In the coming weeks, Congressional House members could begin committee work on the effort to repeal the Affordable Care Act (ACA). MBPC released a report last month on the detrimental impact of repeal on those who risk losing insurance coverage, including the over 71,000 Montanans who have gained coverage through Medicaid expansion. Montana is experiencing record levels of Montanans with insurance, but that could change quickly as families lose access to Medicaid and adequate subsidies to pay for insurance through the exchanges. A more recent report from the Urban Institute describes the impact of repeal on Montana’s hospitals and medical providers. This report assumes partial repeal similar to that passed by Congress in 2016 (and vetoed by President Obama), which included the elimination of Medicaid expansion, the individual and employer mandates, and Marketplace subsidies.
We don’t yet have full details on what exactly the House will take up this week, but Urban report provides a glimpse at how repeal of ACA could impact hospitals and providers across the state. If Congress does choose to eliminate these aspects of the ACA, Montana providers could face nearly one billion dollars less of health care spending in 2019, putting additional pressure on uncompensated care costs and those with insurance.
|Estimated total Health Care Spending in Montana for 2019 (in millions)|
|ACA||ACA Repealed through Reconciliation||Difference|
|Total Health Care Spending||5,636||4,664||-972|
When fewer people have health insurance, health care spending decreases because people either forego care or are unable to pay in full. Statewide, health care providers stand to lose $972 million in 2019 with the loss of Medicaid expansion, the individual mandate, and existing health care subsidies.
From 2019-2028, these costs would add up. If the ACA were kept in place, Montana insurers would spend an estimated $71.3 billion on health care over this time period. But if the ACA is repealed without an adequate replacement plan included, this spending could decrease by $13.6 billion.
If someone is unable to forego medical care without insurance, and are unable to pay out of pocket, hospitals and other providers are left to pick up the tab. In 2019, uncompensated care would rise by $481 million across the state. Between 2019-2028, this figure would rise to over $5 billion.
Someone must pay for uncompensated care, meaning hospitals and other providers shift the cost to private insurance companies. This “cost-shift” forces insurance companies to raise their premiums, passing the burden along to those with insurance.
Reduction in health care spending would also result in the loss of jobs across the state. In 2019, Montana could lose up to 8,000 jobs, according to the Commonwealth Fund. Three thousand of these jobs would be in the health care sector.
Repeal of the ACA could have dramatic effects for Montana’s economy, from rising health care costs to lost jobs. For more information about the effects of repeal, be sure to read MBPC’s latest report: 142,000 Montanans Face Uncertainty of Health Coverage with Threat of ACA Repeal.
This week, Congressional House Republicans are aiming to move forward with a bill to repeal the Affordable Care Act (ACA), putting the health care of tens of thousands of Montanans at risk. Exactly what the bill will look like is still unclear, but as we get more details, we will be sure to share our initial analysis of the impact on Montana families and the broader economy. With thousands of Montanans depending on provisions of the ACA – including 71,000 who have received insurance through Medicaid expansion and another 58,000 who access insurance through the exchange – repeal of the ACA could have devastating impacts on access to health care, jobs, and the economy.
Last month, MBPC released a report highlighting the repeal of ACA could put coverage for 142,000 Montanans in danger. Before the law was passed, a staggering one in five Montanans did not have health care coverage. Now, that number is down to only one in 14. Repeal could cause an even higher rate in the uninsured, as uncertainty in the marketplace causes insurers to raise their prices.
Those at greatest risk of losing their insurance are people who gained coverage when the Montana state legislature decided to expand Medicaid with bipartisan support. The Health and Economic Livelihood Plan (HELP) was the first of its kind in the country, and today over 71,000 Montanans have accessed affordable health coverage, including:
- 38,832 women
- 60,988 people living below the poverty level
- 9,916 American Indians
- 17,130 people between 50-64 years old
The HELP plan has also provided thousands of preventative care services to patients, including:
- 19,491 cancer screenings
- 7,137 diabetes screenings
- 26,581 dental services
- 7,419 preventative wellness exams
- 5,409 vaccines
Repealing Medicaid expansion could also significantly hurt Montana’s economy, as it has increased the demand for health care services and therefore increased the need for health care jobs for doctors, nurses, laboratory technicians, and other medical services staff. In just one year, Medicaid expansion has brought in $284 million in federal funds to health care services to Montanans.
