This tax bill is a health care bill too.

We anticipate that the House and Senate will vote on the final GOP tax plan early next week. While this proposal is first and foremost a give-away to the super wealthy and corporations, it’s important to remember that it is also a direct attack on the health care coverage of Montanans.

We briefly explained in an earlier post about why the Senate tax bill would hurt Montanans with health care needs. Today we are going to take a closer look at how this tax bill is a health care bill too:

If the Affordable Care Act’s individual mandate were repealed, 13 million more Americans would go uninsured. While the Congressional Budget Office (CBO) notes that the magnitude of the coverage effects is uncertain, it concludes that there’s no doubt that “the number of uninsured people would be millions higher.”

In Montana, 146,717 people are enrolled in Medicaid as of September 2017, and 86,000 people are enrolled in Montana’s Medicaid expansion as of November 2017.

And, thanks to the Affordable Care Act, Medicaid and the Children’s Health Insurance Program (CHIP), 92 percent of Montana’s children now have health insurance coverage.

With over 232,000 Montanans insured through Medicaid and Medicaid Expansion, cuts to Medicaid would be devastating for our state. Montana is already grappling with an opioid epidemic, as well as major funding cuts to support rural health care needs and Montanans with disabilities. As recent media has reported, Medicaid and Medicaid Expansion has been a critical lifeline for Montanans.

Without the ACA individual mandate, individual market premiums would also increase 10 percent. Fewer healthy people would sign up for individual market coverage with no mandate, which would increase average costs and therefore premiums in the individual market as less healthy and young people enroll and more people with expensive medical needs tilt the cost of health care needs.

The Congressional Budget Office (CBO) estimates that repealing the mandate would permanently raise premiums by 10 percent, and some major insurers have projected larger effects. As Senator Collins has noted, these premium increases would likely erase — or more than erase — the Senate bill’s tax cuts for millions of people who buy coverage in the individual market. Unaffordable premiums should not be a barrier to folks who need coverage.

The individual mandate is also critical to keeping the individual market stable. As the American Academy of Actuaries commented in its recent letter to Senate leaders about repealing the mandate, “increased uncertainty and instability regarding future enrollment, premium rates, and risk pool profiles if coverage incentives are eliminated would increase the risk of insurers incurring losses. Insurers would likely reconsider their future participation in the market. This could lead to severe market disruption and loss of coverage among individual market enrollees”

And last, but not least, if repealing the individual mandate is included in the final federal tax plan, it would also result in the loss of $5.5 million in general fund revenue per year for Montana. Since it is predicted less Montanans would enroll, the state would lose revenue from no longer collecting the health insurance premium tax from enrollees.

Affordable health care coverage for Montanans is a value that we all share. Our Montana congressional delegation should work to advance tax policies that strengthen the state of Montana and invest in our working families. Equally, our congressional delegation should support health care legislation that strengthens the Affordable Care Act—not provisions that work to cut it down.

US Senate Tax Plan in Montana: Winners and Losers

In mid-November, the House passed a tax plan that would add $1.5 trillion to the federal deficit and increase taxes on working and middle-class people to pay for permanent tax cuts for large corporations and the super wealthy. The proposal also sets up deep cuts to Medicaid, Medicare, education, and SNAP that would add to the pain families feel as a result of this bill.

The Senate bill has the same basic flaws as the House bill, but this time the tax legislation also includes a direct attack on the Affordable Care Act, resulting in millions of Americans losing coverage. As we anticipate the Senate vote this week, let’s take a closer look at who are the real winners and losers in the Senate tax plan:


The Super Wealthy: Despite all of the talk about helping the middle class, wealthy individuals and their heirs win big from the Senate tax plan. The top tax rate for millionaires has been shaved down to 38.5 percent from 39.6 percent, while the exemption from the estate tax—which is a an inheritance tax on multi-million dollar estates—doubles to $11 million for individuals and $22 million for couples. The Senate bill also eliminates the alternative minimum tax (AMT), a levy aimed at ensuring that higher-earning people pay at least some tax.

By 2025 (when most of the Senate bill’s provisions would be in place), high-income households would get the largest tax cuts as a share of after-tax income, on average. Meanwhile households with incomes below $30,000 would, on average, face a tax increase.

Multi-National Corporations: The Senate bill slashes the corporate tax rate from 35 percent to 20 percent, going into effect in 2019. U.S. oil companies with foreign operations would pay reduced taxes under the Senate bill on their income from sales of oil and natural gas abroad. Beer, wine and liquor producers would also reap tax reductions under the Senate measure. Like the House bill, the Senate bill creates a lower corporate tax rate for multinationals’ foreign profits. That’s a big incentive for companies to shift profits and investments offshore to get the lower rate, and it advantages large multinationals compared to small, domestic firms.

