- Associated Press - Monday, January 9, 2017

HELENA, Mont. (AP) - Montana lawmakers are assembling a panel that will try to come up with a replacement for the Affordable Care Act in the state and recommend how the Legislature should respond to changes Congress makes to President Barack Obama’s health care overhaul, Republican leaders said Monday.

The working group will meet for the first time on Wednesday, said Senate Majority Leader Fred Thomas, R-Stevensville. Some 15 to 20 legislators from both parties and leaders from the health care and insurance industries have been invited.

Congress is planning to roll back the Affordable Care Act, also known as Obamacare, after President-elect Donald Trump takes office. But lawmakers and state administration officials believe a full repeal won’t be implemented before 2019.

It is important to begin planning for a replacement now, and Congress will likely take incremental steps this year in repealing the law that the state may have to adjust to, Thomas said.

“It gives us the ability to re-approach this and redo it like it ought to be done,” Thomas said of the pending repeal. “That may be the best thing that comes out of Obamacare.”

Sen. Mary Caferro, D-Helena, said she and Senate Minority Leader Jon Sesso are two Democrats who have been asked to join the group. Caferro, an ardent supporter of the Affordable Care Act, said she will listen to Thomas‘ plans, but she believes the focus should be on lowering costs rather than scrapping the law completely.

“I’m open to hearing what he has to say, but I think it’s politically based and motivated,” Caferro said. “The president-elect isn’t even sworn in.”

The Affordable Care Act allowed Montana to expand its Medicaid program to the working poor in 2015, and more than 61,000 people have enrolled since then. Tens of thousands more have signed up for subsidized health insurance through the federal insurance exchange.

Democratic Gov. Steve Bullock’s budget director, Dan Villa, said his office is also tracking what Congress does with the federal law. Repeal would mean the cost of covering the 61,000 new Medicaid enrollees would fall to Montana, which the state can’t afford. But Villa said he doesn’t see that happening any time soon.

“When we see it move from a ‘repeal and delay’ to a ‘repeal and replace,’ then we’ll have to switch into fifth gear,” Villa said.

Thomas said his concept of an Obamacare replacement is to have a broad-based insurance plan that covers major medical incidents and would replace Medicaid expansion and the federal exchange.

It includes eliminating the individual mandate requiring individuals to be insured and tax penalties for those who don’t comply. Instead, those who forego coverage will have to pay higher rates initially when they do seek insurance, Thomas said.

The concept includes several assumptions about what Congress plans to do, including passing a tax credit system and a return to state-based insurance plans.

The working group will flesh out the concept or come up with a better proposal, Thomas said. The group will be led from the state auditor’s office by former Sen. Kris Hansen, R-Havre.

The panel also will help lawmakers prepare bills for this session that would be ready to move when Congress begins its repeal process. Though nobody is sure what specific actions Congress may take, those bills will act as placeholders that can be amended, Thomas said.

An Obamacare repeal is likely to come in phases, with one of the first possible steps a change in how the federal Centers for Medicare and Medicaid administers Medicaid, said state Sen. Ed Buttrey, R-Great Falls, who sponsored the Medicaid expansion bill in 2015.

That may mean the waiver that set restrictions on Montana’s Medicaid expansion law could also change or be eliminated, he said.

Buttrey said that would open up the possibility for the state to charge more for premiums, inspect beneficiaries’ assets to eliminate fraud and to require Medicaid recipients to participate in a job training program linked to the expansion bill.

Right now, the federal government requires Montana’s HELP-Link jobs program to be voluntary and limits how much the state can charge beneficiaries who qualify.

Villa said the changes Buttrey is suggesting would be a bad idea.

“That’s going to scare some folks,” Villa said. “And I think there’s enough people scared right now with these budget cuts that (Republican lawmakers) are considering.”

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