This week on the blog we will be looking into the ways that repeal of the ACA could impact Montanans. Please be sure to follow along as we explore how repeal effects children, hospitals, American Indians, and people who used the federal exchange to find affordable insurance.
This week, the Legislative Fiscal Division (LFD) released the first general fund status sheet for the 2017 legislative session. The status sheet provides a glimpse at where we stand with revenue, projected spending, and the resulting ending fund balance, factoring in actions taken so far by the legislature. Right now, we sit roughly $140 million below the goal of a $300 million ending fund balance. Unless legislators get serious about the need for additional revenue, we could expect even further cuts (on top of the devastating cuts already taken).
Over the past month of session, subcommittees in charge of various parts of the budget have been taking action on the main budget bill – HB 2. These early actions on the budget included deep cuts to nearly all state agencies, including cuts to social service programs for seniors, the disabled, and our most vulnerable families, as well as cuts to higher education that will likely result in double-digit tuition increases for Montana students and families. When factoring both state cuts and corresponding federal dollars we lose, the legislature’s initial actions represent a total $449 million in cuts.
While subcommittees have taken action to add back some funding, most of these additions are “present law adjustments” and are simply a reflection of inflationary needs to continue the current level of services in the next biennium. To be clear: the cuts made in subcommittees will have a serious impact on our communities and families across the state.
The second page of the status sheet provides the general fund balance sheet. It shows that we begin the session with a beginning fund balance of $110 million. As we’ve talked about previously, lower revenue levels than projected have resulted in a much lower beginning fund balance than previously anticipated. The balance sheet then shows the amount of revenue projected to come in during the next biennium. The balance sheet also provides an estimate of expenditures that the legislature has approved thus far. This includes subcommittee action on HB 2, bills on which the legislature has taken positive action, and one-time-only spending approved so far. LFD will update the general fund status sheet on a weekly basis, take into account further changes to HB 2 and bills passing or failing. Right now, when you factor in the projected revenue minus the expenditures passed thus far, we finish the next biennium with an ending fund balance of $159 million.
We are not yet halfway through the session, but Montana families should be concerned about the deep cuts already taken to the state budget and how that will impact our seniors, students, and services vital to our communities. The good news is that there is still time. The Legislature has 49 more days to identify new revenue in the state and restore the deep and potentially devastating cuts they have made to the budget. It is possible in the state of Montana to have a balanced budget, fund the services that help citizens and communities across the state, and leave a healthy ending fund balance. We can do all of this by ensuing that the super wealthy and out-of-state corporations are paying their fair share.
It can be hard to imagine that thousands of our neighbors struggle with hunger, yet that is the reality for the nearly 140,000 Montanans living in food insecure households. Seniors, families with children, veterans, and even working Montanans aren’t always able to put food on the table, impacting the health, productivity, and academic success of our families and communities.
Our nation’s most important tool to combat hunger is the Supplemental Nutrition Assistance Program (SNAP). SNAP fills in the cracks for low-wage workers, making sure they aren’t forced to choose between feeding their families and paying the rent. For kids, SNAP ensures they have nutritious foods outside of school hours, helping them focus and succeed in the classroom. For seniors, SNAP ensures they can fill their prescriptions and still buy enough groceries to remain healthy and independent. And for adults struggling through an unexpected job loss, illness, or other tragedy, SNAP provides an important stepping stone, helping them get through a hard time. Last but not least, SNAP supports our grocery stores, farmers markets, and state economy by bringing our federal tax dollars back to Montana.
That’s why we are concerned by continual attempts to weaken SNAP, at both the state and federal levels.
The first threat at the federal level will be through the upcoming budget resolution process, followed by the reauthorization of the Farm Bill. Congress has yet to develop specific policy proposals so it is crucial to reach out now to express the importance and effectiveness of SNAP. Let Montana’s Congressional leaders know that attempts to cut the program or undermine its foundational effectiveness through block granting or other structural changes are unacceptable.
