Money Moves and Health Care Transparency Blues in Week 13 of the Montana Legislature

Montana House Approves Draft of Bill to Spend $3 Billion in Federal COVID-19 Relief; Senate Panel Advances Budget

Ahead of a key deadline on April 8, the Montana Legislature is quickly advancing a bill to spend billions in federal COVID-19 dollars as guidelines for how that money can be spent continue to roll in.

House Bill 632, sponsored by Rep. Frank Garner, R-Kalispell, and dubbed the "Beast Bill" by lawmakers, advanced out of the House Appropriations Committee on Monday, March 29, and cleared the full House on an 83-14 vote just three days later. The bill distributes about $2 billion to water and wastewater projects, public and private schools, broadband expansion, housing assistance and more.

Lawmakers in the House of Representatives raced to pass the bill to the Senate prior to April 8, the date by which all bills with money attached must be passed by their chamber of origin or are considered dead.

Work to assemble a framework for how to spend the money began after President Joe Biden signed the American Rescue Plan Act on March 11, distributing $1.9 trillion in federal aid to states, schools, individuals and other areas to combat the economic effects of COVID-19-related shutdowns. While some state Republican lawmakers have openly protested the move as one that will lead to inflation and increased national debt, leadership has said they intend to put the money to work in sewer, infrastructure and broadband projects.

"Everybody isn't on the same page with how responsible it is to dump another trillion dollars or so into the economy, but since it gets stuck back in the federal coffers if we don't spend it, we've got to spend it," said House Speaker Pro Tempore Casey Knudsen, R-Malta.

Members of both parties acknowledge the bill is a long way from finished, as the federal government continues to give guidance limiting where and how the funds can be spent. Still, lawmakers said the bill was in "good shape" during debate on the House floor.

"House Bill 632 is a testament to the people that we represent," said Rep. Mary Caferro, D-Helena, vice chair of the House Appropriations Committee. "We worked really hard -- amazingly hard -- to make sure we touched on all corners of the state and all the different aspects of people's lives to put together a plan that gets Montana back on the road again. I'm proud to support this bill."

The current bill addresses areas of spending in general terms and is expected to become more specific as it moves through the Legislature. More than $600 million is set aside for infrastructure grants for publicly owned facilities, water and wastewater projects, $250 million for communications and broadband projects, $150 million for "economic stabilization grants," $50 million for mortgage assistance, $11 million for low-income housing solutions and $152 million for emergency rental assistance and workforce development.

The bill also contains funding for a number of programs in the Department of Public Health and Human Services, like $13 million for the Supplemental Nutrition Assistance Program, or SNAP, $1 million for child abuse prevention, nearly $2 million for state veterans' homes, and more than $160 million for increased COVID-19 testing, contact tracing and vaccine distribution.

Public and private schools are set to receive about $400 million in a number of areas from after school and summer enrichment programs to administrative costs and support for students with disabilities. The bill would also create advisory commissions for each section receiving money comprised of nine members: three senators, three representatives and three members appointed by the governor. The commissions would work outside of the session to accept grant applications for funding from their specific sections.

Lawmakers from both parties have pinned HB 632 as a "once in a generation" opportunity to pay for long-standing projects that are often left unfunded due to budget restraints and tight revenues. HB 632 holds as much money as the state typically appropriates from its coffers in a single year, effectively doubling the capacity for state spending this year.

While most Democrats voted in support of the bill, some still attempted to amend the bill while it was on the House floor. Rep. Caferro proposed an amendment that would have distributed one-time, $1,000 payments to essential workers as a "thank you" for their work during the pandemic.

"These essential workers, along with the businesses, have been the engine keeping Montana moving," Caferro told lawmakers.

But Rep. Garner, the bill's sponsor, urged members to resist the amendment, saying it would pull away funds for one-time payments that could be used to fund larger projects.

"I think the best thing we can do is invest this money in the future of these families and the state," Garner said, adding that many essential workers would qualify for federal stimulus checks. The amendment died on a 34-66 vote.

Democrats also attempted to amend the bill to eliminate a provision that would reduce funding by 20% to local jurisdictions that maintain COVID-19 regulations stricter than the state's. That amendment also died after Republicans argued more funds should be going to counties and cities that aren't "hurting" local businesses and the economy.

During his closing remarks, Garner said he was "extremely proud" of the body for the work they'd done so far, while echoing earlier remarks that the bill wasn't perfect.

"I want to make sure that we understand that we don't let 'pretty darn good' get in the way of 'perfect,'" Garner said. "This is about transforming our state -- it's about anticipating what's yet to come. Let's put this money to work for the future of the people of Montana."

HB 632 now heads to the Senate Finance and Claims Committee for additional debate.

The Senate Finance and Claims Committee also voted to advance House Bill 2, the state budget bill, on a bipartisan 13-6 vote on March 31. The more than $12 billion bill appropriating money to state agencies for the next two years cleared the House on a partisan 67-33 vote, with Republicans voting in favor and Democrats against, a week earlier.

The Senate committee added back several programs the House cut, including $2.2 million for mental health services for students and $763,000 for refugee programs in the Medicaid and Health Service Management divisions. The next stop for the budget is additional debate and potential amendments in the full Senate.

House Committee Tables Health Care Price Transparency Bill After Bipartisan Support in Senate

A House committee in the Montana Legislature has tabled another bill seeking transparency in health care pricing after the defeat of similar measures earlier in the session.