The Senate bill makes all these tax cuts for corporations and multinationals permanent—paying for that by repealing the individual mandate and making millions more uninsured, even while allowing provisions that are intended to benefit middle-income families expire at the end of 2025.

Senate tax plan


Montanans with Health Care Needs: The Affordable Care Act’s individual mandate would be repealed, which would cause 13 million more Americans to be uninsured and raise individual market premiums by 10 percent. The individual mandate is critical to keeping individual market coverage affordable and keeping the individual market stable. The $338 billion in savings from repealing the individual mandate are being used to pay for making part of the Senate bill’s corporate tax rate cut permanent, which overwhelmingly benefits high-income households: the top 0.1 percent of households would get an average tax cut of about $100,000 annually.

Working Folks: Many families making less than $30,000 a year would face tax increases starting in 2021 under the Senate bill, according to Congress’ nonpartisan Joint Committee on Taxation. By 2027, when many of its provisions would have expired, those at the top would still get large tax cuts, but every income group below $75,000 would face tax increases, on average.

Working Families with Children: The Senate plan’s signature “middle class” tax cut, its Child Tax Credit (CTC) increase, provides almost no benefit ($75 or less) to 10 million children in low-income working families, and provides less than the full $1,000 increase in the credit to millions more. At the same time, it newly extends the full $2,000 per child credit to couples with incomes between $110,000 and $500,000. Even this meager increase would be temporary, as the Senate tax plan ends the entire CTC increase after 2025. Low-income working adults without children and non-custodial parents are also largely excluded from the plan’s tax cuts, so millions would continue to be taxed into or deeper into poverty.

Charities: Charities that support low-income families and supplement government services are nervous about the impact of doubling the standard deduction. The National Council of Nonprofits warns that charitable deductions are likely to go down under this bill. While the GOP enables the wealthy to continue deducting their charitable giving, many middle- and upper-middle-class families would no longer get that tax break, because they probably would stop itemizing their deductions. At the moment about 30 percent of Americans itemize, but under the GOP bill, the standard deduction roughly doubles from $6,350 to $12,000 for individuals and $12,700 to $24,000 for married couples, meaning fewer people would probably itemize.

All of us in Montana: About half of Montana’s budget comes from federal funding. If these cuts become law, state policymakers will have to find ways to pay for health care, food aid, grants for college, and more. Thanks to low revenue due to our own trickle-down policies, it is highly unlikely Montana will make up the difference. This tax proposal on top of our current budget crisis in the state will be devastating to our economy, our communities, and our families that are already struggling.

Montana Families Rely on the Children’s Health Insurance Program: CHIP Facts

The Children’s Health Insurance Program (CHIP) provides vital coverage for thousands of Montana’s children. Federal funding, however, expired at the end of September 2017, jeopardizing financial stability for families and for the state.

CHIP birthsMontana cannot afford to provide coverage to CHIP families without continued federal funding, and Montana families cannot afford to lose their children’s health insurance. Our elected officials in Washington, DC must act immediately to continue this vital program.

To learn more about CHIP in Montana and what is at risk with its expiration, read our CHIP fact sheet – Montana Families Rely on the Children’s Health Insurance Program.

Montana Budget Update: Where Do We Go from Here?

The recent decline in state revenue threatens Montana’s ability to adequately invest in the public institutions and services that educate our children, keep our communities safe, and provide health care and other services to our most vulnerable neighbors. Between January and July 2017, legislative action has resulted in $218 million in general fund cuts, and it appears more cuts are on the horizon which will impact every part of the state budget.

This report Montana Budget Update: Where do we go from here provides a recap of how we got here and the deep cuts already made to the budget. It also calls for the legislature to seriously consider revenue to stave off deeper cuts and factors to weigh when making budget cuts.

Read the full report Montana Budget Update: Where do we go from here.


News Release: 120 Montana organizations and leaders oppose proposed cuts to Medicaid and loss of coverage for thousands of Montanans

An unprecedented cross section of 120 organizations and leaders, including patient advocates, mental health providers, nurses, hospitals, tribal health centers, disability advocates, faith leaders, and other health care service providers, publicly raised concerns about ongoing deliberations on health care and potential cuts to Montana’s Medicaid program. The signers of the message used ads printed in the Bozeman Chronicle and Great Falls Tribune to call on Senator Daines to reject any bill that would cut Medicaid, eliminate Montana’s bipartisan Medicaid expansion, or result in the loss of coverage for millions of Americans.