SNAP is also at risk at the state level. A bill to revise SNAP eligibility, HB 361 sponsored by Rep. Tom Burnett, would make income guidelines even more stringent than they currently are, and would reinstitute a resource limit. Decreasing our state’s gross income test will primarily hurt working families with children, as well as families with high housing costs. Resource limits can be particularly harmful for low-income seniors but negatively impact all families. Numerous studies have demonstrated that having savings and other resources are critical for families trying to get back on their feet. Building assets helps low-income families invest in their future and avert a financial crisis that can push them deeper into poverty. At asset limit discourages savings and forces families to spend down all of their resources before receiving help.
Please speak out against harmful changes to SNAP. Let our lawmakers know that SNAP is one of our most effective and efficient public programs. It is quietly providing dignity and opportunity for thousands of Montanans when they need it most. Denying individuals the ability to access food assistance would have long terms costs on our nation’s health and productivity that are far greater than any immediate budget savings.
Lorianne Burhop, Chief Policy Officer, Montana Food Bank Network
We need a state Earned Income Tax Credit. Here’s Why.
A state Earned Income Tax Credit (EITC), like the federal credit, could go a long way to helping Montana families meet their basic needs. But it could also do a lot to improve the fairness of our tax code.
Low- and moderate-income families in Montana pay a higher percentage of their income in taxes than do the wealthiest families. The lowest income one-fifth of Montanans pay 6.1 percent of their income in taxes, whereas the top 20 percent pays far less. In fact, the top one percent pays just 4.7 percent of their income in taxes.
While Montana’s income tax is progressive, meaning the more you earn the larger percentage of your income you pay in taxes, other taxes like sales and property taxes are not. People with smaller incomes end up spending a much greater percentage of their income on these taxes than higher income taxpayers. For example, families in the bottom 20 percent of incomes pay 3.3 percent of their income on property tax. The top one percent, however, pays just 1.6 percent. As a result, people with the lowest incomes actually spend much more of their money on state and local taxes than people with the highest.
Twenty six states, plus the District of Columbia, have enacted state EITCs in order to help improve the lives of
working families. After seeing the success of the program, many have expanded their programs. Iowa, for instance, raised their credit to 15 percent of the federal credit. New Jersey recently set their credit to 35 percent of the federal credit. Maine also decided to make their credit refundable, meaning if the total amount of credit exceeds the taxes paid, the taxpayer receives the difference.
A state EITC would be easy for Montana to administer because it is calculated based off of the federal EITC. Administrative costs would be equal to less than one percent of the benefits provided.
It could also boost our local economy. House Bill 391 would establish a state EITC at 10 percent of the federal credit. If passed, this credit would funnel $16.5 million back into the hands of working Montanans and into our economy.
When families spend their tax credit on basic needs like school supplies and groceries, local businesses reap the benefits. A state EITC that could help the economy, as well as reduce the inequalities in our tax code, is a good deal for Montana.
Kids don’t usually get too excited about things like tax credits. But they do appreciate things like being healthy, doing well in school, and having working parents. A state Earned Income Tax Credit (EITC) could help families provide their children with each of these things, and support our local communities as well.
Today we are going to talk about how children benefit from the EITC. If you’re not sure what that is, check out yesterday’s blog post first to get caught up.
While some very low-income families without children receive the EITC, most of the credits go to families with children. In Montana, 80,000 low- and moderate-income households benefit from the federal EITC. House Bill 391 would establish a state EITC, and help improve the lives of families and children all over the state.
The EITC essentially raises the income of working families by providing them with a tax credit. This bump in income has significant benefits for children. Nationwide, the federal ETIC has been the single most effective way to reduce poverty. In 2013, it lifted 6.2 million people, including 3.1 million children, out of poverty.
Although most families only receive the credit for a year or two, the benefits for children last much longer. Here are few examples of the long-lasting benefits the EITC can have on children:
- Better health at birth. Studies have shown that receiving the EITC can mean fewer babies born premature, or with low birthweight. Mothers were also more likely to receive prenatal care, and had better health indicators themselves.
- Better school performance. Children whose families receive larger EITCs are also more likely to do well on school tests, particularly in math.
- Brighter futures. Kids whose families receive larger ETICs are more likely to graduate from high school. They are also more likely to attend college.
