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Gov. Bullock waited until nearly 60 of the 2013 legislative session’s 90 days had passed before making a Medicaid expansion proposal that essentially said “do what the feds want.” That’s a wasted opportunity. Since Medicaid rules are made in Washington, D.C., we frittered away a chance to negotiate reforms that could better meet the needs of Montana’s most at-risk population while also being fair to taxpayers.

So now in the session’s waning days we’re stuck with a take it or leave it choice for creating an entirely new dependency class without addressing any of Medicaid’s widely acknowledged shortcomings. This is simply irresponsible. Providing better healthcare access at lower cost to those most at risk should come first. Then we can debate the pros and cons of putting tens of thousands of young, healthy, childless adults into the program; and of taxpayers footing the bill.

There are two major arguments for fixing Medicaid before expanding it, one of them financial and the other one moral. The financial argument is that this expansion isn’t “free money” for Montana. It will actually come at a net cost to Montana’s taxpayers, a cost that will only grow if and when the federal government decides it is unable to fulfill its end of the deal.

And the moral argument is that it will result in tens of thousands of Montanans being dumped into a system that results in inferior access to care, with many of them forced out of much better private insurance plans.

Forty-four percent of the newly eligible would be healthy adults under the age of 34, and 75 percent would be childless. In addition, a fourth of all new enrollees would be crowded out of their much better private insurance plans, creating a new dependency class that taxpayers can ill afford as state and federal budgets are increasingly consumed by expanding entitlement programs. Expansion will trap young, healthy, able, and mostly childless adults in a failing system and reduce their incentives to work and succeed.

And it is a failing system. Medicaid recipients encounter barriers to primary care at nearly twice the rate as those with private insurance. They use emergency rooms at rates nearly twice those of the privately insured. Shoveling over 70,000 new Montanans into this system while also decreasing provider reimbursements under Obamacare won’t make access to quality care any easier for these people or for anyone else in the state.

Expansion would also come at a high cost for Montana’s taxpayers. The net costs to Montana taxpayers through 2021, with all new taxes and jobs included, range from $50 million to well over $100 million. That’s enough to hire 230-460 new teachers for the same period.

Montana should resist any Medicaid expansion until the federal government gives states more control over how the money is spent to get the best care at the lowest cost for their own citizens. At a minimum, deferring the decision will give Montana’s leaders and citizens ample opportunity to evaluate expansion in other states and make a more informed decision during the 2015 legislative session.

Carl Graham is CEO of the Montana Policy Institute, a nonprofit policy research and education center based in Bozeman.

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