Montana’s Legislature Could Decide Medicaid Expansion’s Fate
By Eric Whitney, Montana Public Radio A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset. “We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure. The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster. Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish. The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana. Part of the expected $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana. Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act. In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.” Republican State Rep. Nancy Ballance, who opposed I-185, disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.” Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products. “No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.” Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won’t qualify. In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge. North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax hike someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.” This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Travel Jobs: Top 10 States for June, July Market Predictions
In our June traveler job market predictions, we talked about the “summer stall”—less new job postings, more competition for every job and more interest in atypical summer job states. Based on StaffDNA job board data, two of our predictions were on target. Job application volume increase by nearly 20 percent from May to June, marking the most active month since January. What we didn’t expect was for supply to match pace with demand. Hospital systems in many states, including popular summer destinations like California and Virginia, bounced back after the late-May and early-June slump. Part of this can be linked to vacation plans for permanent hospital staff, according to travel agency sales staff sources. As the regular staff takes off for the summer or cuts back on hours, that provides opportunities for travelers to fill the gaps. We expect for this market momentum to stay strong in July, as travelers who took time off in June will be planning ahead for the start of the school season in August or to find a fall contract in September. The back-to-school rush marks a yearly milestone for many travelers with children or grandchildren. They will typically take a break during the summer for childcare, and return to hospitals once the kids are back in school. “The experienced travelers know it can take four to six weeks to find and start a job, so they start the search for an agency and position mid-summer,” said Kate Quinn of LiquidAgents Healthcare. Let’s take a look at what we learned from our top markets for June. Rankings barely shift as travelers settle in for the summer While April and May saw a lot of “movement” in terms of where healthcare travelers applied across the country, ranking shifts were much more conservative in June, despite the high application volume. Most states moved up or down the list by 5 ranks or less, and five states—North Carolina, Pennsylvania, Nevada, Wisconsin and Washington—didn’t move at all. We expect the list to remain mostly stable for July, August and potentially in early fall, as traveler won’t start making big moves until we get closer to the holiday season. Michigan, Missouri, Virginia enter the Top 10 For the first time this year, Missouri joined the likes of Texas, California and Florida in the top 10, moving up two spots from May to No. 9. Virginia moved back up as anticipated, jumping up five ranks to No. 10 on the list. The state is both a top travel destination for summer 2018 and one of the top five highest paying travel nurse states in the U.S. Montana, Wyoming climb the charts; Connecticut drops to dead last Montana and Wyoming both moved up seven ranks to take the No. 41 and 42 slots, respectively, while Connecticut dropped 16 spots to the bottom of our list. Connecticut has consistently ranked in the bottom half of the list for job board applications. It’s also one of the most expensive states to work in as a traveler because of the high regional cost of living and low average pay packages. Interest in Maine uncertain as Medicaid expansion remains in flux Enrollment for the voter-approved Medicaid expansion was supposed to roll out on July 2, which would have provided a $500 million shot in the arm for healthcare funding in the state and coverage for more than 70,000 eligible recipients. Pending litigation surrounding the expansion has left the issue in limbo. A Maine judge forced Gov. Paul LePage to submit an expansion plan to the federal government by June 11, but LePage’s administration submitted an appeal for the ruling. While the appeal is pending, LePage also vetoed the expansion bill this week. Because of the political turmoil, it’s uncertain whether the expansion will have an impact on the Maine traveler job market as expected. June’s Top Markets Florida California Texas North Carolina Georgia South Carolina Michigan Pennsylvania Missouri Virginia Illinois Indiana Kentucky Tennessee Arkansas Arizona Nevada Idaho Oklahoma Iowa Wisconsin West Virginia New Mexico Maine Oregon Colorado Washington Hawaii Ohio Alabama Louisiana Maryland Mississippi New Jersey Alaska Utah Kansas Montana Wyoming Minnesota Massachusetts North Dakota New York District of Columbia Delaware Nebraska New Hampshire Rhode Island South Dakota Vermont Connecticut