Montana will become the 30th state to expand its Medicaid program after federal health officials on Monday approved provisions that include requiring beneficiaries to pay premiums that amount to 2 percent of their income. Gov. Steve Bullock announced the Centers for Medicare and Medicaid Services' approval of the federal waiver needed for state officials to start enrollment immediately and begin coverage on Jan. 1.
When the U.S. Supreme Court ruled that the Affordable Care Act is constitutional in 2012, the ruling came with a hiccup: Medicaid expansion at the state level, the justices said, had to be voluntary, not mandatory.
For health care proponents, the news wasn't too discouraging at the time. After all, the wonks argued, even the most unhinged state officials aren't crazy. Who cares if the policy is optional when states would be insane to say no? It's not as if states would punish themselves on purpose to scratch an ideological itch, right?
In practice, however, it's been far more complicated. Republican partisans in a wide variety of states have resisted anything associated with "Obamacare," whether it makes sense or not. Like so many issues, Medicaid expansion through the ACA became a terrific benefit for low-income families, but the progress was largely limited to "blue" states.
Slowly but surely, this has changed. The Billings Gazette reported this morning:
The Gazette noted one Montana woman, Holly Blouch, who will now be able to have the surgery she needs to go on dialysis and possibly get on the list for a kidney transplant.
Cheering the policy breakthrough, she told the paper, "I can finally stop worrying and start focusing on getting well."
Delivering remarks to a large crowd of supporters at the Montana Capitol yesterday, the Democratic governor declared, "I am pleased to stand before you today to say that for over 70,000 Montanans, the wait is finally over."
White House Press Secretary Josh Earnest added in a statement, "Montana has chosen to put people over politics, and we hope that the remaining states will join Montana and the other 29 states that have designed programs to meet the needs of their residents who need health care."
The next question is whether that hope will be realized.
South Dakota appears to be moving forward with its Medicaid-expansion plans, and if John Bel Edwards wins his gubernatorial race this year, he hopes to add Louisiana to the national list.
In the meantime, Alabama Gov. Robert Bentley (R) has begun to reconsider his opposition to the policy, as are some Republican policymakers in ruby-red Kansas.
As we discussed a couple of weeks ago, conservatives should prepare for more defeats soon. There will no doubt be some holdouts and dead-enders, but the arithmetic and common sense can only be denied for so long.
Those who continue to argue that states should reject the policy out of partisan spite -- regardless of the benefits for families, regardless of the needs of state hospitals, regardless of the effects on state finances -- are facing headwinds that are only growing stronger.