- Higher earnings. A small boost in a family’s income when kids are little can mean big payoffs when they are older. For every $3,000 in extra income a year that a child in a low-income family received before age six, their working hours increase by 135 hours per year by the time they reach 25. Income increases by 17%.
Families spend their tax credits on basic needs, most of which directly benefit their children. About half of the credit tends to go to things like groceries or school supplies. Families spend the other half of things like paying off debt, or on home repairs, education, or savings. The EITC can help parents better provide for their children.
If Montana creates a state EITC, we can help build even healthier and stronger families across the state. House Bill 391 is an important opportunity to help our children succeed.
To learn more about how a state EITC would benefit Montana, read our report here.
This Wednesday, the Montana legislature will have a hearing on a bill that could help brighten the prospects of working Montana families. The bill is HB 391, a proposal to create a state Earned Income Tax Credit (EITC). So let’s first figure out what exactly the EITC is, and how it helps working Montanans.
The federal Earned Income Tax Credit was first created in 1975, as a bipartisan means of reducing poverty and creating jobs. President Ronald Reagan once said,
“The Earned Income Tax Credit is the best anti-poverty, the best pro-family, the best job creation measure to come out of Congress.”
The federal EITC gives families with incomes between about $39,500 and $53,000 (depending on marital status and number of kids) credit for the taxes they have paid. In 2015, the average EITC was $3,186 for a family with children, raising the family’s wages by about $265 a month. Only families that work qualify, and most families only use the credit for a year or two.
In HB 391, Montana’s proposed state EITC would be set to 10% of the federal credit.
A state EITC would:
- Benefit 80,000 families across Montana. Montana’s low-income families actually pay a higher portion of their income in taxes. A state EITC could help even out this disparity.
- Improve children’s lives. Children see plenty of benefits from the EITC – better health, better school performance, higher rates of college attendance, and even higher earnings for adults.
- Promote work. With an EITC, the more you work, the higher your refund. This format encourages families to work more hours, meaning better opportunities and higher pay as their careers continue.
- Strengthen communities. Families use their EITC to buy pay bills, buy groceries, and buy school supplies – pouring money back into their local businesses.
Twenty-six states plus the District of Columbia have already created state EITCs. This year, Montana legislators should make the same move to help support working families and their children.
To learn more about how a state EITC would benefit Montana, read our report here. Be sure to check back tomorrow, when we will talk more about how a state EITC would benefit our children.
When a new baby enters the family, everyone’s life turns upside down. While mothers might need paid leave while they recover from childbirth, it is vital that fathers are also home to participate in family life during those earliest days.
As we wrote about yesterday, the legislature is considering H.B. 392, which would establish a family medical leave insurance program (FAMLI). The FAMLI Act would combine small amounts from employees and employers (less than one percent of wages) to create a dedicated funding stream for workers when they need time off to care for themselves or a loved one. From these small contributions, workers would receive a portion of their wages while on leave.
But it’s not just new mothers who need paid leave. When fathers are able to take even just two weeks paternity leave, they are more active caregivers – feeding, changing diapers, and rocking the baby to sleep in the middle of the night, even well after he has gone back to work. The more engaged fathers are with their children, the better developmental outcomes are for the kids, from improved cognitive ability to fewer behavioral problems.
While paid paternity leave has obvious financial benefits for the dad, it actually can boost employment and earnings for moms too. Studies from Canada and Sweden show that when men take leave, women are better able to return to work because they have a trusted and affordable source of childcare at home.
Right now, only 13% of men have access to paid leave, meaning that many fathers take far less time at home with their families than they would prefer because they simply can’t afford it. In California, a state with a similar paid leave program, one-third of men took time to bond with their children in 2014, compared to only 21% in 2007. This increase in popularity shows that men want to spend time caring for new family members, when they can afford to do so.
Paid leave provides both men and women the opportunity to provide for their families physically and financially. The benefits of an involved dad last far longer than the just during the newborn days – they can last a lifetime.
Paid leave benefits many types up families as well, including workers who have aging parents to care for, or someone who is facing a serious illness. For single workers who might not have other means of support, paid leave can be a lifeline. Everyone benefits when they have the ability to provide for their family.