Senate Bill 236 debuted in the House Human Services Committee on Monday, March 29, following a bipartisan 35-14 vote of approval in the Senate. Sponsored by Sen. Shane Morigeau, D-Missoula, the bill would have required health care providers and insurers to disclose the price of procedures to patients at their request prior to a procedure if it costs more than $500. However, during the House committee hearing, opposition to the bill piled on from small health care providers and insurance companies who said the bill would be redundant and would burden them with time-consuming paperwork. The committee voted to table the bill on March 31, and unless revived, the bill is considered dead.

During the hearing, Morigeau said the bill would restore "lost trust" in the state's health care system and would prevent patients from being surprised by unexpected medical bills.

"Let's show them where we started at 'point A' with that hospital visit, and where it ends at 'point B' with that insurer and that bill they get in the mail," Morigeau said. "I think we should let people see those cost changes so that they're making the best health care decisions for both them and their families."

One proponent spoke in support of the bill -- Jean Branscum, the CEO of the Montana Medical Association. Brascum said patients ought to know the price up front prior to receiving a service, but added she'd like to see amendments to ease potential administrative burdens and require a written request from patients -- arguments that many opponents echoed in their criticisms of the bill.

John Doran of Blue Cross and Blue Shield of Montana opened testimony for the bill's opponents and gave the committee three reasons he said they should vote against it: insurance and health care providers already provide pricing information online, the bill's provisions would be superseded by a federal law passed under the Trump administration that requires price transparency and the Legislature already decided after an interim study in 2017 that transparency legislation was not necessary.

Doran said the online tool Blue Cross and Blue Shield uses gives patients exact costs for services and also assesses the quality of those services.

"That's one thing that's woefully lacking from this bill is the contemplation of quality," Doran said. "We have to consider the quality in addition to the cost in any health care service."

Bruce Spencer testified against SB 236 on behalf of the Mountain Health Co-op, a veterans' health insurance company, saying the bill would strap on another layer of transparency requirements health insurance companies have to follow only in Montana, leading to more administrative hoops for companies and patients to jump through.

"It's death by a thousand cuts, and this is a classic example of that," Spencer said.

He added that insurance companies are already preparing for compliance with the "No Surprises Act," which passed Congress in late 2020, which will limit surprise billing for patients starting in the new year, according to the Brookings Institution

Other opponents from small, self-owned health care offices like psychologists and optometrists said the bill would lead to massive administrative undertakings that would overwhelm their staff and leave them with less time for their patients.

"Doctors need time to treat their patients," said Marti Wangen, representing the Psychologists and Podiatrists Association. "This bill puts paperwork over patients."

HB 236 is not the first health care transparency bill to be defeated this legislative session. An attempt to pass health care pricing transparency earlier this session was defeated when a Senate committee tabled the bill and it missed the deadline to advance to the House. Senate Bill 137, sponsored by Sen. Steve Fitzpatrick, R-Great Falls, sought transparency from prescription drug manufacturers and insurance companies as to how they set their prices. That bill also drew opposition from insurance companies during its hearing.

Look What's Law: Gov. Gianforte Signs Bills Banning Sanctuary Cities, Allowing Direct Judicial Appointments

Republican Gov. Greg Gianforte has signed a controversial bill prohibiting sanctuary cities in Montana that opponents have said is unnecessary and could worsen relationships between immigrants and law enforcement.

House Bill 200 became part of state law on Wednesday, March 31. Under the new policy, all cities in Montana must comply with federal recordkeeping and immigration investigations, and law enforcement must comply with all federal detainer requests.

During its first hearing, bill sponsor Rep. Kenneth Holmlund, R-Miles City, called the measure "proactive," as there are currently no sanctuary cities in Montana. The bill's supporters frequently said individuals who entered the country illegally committed a crime and should be subject to immigration enforcement anywhere in the nation. Opponents of the bill had suggested it would increase fear among immigrant communities and cases of false detainment while decreasing trust between immigrants and law enforcement.

In a press release regarding the signing, Gianforte echoed comments from the bill's supporters.

"We are a nation of laws, and immigration laws will be enforced in Montana," Governor Greg Gianforte said. "HB 200 ensures drug dealers, human traffickers, and other criminals who are in our country unlawfully will have no refuge in our state."

As of Wednesday, March 31, Gianforte had signed 99 bills into law, including one he requested that makes significant changes to the judicial appointment process.

Gianforte signed Senate Bill 140, sponsored by Sen. Keith Regier, R-Kalispell, on March 16 following a partisan run through the Legislature, with Republicans voting in favor of the bill and Democrats against. The bill eliminates the Judicial Nominating Commission, a nonpartisan group that has presented governors with lists of judges to choose from when filling judicial vacancies since the passage of Montana's constitution in 1972. With that commission gone, Gianforte and all future governors can directly appoint judges at their discretion.

Lt. Gov. Kristen Juras supported the bill on behalf of the governor throughout its journey in the Legislature, repeatedly stating that the nominating commission was not "nonpartisan" as it claimed to be, while maintaining that Gianforte would pick judges in a nonpartisan manner.

"The appointed judiciary is a farce. It's much more political than elections," Juras told committee members during the bill's initial hearing. "Let's get rid of the fiction that this is somehow a nonpartisan process. Moving forward, Governor Gianforte is committed to appointing well-qualified judges in a transparent manner."

The bill drew criticism from Democrats who said it would have lasting impacts to Montana's judiciary and its ability to remain nonpartisan. Several bills seeking to make the judicial elections partisan on ballots died during the session.

The governor also signed a bill sponsored by Rep. Steve Gist, R-Cascade, on March 26 that removes the requirement to list an occupation on an application for a fishing or hunting license. The bill advanced through the Legislature without a single vote in opposition.

Austin Amestoy is a reporter with the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Broadcasters Association, the Montana Newspaper Association and the Greater Montana Foundation. He can be reached at [email protected].