The ad included numerous patient advocates like the American Cancer Society Cancer Action Network, the American Lung Association, and the American Heart Association.

“We know that having access to quality, affordable health insurance is a key determinant in surviving cancer. While the current law needs improvement, its greatest achievement has been getting more uninsured people the coverage that meets their needs,” said Kristin Page Nei of the American Cancer Society Cancer Action Network. “We urge the Senate to reject the flawed House bill and work together to find ways to stabilize the insurance market, retain patient protections and reduce rather than increase premiums, so we can improve our health care system and protect cancer patients.”

Signors also included nearly every association representing health providers, including hospitals, doctors, nurses, pediatricians, family physicians, primary care clinics, and public health officials.

John Goodnow, CEO of Benefis Health System called on a rejection of the Medicaid provisions being considered by Congress. “The Senate must reject federal caps and cuts that will hurt our most vulnerable Montanans – like low-income children, seniors, and people with disabilities, and the over 75,000 Montanans who have benefited from the expansion of Medicaid in Montana,” said Goodnow. “Proposals to cap federal Medicaid funds will devastate not only Montana’s Medicaid and Medicaid expansion patients but also health care providers, particularly small rural hospitals and the rural communities they serve.”

The breadth and the depth of the signers requesting that the Senate reject cuts to Medicaid speaks to the enormity of what is at stake for Montana patients and providers. Since passage of Montana’s bipartisan Medicaid expansion, the uninsured rate in Montana has dropped to 7.4% in 2016, from 20% in 2012, according to the Montana Commissioner of Securities and Insurance.

“We have seen Montana’s uninsured rate fall significantly since passage of Medicaid expansion,” said Matt Kuntz of NAMI MT. “Thousands of Montanans now have access to ongoing and mental health and addiction treatment for the first time ever. We can’t afford to go backwards.”

The House passed the American Health Care Act (AHCA) in May. The non-partisan Congressional Budget Office projected that the AHCA would result in over 20 million Americans losing coverage and over $800 billion in cuts from Medicaid over ten years. More recently, the Montana Healthcare Foundation projected that the state of Montana would lose $4.8 billion in federal Medicaid support by 2026 putting significant pressure on the state budget and likely forcing deep cuts in benefits, enrollment, and payments to hospitals and providers. The Healthcare Foundation also projected over 70,000 Montanans would lose Medicaid coverage.

Unfortunately, the Senate version, released on Thursday after weeks of secretive, back room meetings, retains many of the most harmful features of the House bill, including cuts to Medicaid funding and the phasing out of Medicaid expansion.

Here is the text of the ad and the full list of signors.


The Montana We Could Be: Tax cuts, aimed at the rich, take a toll

Montana today could be a more prosperous state. Through investments by our state, we could have more modern schools, better roads, updated water and sewer systems, and a greater access to a college education.

Our state does not have these things – not because of a natural disaster or a financial crisis brought on by things out of the state’s control. Instead, Montana is not the state it could be because of the decision made in 2003 to sharply reduce taxes. These tax cuts that mostly benefited the wealthiest Montanans have cost the state nearly $1 billion in one decade.

Read the full report The Montana We Could Be: Tax cuts, aimed at the rich, take a toll.

Paid Family and Medical Leave: Supporting Families, Businesses, and The Economy

Shifting work and family structures in the 21st century highlight the need for workplace policies that help parents balance caregiving and career demands. In collaboration with the Montana Department of Labor and Industry, the Montana Budget and Policy Center will conduct three reports on paid leave. This is the first report, which uses evidence from state-initiated paid leave programs, and national studies to examine how paid leave benefits families, businesses, and the economy.

>>>Read our first report: Paid Family and Medial Leave: Supporting Families, Businesses, and the Economy here.


Montana Loses Millions Each Day By Not Expanding Medicaid

Montana's Fading OpportunityMontana is missing out on millions of dollars every day, in addition to thousands of jobs, by not expanding the state’s Medicaid program so more Montanans can gain health coverage.

On January 1, 2014, the federal government made funds available to states that choose to expand their Medicaid programs. Because Montana’s legislature has so far refused to accept the federal funds and extend Medicaid coverage to as many as 70,000 low-income individuals, Montana has been losing as much as $1.96 million of federal funds every day.

Additionally, Montana is losing out $1.38 million in increased labor productivity from the 12,000 jobs that expansion would create. This increased labor income would also help generate $143,750 in state and local tax revenue every day. Medicaid expansion is an important opportunity for our state, and every day it is delayed Montana loses out on millions of dollars that could be used to create jobs, support our economy, and provide health care coverage to 70,000 low-income Montanans.


>> Read our full fact-sheet here.