Paid leave models like this have been successful in other states, and are an important measure that benefits both families’ health as well as their financial stability.
If you want to read more about the benefits of paid leave, be sure to check out MBPC’s series on the topic.
When faced with an illness, caring for a loved one, or a new child entering the family, many Montana workers are forced to choose between taking time off to care for their family, and financial stability.
But a new bill before the legislature (H.B. 392) gives Montanans a chance to provide for the families to face these hurdles without taking a financial step back. The Montana Family and Medical Leave Insurance Act (the FAMLI Act) combines small amounts from employees and employers – less than one percent of wages into a pool, from which eligible workers could receive a portion of their wages while on leave.
While the Family and Medical Leave Act (FMLA) of 1993 provided workers with some job security, the law only guarantees unpaid leave. Without pay, many workers are not able to take as much time off as they need to adequately take care of themselves and their families. And if they do, the loss in wages may mean difficulty paying the rent or putting food on the table.
Some companies do provide paid leave, but they are the minority. Less than a quarter of workers in the private sector had access to any type of paid sick or family leave.
And when families and workers miss out on wages, everyone suffers. Not only do families face financial insecurity, but the local businesses where they would have spent their wages do as well. Small businesses who wish to not only take care of their workers, but also compete with the benefit packages larger companies offer, benefit from a more equal playing field.
California, New Jersey, and Rhode Island have instituted paid leave programs for workers in their states, and have been reaping the benefits for years. In fact, one study found that women who used paid leave were less likely to need public assistance and Supplemental Nutrition Assistance Program (SNAP) benefits. The study also found that women were much more likely to be working within the year after their birth, and also had higher wages. Montana has the opportunity to see the same benefits by enacting the FAMLI Act.
Paid family leave can help strengthen the economy, local businesses, and improve the economic and physical health of families. A cost effective program like the FAMLI Act can help strengthen all working Montanans and their loved ones. It’s time for paid leave in Montana.
To read more about how paid leave could benefit Montana, be sure to read MBPC’s report: Helping People Balance Work and Family: It’s Within Montana’s Reach.
The 2017 Montana Legislature has been marked with concern over massive budgetary cuts and the major shortfall in revenue. While not all cuts can be avoided, the legislature should take a balanced approach to ensure the state can continue to invest in our families and communities. This includes ensuring we have adequate revenue in the state by putting in place common sense measures to ensuring wealthy corporations are paying their fair share.
Earlier this session, the House Taxation Committee heard House Bill 215, an act revising the rate of tax for certain oil and natural gas production. Reducing or even eliminating this tax break, called the oil and gas tax holiday, is one step toward balancing the budget and making sure corporations are paying their fair share. Unfortunately, the House Taxation Committee tabled HB 215 earlier this week.
The oil and gas tax holiday is a policy that allows newly drilled wells to be taxed at a substantially lower tax rate during the beginning of production. Wells, however, produce significantly higher amounts of oil and gas at the start of usage, which means these oil companies receive this tax break during the most profitable period of extraction. While some argued these tax holidays attract developers and increase revenue, the data clearly shows such tax holidays only suppress potential state revenue and does little to increase developer interest.
Montana, despite its lower tax policies, is not outperforming neighbors with higher tax policies. Wyoming, New Mexico, and North Dakota all have higher taxation rates for oil companies. All three states have consistently out produced Montana in terms of barrelage. Oil and gas companies do not seek to drill based upon the tax policy of that area. They drill where there are natural resources available.
Montana has lost millions of dollars in revenue due to this tax policy. From 2008 to 2014, the tax holiday cost the state and counties $265 million in revenue. This money could have been used to pay for public services, such as schools and roads. In oil-producing counties, especially those near the Bakken region, they have been forced to deal with increased demand on their infrastructure, but no increased revenue to update such necessary services.
HB 215 proposes to increase in Montana’s production tax would to 4.5 percent, which is still lower than the national standard of 9.26 percent. But even this small step is crucial in insuring our legislature can make strategic investments in Montana communities.
The increased revenue could be used to assist in failing infrastructure, public services, and our schools and universities. Oil and industry should not get a free ride in this state. We all need to pay our fair share especially when so many Montanans are struggling with significant budget cuts.