Montana, advocates also learned what each audience was looking for and how they received/interacted with information. Then they met people where they were.
- Relationships: Again, plant that tree as soon as possible. Healthcare insiders in Montana were doing the legwork to build rapport with stakeholders long before the vote, not just when they needed something.
The power of local
With the right kind of campaign and the right voices, you can have an influence on what happens next. The perspective, knowledge and lived experience of constituents, coupled with a coordinated and localized message, matter to elected officials at every level. It’s easy to become jaded and think that only conversations and Very Big Efforts in D.C. or state capitols are all that matter. But Montana proves otherwise. Local efforts are additive, impactful and help move the needle.
A parting thought of encouragement: Nurses and doctors are most trusted by the public on questions of healthcare policy. Hospitals are trusted more than just about anyone except for nurses and docs. Your people and your organization are perfectly placed to take on this admittedly challenging work.
So, get your ground game going before the cutting begins.
Contributors: David Jarrard, Susan Gleiser, David Shifrin, Tim Stewart, Emme Baxter
Image Credit: Shannon Threadgill
